Clinical and clinicopathologic features of transport tetany of feedlot lambs

Clinical and clinicopathologic features of transport tetany in 9 feedlot lambs were investigated. The lambs became recumbent within 10 days after arrival in the feedlot. The mean serum calcium concentration, mean magnesium concentration, and calcium:phosphorus ratio were significantly (P less than 0.01) less in affected lambs than in 6 unaffected lambs from the same feedlot. The mean serum phosphorus concentration was significantly (P less than 0.05) greater in the group of affected lambs. High activities of serum glutamic oxalacetic transaminase, creatine kinase, and lactate dehydrogenase in the serum of affected lambs indicated muscle necrosis, which was confirmed by histologic examination. Blood pH, HCO-3, and total carbon dioxide were significantly greater in affected lambs (P less than 0.01) than in unaffected lambs.

[Two cases of tetany in the horse (author's transl)]

Two cases of tetany in the horse are reported. The two patients were thoroughbreds. One was eight and the other thirteen years old. The mares were in heat and were brought to the service (stud) station to be mated. Both patients were nursing a foal. One was a four-week-old foal and the other was seven weeks old. The calcium level of the serum had dropped in the two patients, to 4.0 mg and 5.4 per ml. respectively. The magnesium level was 1.0 mg and 1.9 mg per 100 ml. respectively. The animals responded satisfactorily to intravenous infusion of calcium borogluconate and magnesium chloride. One of the mares was also give 10 1. of physiological saline a few times.

The functional status of the parathyroid in adult spasmophilia patients estimated by plasma parathormone assay

In 25 cases of spasmophilia the parathyroid function was assessed by complete exploration of the P-Ca metabolism and radioimmunoassay (RIA) of parathormone (PTH). Concomitantly the bone mineralization status was assessed by induced hypercalciuria tests and administration of 30 mg vitamin D2. RIA of PTH revealed increased values in 50% of the cases. The values fall within the range of secondary hyperparathyroidism, but this percentage varies with the values of the parathyroid function obtained by P-Ca metabolism explorations. The increased PTH values do no correlate with the level of plasma total calcium, ionic calcium, and magnesemia. Nor do they correlate with the bone mineralization disorders or the duration of the disease and the age of the patients.

[25 OH CC (25-hydroxycholecalciferol in spasmophilia) (author's transl)]

The level of 25 OH CC in plasma was evaluated in spasmophilia (126 cases) comparatively with normal persons. This level is significantly decreased in spasmophilia. Therapeutic by 25 OH CC of the calcipenic symptoms was tested with good clinical results. Some precautions are necessary when spasmophilia is associated with idiopathic hypercalciura.

[Mitral valve prolapse and spasmophilia in children and adolescents]

71 cases of mitral valve prolapse (MVP) in the child and adolescent with an age range of 3 to 20 years were reviewed. The clinical symptoms, electrocardiography and catheter and angiographic data of this mitral abnormality were analysed. A systematic study of the electrocardiogram showed a tendency to spasmophilia in 68% of cases. The serum calcium, phosphate and magnesium levels were normal in 90 to 95% of patients. A reduced erythrocytic magnesium level seems to have been found in some patients. It is interesting to observe the similarity between the clinical signs in MVP and in spasmophilia. These clinical, biochemical and electrocardiographical results justify the systematic investigation of children and adolescents with MVP, with a view to the diagnosis of spasmophilia.

Tetany, malabsorption, and mastocytosis

Mastocytosis is characterized by increased proliferation of mast cells. Two patients had systemic mastocytosis involving the skin and gastrointestinal tract, complicated by malabsorption and tetany. Absorption studies in these patients suggested that the entire small bowel was involved and that the defect was mild in the absence of diarrhea. Small bowel biopsies disclosed infiltration of the lamina propria and submucosa by mast cells, and gastrointestinal tract x-ray films showed nodular densities, edema, and thickening of the bowel wall. Tetany was due in part to combined hypocalcemia, hypomagnesemia, and hypokalemia. Diarrhea and malabsorption were due to mast cell infiltration of the bowel rather than to histamine. patients with signs of systemic mastocytosis should have careful evaluations and be followed up to prevent development of malabsorption and tetany.

Thoracic outlet syndrome with tetany of the hands

A patient presenting with tetany was found to have thoracic outlet obstruction. This was treated by transaxillary first rib resection, and good relief of the carpal spasm was obtained. The mechanism whereby neurovascular compression may produce tetany is discussed.

Normal total plasma calcium in the newborn

The first week of human life is characterized by rapidly changing plasma calcium levels, as well as low concentrations in comparison with adults. Whereas the infant's cord blood has a higher concentration than the mother's blood, the level drops precipitously in the first 24 hr (first drop) after birth and reaches a minimum level (second drop) at about 48 hr. A third drop may follow between the fourth and seventh days, but is different from the other two in that it is generally preventable with proper milk feeding. The level is markedly influenced by starvation, diet, and age. During the first week, the full-term newborn may show calcium levels in the range of 1.75 to 3.00 mmol/1, whereas the premature newborn shows values of 1.50 to 2.50 mmol/1. The low birth weight infant displays intermediate values. The literature on diseases involving calcium in the newborn, particularly neonatal tetany, is especially helpful in establishing a concept of normal levels, providing clinically supported upper and lower values. Calcium studies on the new born have been notably advanced by use of sound ultramicrochemical analytical methods.

Masked primary (or tertiary) hyperparathyroidism

Two patients are described in whom the preliminary clinical and laboratory investigations suggested a diagnosis of osteomalacia, from gluten-sensitive enteropathy in one and from anticonvulsant therapy in the other. However, when the primary disease was corrected by diet and extra vitamin D, respectively, both patients developed hypercalcaemia. A standard hydrocortisone test in the second patient failed to reduce the hypercalcaemia. In both patients parathyroid tumours were found at operation. It is suggested that both patients had tertiary hyperparathyroidism in which the normally tell-tale hypercalcaemia was at first masked by the other abnormalities, and that this masking may account for some cases reported as having normocalcaemic primary (or tertiary) hyperpatathyroidism. Interpretation of total plasma-calcium is likely to be unreliable unless the 25-hydroxyvitamin-D levels can be shown or assumed to be normal.

A case of maternal hyperparathyroidism presenting as neonatal tetany

A three-week-old infant presented with tetany and with serum calcium and phosphate levels compatible with the diagnosis of hypoparathyroidism. Investigation of the asymptomatic mother revealed serum calcium and phosphate levels and urinary phosphate clearance values diagnostic of hyperparathyroidism. The maternal hyperparathyroidism was treated by removal of a parathyroid adenoma.