In the modern world, young parents have a high chance of never encountering certain diseases. Prevention played a huge role in this. So, for example, infectious diseases are prevented by timely vaccination, hypo- and avitaminosis - by taking modern multivitamin complexes or individual vitamins. Now every mother knows that the baby needs vitamin D. It is commercially available and comes in forms that are convenient for the child. That is why, at present, severe rickets is rare, and even less often its concomitant condition called spasmophilia.
What is spasmophilia
In another way, spasmophilia is also called rickets tetany. Probably, it would be more correct to speak of spasmophilia not as a separate disease, but as one of the symptom complexes of vitamin D deficiency.
Spasmophilia is a condition that is associated with rickets by the mechanism of development. It is caused by a violation of mineral metabolism and a decrease in the work of the parathyroid glands, polyhypovitaminosis. For spasmophilia, a characteristic feature is the tendency of babies in the first 6-18 months of life to seizures and other manifestations of increased neuromuscular excitability, for example, to sudden muscle tension of the skeleton, respiratory tract. Such symptoms arise as a result of the fact that the level of ionized calcium in the baby's body is sharply reduced.
Spasmophilia in children can occur if suddenly the level of vitamin D-cholecalciferol rises in the body of a child who suffers rickets. The associated metabolic changes trigger the mechanisms of tetany development.
According to statistics, spasmophilia will manifest itself in 3-4% of babies suffering from severe and moderate forms of rickets. More often they will be boys than girls. The time of year when the number of cases of spasmophilia increases sharply is spring.
Some researchers designate the term "spasmophilia" tetany of various origins: with impaired absorption of minerals in the intestine, kidney disease, impaired function of some endocrine glands and various other pathological conditions.
Why does spasmophilia occur in children?
The connection between spasmophilia and rickets was noted for a very long time, but it was possible to prove it only in 1979, when they learned to determine the level of vitamin D metabolites in the blood.
In order to understand how spasmophilia and rickets are connected and what has calcium to do with it, you need to understand a little about how metabolism occurs normally.
Vitamin D Is a group of chemically related substances that have a pronounced antirachitic activity. The most important of these are ergocalciferol and cholecalciferol. In the human body, their main functions are associated with maintaining a constant amount of calcium and phosphorus. This constancy is carried out by the processes of mineralization and restructuring of bone tissue.
Near the thyroid gland, in the thickness of the fatty tissue of the neck, there are oval bodies with a smooth surface, about the size of a lentil. These little bodies are called the parathyroid glands. They produce parathyroid hormone, or parathyroid hormone, which regulates calcium metabolism in the body.
The body needs calcium not only to build bone tissue. It participates in the conduction of a nerve impulse into the cell, maintains the excitability of the nervous tissue, and provides muscle contraction. Ionized calcium, which is not bound to proteins, is determined in the blood. Total, or bound, calcium is found in bones. It serves as a kind of "depot" of ionized calcium.
Parathyroid hormone is activated when the level of ionized calcium in the blood decreases. Together with vitamin D - cholecalciferol and its metabolites, it activates cells that destroy excess bone tissue - osteoclasts. As a result of their vigorous activity, part of the calcium is released from the bones.
Under the influence of parathyroid hormone and vitamin D, calcium is absorbed in the intestines and enters the bloodstream, becoming already free calcium, that is, ionized and maintains the constancy of the internal environment of the body, participates in the work of the nervous and muscular systems.
With rickets, the lack of vitamin D and its active metabolite, which is formed in the kidney tubules, leads to a decrease in the formation of a special protein that binds calcium. As a result, calcium, which is supplied with food, is not absorbed in the intestines and does not enter the bloodstream. Its deficiency develops - hypocalcemia. In this case, parathyroid hormone cannot stimulate the release of calcium from the bone tissue. The metabolism of the phosphorus mineral is also disrupted: it is also poorly absorbed from the intestines and is excreted in urine.
Vitamin D is able to enhance the synthesis of citric acid in the body. It also influences the accumulation and dissolution of calcium salts. With rickets, its concentration in the bones decreases, so the processes of bone mineralization are disrupted. A decrease in the level of citric acid disrupts the oxidation processes in cells, therefore, metabolic products accumulate in the tissues of the body: peptides, amino acids, urea and others. Acidification of the body occurs, which is called acidosis.
