Tetany may be present in all the following conditions except –
Correct Answer: Hyperkalemia
Description: Tetany is a disorder with an extremely variable clinical presentation. It includes enhanced neuromuscular activity and associated sensory disturbance. Mild symptoms may include circumoral numbness, muscle cramps, or paresthesias of hands and feet. In severe cases, patients may present with laryngospasm, generalized muscle cramps, seizures, or even myocardial dysfunction. Trousseau sign and Chvostek sign are clinical tests to unmask latent tetany. The increased excitability of the peripheral nerves is due to either a low serum calcium (true hypocalcemia denotes a decrease in the ionized calcium level even though the total serum calcium level may be normal) or alkalosis in which the propoion of the serum calcium in the ionized form is decreased. The etiology of tetany in our patient was probably multifactorial. The hyperventilation causes alkalosis and decrease in the ionized fraction of serum calcium, which manifested as carpal spasm in the patient. Edmondson et al. have demonstrated that hypocalcemia in combination with alkalosis always produced tetany. Magnesium deficiency could have been a contributory factor but there was no clinical evidence to suspect magnesium deficiency. Magnesium deficiency is usually caused by long-standing etiological factors, which may include inadequate intake during starvation or increased requirement during early childhood, pregnancy, or lactation. Hypomagnesemia may also be caused by malabsorption from the gastrointestinal tract, loss from the kidneys during use of diuretics, or due to a combination of the two, as in alcoholism. A Hypokalemia in the absence of alkalosis has also been repoed to cause tetany , Usually hypokalemia manifests as tetany in association with alkalosis. Ref - pubmed.com , Davidson's medicine 23e topic Primary hypehyrodism.
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