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ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 45-50

Etiological spectrum of tetany in a teaching institution of western part of West Bengal - A cross-sectional study


Department of Medicine, Midnapore Medical College, Paschim Medinipur, West Bengal, India

Correspondence Address:
Gouranga Santra
Block-P, Flat No. 306, Binayak Enclave, 59 Kalicharan Ghosh Road, Kolkata - 700 050, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_20_17

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Introduction: Studies describing etiological distribution of tetany are rare, and awareness regarding it is poor among physicians. Our study describes different causes of tetany beyond the decrease in total serum calcium level. Methods: Patients with overt or latent tetany were evaluated clinically and from laboratory investigations. Initial investigations done were serum calcium, potassium, and arterial blood gas analysis. Both ionized and total calcium were assessed and corrected according to serum albumin level. Depending on initial reports, further tests were done such as serum phosphate, alkaline phosphatase, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels. Results: Gitelman's syndrome (GS), Bartter's syndrome (BS), recurrent vomiting, anxiety hyperventilation, Vitamin D3deficiency (VDD), idiopathic hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis syndrome (TLS), and hypomagnesemia were the different causes of tetany identified. Out of 53 patients, total serum calcium was normal in 41 patients with metabolic or respiratory alkalosis (GS, BS, recurrent vomiting, and anxiety hyperventilation). Total calcium was low only in 12 patients (in VDD, IHP, PHP, acute pancreatitis, TLS, and hypomagnesemia). Ionized calcium was low in all patients. GS was the most common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia, and IHP were uncommon. Conclusion: Tetany has diverse etiologies. Both metabolic and respiratory alkalosis cause decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany.


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