Thus, with rickets in the baby's body, the content of calcium and phosphorus decreases, and acidosis develops. But due to the influence of other factors and hormones on the metabolism, a constant composition of free calcium is maintained in the blood.
As you know, the synthesis of vitamin D is carried out in the skin under the influence of sunlight. With a sharp change in the weather or climate, under the intense influence of ultraviolet radiation in the skin, the synthesis of vitamin D increases, and then the level of its active metabolite, 25-hydroxylcholecalciferol, rises in the body. The latter suppresses the function of the parathyroid glands, which can no longer produce parathyroid hormone.
As a result, calcium is heavily deposited in the bones, and its concentration in the blood decreases to a critical level. The balance of the internal environment is disturbed, because together with calcium, the level of other ions also decreases: magnesium, chlorine, sodium. But at the same time, the level of potassium and phosphorus rises. As a result, the pH of the blood changes. It builds up alkaline substances, causing a condition called "alkalosis".
An increase in the level of phosphorus in the blood is facilitated by feeding the baby with whole cow's milk, in which its content is quite high. The kidneys of the child are not able to remove it completely, and due to the suboptimal calcium content, phosphorus is poorly absorbed by the bone tissue. Therefore, it accumulates in the blood, changing its electrolyte composition and contributing to the development of spasmophilia.
A decrease in the level of ionized calcium against the background of a decrease in the work of the parathyroid glands, an increase in the content of phosphorus and potassium ions in the blood, as well as the developed alkalosis lead to the fact that the excitation threshold for the muscle cell decreases. It reacts by contraction to weaker nerve impulses and external stimuli. As a result, the baby has an increased convulsive readiness.
The risk group for the development of spasmophilia should include babies who are bottle-fed, as well as those who do receive whole cow's milk. Children who do not receive cholecalciferol to prevent rickets are also at risk of developing spasmophilia. This also includes all babies who have a high probability of rickets: premature babies, low birth weight, born with signs of immaturity, diseases of the digestive system, from twins or from repeated births with small intervals between them.
Babies who receive breast milk never develop spasmophilia. In human milk there is an optimal ratio of trace elements, due to which they are well absorbed from the intestines and absorbed by the child's body. And if the mother herself takes vitamin D and gives it to the child, then he will never have rickets.
What types of spasmophilia are
Depending on the external manifestations of spasmophilia, it happens hidden, or latent. Children in this case have only signs of rickets of one degree or another. In order to determine the latent spasmophilia, you need to conduct special tests.
Explicit spasmophilia manifested by muscle spasms, which can be harmless, or vice versa, threatening the child's life: laryngospasm, bronchospasm, generalized convulsive seizures.
Both types of tetany can pass into each other. Latent spasmophilia always precedes overt tetany. If it is noticed in time and appropriate treatment is carried out, the terrible symptoms and consequences of obvious spasmophilia can be avoided.
Symptoms of spasmophilia
Since spasmophilia occurs against the background of rickets, babies to one degree or another will have its manifestations.
A few months before the height of spasmophilia, the child becomes moody, restless. Shudders appear, first in sleep, and then during wakefulness. They are provoked by loud or unexpected sounds, bright light. Sleep and appetite decrease.
The baby begins to sweat a lot, this symptom is especially pronounced on the scalp. As complications of excessive sweating, diaper rash and prickly heat occur. Due to the peculiarities of metabolism, sweat and urine of the child acquire a characteristic "sour" smell. The doctor may notice that the child's heart rate is increasing. When a blood test is taken for any other reason, the activity of the enzyme alkaline phosphatase will be increased.
1-2 months after the onset of rickets, in addition to the above symptoms, changes appear in the bones of the child. At first, you will notice that the bones of the skull become softer along the edges of the large fontanelle. This phenomenon is called osteomalacia. Later, such softening appears in the places of their junction and in the parietal bones. Over time, there are more such areas. When pressed, they feel like thick parchment paper.
Such softening of the bones of the skull with rickets is called craniotabes... The soft skull changes its shape. As a result, over time, the child's back of the head flattens and head asymmetry occurs. Other bones of the skeleton also soften: the chest, pelvis, spine are deformed, the arms and legs of the baby are bent.
Spasmophilia in a baby happens at such a stage in the development of rickets, when changes in bones and muscles are already noticeable.
A characteristic feature of rickets is a decrease in muscle tone and their weakness - hypotension, "looseness" of the joints. Babies often have a large belly. And the combination of a decrease in the tone of muscle groups with softening of bones contributes to an even greater formation of deformities of the spinal column. The formation of rickets kyphosis, that is, the curvature of the spinal column anteriorly, is not excluded.
Later, when the child learns to sit down, get up, take the first steps, lordosis - posterior curvature joins, and in the absence of adequate treatment and severe rickets, it comes to scoliosis. In this case, the baby's spine is bent either to the right or to the left.
Deformation of the chest, decreased tone of its muscles and changes in the nervous system lead to the fact that gas exchange between the lungs and the environment is disrupted. The chest can no longer work so that inhalation and exhalation are effective, that is, pulmonary ventilation is impaired. All this predisposes to the development of pneumonia, the load on the baby's heart increases.
As a result of changes that affect almost all internal organs and systems, children begin to lag behind in physical development. The formation of new skills and abilities is delayed: babies later begin to hold their heads, sit, get up, walk. Such children also have mental retardation.
Latent spasmophilia can last for weeks or months. It is detected only when conducting special tests that provoke muscle contractions. Parents can independently test their baby for symptoms of spasmophilia.
The most common symptom of latent spasmophilia is facial symptom of Khvostek... When tapping with fingers in those places where the facial nerve comes out: the zygomatic arch or the corner of the child's lower jaw, muscle contraction and twitching of the corners of the lips, nostrils, eyelids occurs. Involved is the side where the tapping is performed.
Trousseau's symptom can be called if you put an elastic bandage on the middle of the baby's shoulder. This action achieves compression of the neurovascular bundle. After a while, the muscles of the hand contract convulsively from compression. The child's fingers are straightened and brought together. In this position, the obstetrician's fingers usually stay when they are inserted into the female genital tract. It received a peculiar name - "Hand of an obstetrician".
If you gently beat your finger on the outer surface of the lower leg just below the knee (this is the place of projection onto the skin of the head of the fibula and the passage of the peroneal nerve), then this manipulation will cause a sharp bend of the foot, as well as its pulling to the right or left.
Maslov's phenomenon can be caused by slightly pricking the skin of the child's leg with something. A healthy baby will be afraid of the injection, which will manifest itself by increased breathing. A kid suffering from rickets tetany will also show fear. But at the same time, a short-term cessation of breathing occurs.
Erb's symptom is one of the persistent symptoms of spasmophilia. It can only be determined in the clinic. An electrode is placed under the child's elbow, and the median nerve is irritated with a weak electric current. In a healthy child, contraction of the forearm muscles and flexion of the fingers occurs if they are exposed to a higher current strength than in a baby with spasmophilia.
Explicit spasmophilia is much more serious. She manifests herself with obvious severe symptoms that threaten the life of the child.
Explicit spasmophilia can manifest itself in such a phenomenon as carpopedic spasm - its most "soft" form. A strong muscle spasm leads to the fact that the baby's right and left hand take on a peculiar shape - the "hand of an obstetrician", and the right and left feet are bent in the soles, the toes are bent down. This can be a short-term phenomenon, or it can persist for more than one week. Prolonged carpopedic spasm will lead to swelling in the feet.
Laryngospasm - This is a sudden contraction of the muscles of the larynx, which leads to a narrowing of its lumen. With it, the glottis practically closes. This is a condition that can occur suddenly. He is provoked by crying, fear. Spasm of the muscles of the larynx can also occur with a loud cry. Laryngospasm begins when the child quits his usual activities. He freezes for a while, then turns pale.
The presence of a sonorous or hoarse breath is characteristic. This closes the glottis. Air can neither enter the lungs nor exit back - breathing stops for a while, more often for a few seconds. At this moment, the baby turns pale even more. He is very frightened, tries to catch air with his lips and inhale, but to no avail. His lips, the area around his eyes and mouth turn blue. Cold sweat appears. The child may even lose consciousness.
And against the background of fright and respiratory arrest, they can join convulsions... When the muscles of the larynx relax, the glottis opens, a loud noisy breath occurs. The frightened child begins to cry loudly, but after a few minutes he calms down and falls asleep from fatigue.
The most striking form of spasmophilia is this is a convulsive syndrome, which is also called eclampsia. Convulsive seizures in rickytogenic tetany are tonic, clonic and tonic-clonic. Tonic cramps are characterized by severe muscle spasm and are often accompanied by pain. They can develop into clonic seizures. Such convulsions are characterized by rhythmic contractions of muscle groups, accompanied by not frequent flinching.
Before the attack, the child is also distracted from the usual activity. He freezes for a while, can stare at one point. Then you can see the tension of the muscles of the face: eyebrows brought together, a frowning look, extended lips. This is a tonic attack. Then it spreads to the muscles of the neck, limbs, trunk. If the convulsions pass into the clonic phase, the child loses consciousness, falls to the floor, and twitches rhythmically. Respiratory muscles are also involved in seizures.
This leads to respiratory distress and cyanosis. The child turns pale. The lips and nasolabial triangle become bluish. The entire body of the child contracts from the disorderly muscle twitching. At the same time, during a seizure, you can hear sobbing and screaming, and the baby is unconscious. This phenomenon is explained by the fact that the muscles of the larynx are also involved in the attack.
The glottis involuntarily closes and opens and air passes through it, causing vibrations of the vocal cords. During an attack, the child's head is thrown back, the corners of the mouth drop. Twitching of the muscles of the face is observed, and foam comes out of the mouth. If the baby does not have a large fontanelle closed, then it will pulsate and bulge out during an attack.
Prolonged episodes of convulsive syndrome easily cause suffocation - suffocation, that is, the child can simply suffocate.
Such attacks of eclampsia can last for several seconds, and sometimes drag on for 20-30 minutes and can be repeated several times a day. They are very exhausting. Since the muscles of the child are intensely contracted during an attack, he sweats a lot during this period. There is often a rise in temperature, which returns to normal after the seizure stops.
Consciousness also returns, but the child is very weak, he has a reduced reaction to the world around him. Prolonged seizures are dangerous, as oxygen starvation of the brain occurs. His cells may stop functioning, and the baby will permanently lose the acquired skills, which will lead to disability.
How is spasmophilia diagnosed?
To begin with, the pediatrician asks parents in detail about the characteristics of the child's development. It is important to find out what the baby receives as food: breast milk, adapted milk formula, or cow's milk; whether he receives complementary foods and when they were introduced, at what age the child was transferred to artificial feeding. Another important question - is rickets prevention carried out, how timely and regularly, and in what dosages does the child receive vitamin D preparations?
Next, the doctor will ask you to describe in detail the attacks of laryngospasm, carpopedic spasm or seizures. After all, it is very important to distinguish spasmophilia from other diseases that are accompanied by convulsive seizures or respiratory arrest in order to find the right treatment. If possible, it is better to film all the oddities that happen to the baby. Sometimes such actions make the diagnosis much easier.
A typical attack of laryngospasm in almost all cases makes the diagnosis of spasmophilia indisputable.
When examining the baby, you can determine the signs of rickets and neuromuscular excitability. Tests are also carried out to determine latent spasmophilia.
Necessarily the doctor prescribes laboratory tests. For this, blood is taken from the vein of the child. In the diagnostic laboratory, the content of calcium and phosphorus, as well as alkaline phosphatase, is determined. It is an enzyme that contains many tissues of the body, including bone tissue. Alkaline phosphatase promotes the movement of phosphorus in the body and increases with any active processes in the bone tissue. The acid-base state of the blood is also determined, that is, with spasmophilia, there will be alkalization - alkalosis.
If spasmophilia is suspected, an electrocardiogram is performed. There, the doctor will also see changes in the form of lengthening the Q-T interval. This means that the time it takes for the heart muscle, the myocardium, to get excited and recover, increases. Such changes indicate a violation of calcium metabolism in the heart muscle.
X-ray images of the bones of the hand, forearm, and legs will show changes that are characteristic of rickets: deformations, irregularities, enlightenment, even fractures.
So, the presence of clinical, biochemical, radiological signs of rickets and increased neuro-reflex excitability in a baby of the appropriate age testifies in favor of the diagnosis of spasmophilia. But at the same time, it should be borne in mind that tetany in babies 6-18 months can also occur with epilepsy, decreased work of the parathyroid glands (hypoparathyroidism), not associated with rickets, persistent frequent vomiting.
In some cases, congenital narrowing of the larynx - stridor, which is accompanied by noisy breathing, is taken for laryngospasm. It is observed in a baby from birth, almost never creates serious breathing problems, does not lend itself well to therapeutic effects and gradually disappears with age.
What diseases does spasmophilia look like?
Latent spasmophilia has its own specific symptoms, so the diagnosis is not difficult. But explicit tetany in its manifestations is similar to many diseases of childhood.
Convulsions with spasmophilia must first of all be differentiated from epileptic seizures, as well as from convulsions in other metabolic diseases and febrile seizures. A carefully collected anamnesis, biochemical blood tests, an electroencephalogram with simultaneous video recording of the attack (video monitoring) will help in this. Febrile seizures occur in acute viral infections against the background of an increase in body temperature or a sharp decrease in antipyretic drugs. They have no connection with rickets. Seasonality is also not typical for them.
Newborn babies have tetany may develop due to the fact that their parathyroid glands do not work, are in a depressed state, are blocked by the mother's parathyroid hormone, which penetrates intrauterinely through the placenta. This condition can also be caused by an excess of calcium in the body of a pregnant woman. More often it is transient, or passing hypoparathyroidism.
A decrease in the level of ionized calcium in the blood can occur due to indomitable vomiting in gastroenteritis, renal failure, in cases where the baby is abruptly transferred to feeding with whole cow's milk. In such cases, the manifestations will be similar to tetany. The child will develop so-called hypocalcemic seizures. In this case, there will be no manifestations of rickets.
True hypoparathyroidism, that is, a decrease or absence of the function of the parathyroid glands can be congenital and acquired. Such cases in children are rare with genetic diseases. These children have sensitivity disorders, mental retardation, visible malformations and malformations of internal organs. Acquired impairment of their function can develop after surgical interventions on the thyroid gland, then the parathyroid glands are often damaged.
When pseudohypoparathyroidism the secretion of parathyroid hormone persists, but the internal organs do not respond to the hormone. Such children are also characterized by developmental defects. They have a special appearance: a moon-shaped face, small stature, stocky body, short fingers. Half of these babies develop mental retardation.
How is spasmophilia treated?
Spasmophilia, like any other disease, is treated under the strict supervision of a pediatrician. He primarily determines whether there is a need for inpatient treatment. With obvious spasmophilia, the baby should be under the supervision of doctors around the clock. Children from socially disadvantaged families are also sent to the hospital, where child care suffers and parents are unable to create and provide conditions for his recovery.
With latent spasmophilia, treatment can be carried out at home. The baby is assigned a protective regimen and diet... A calm, welcoming atmosphere should be present at home. Flickering on screens, flashes of light, loud sounds are excluded. Listening to quiet, calm classical music is recommended.
Mandatory daytime sleep according to age regimes, walks in the fresh air in calm weather in quiet places. All procedures that are unpleasant for the child, especially injections, examination of the pharynx and oral cavity, should be performed with extreme caution so as not to provoke laryngospasm or convulsions.
If the child was fed with cow's milk, then an adapted milk formula with an optimal ratio and content of calcium and phosphorus is selected. Better generally eliminate whole cow's milk from the diet child, as it contains a large amount of phosphates. The share of vegetable dishes in the diet is increasing. The individual need for proteins, fats, carbohydrates is necessarily calculated. In the first days of treatment, you can organize a tea diet for your child, which will reduce alkalosis.
A prerequisite for the treatment of spasmophilia is the appointment vitamin D preparations in therapeutic dosages and calcium preparations (calcium chloride, gluconate or lactate). The need for calcium in an infant is 50-55 milligrams per kilogram of body weight per day. In order to reduce excitability, sedatives are prescribed.
First aid for obvious spasmophilia
Parents need to know first aid techniques in case of deterioration of the baby's condition. So, to relieve laryngospasm, you can bring a cotton swab moistened with ammonia to the child's nose, or tickle him. You can prick the child, pat, pour cold water over, shake or change the position of the body. These techniques help the brain to distract itself and switch to something else.
Parents also need to be prepared for a seizure to provide first aid to their baby. If this happens, you need to immediately call the ambulance. Since there is a lack of oxygen in any seizure, it is important to provide fresh air into the room, for example, open a window or door to the street.
A child with convulsions should never be left alone. It is better to lay it on the floor on either side, away from any objects so that they cannot cause injury. Legs do not have to be bent, but a soft cloth should be placed under the head. Such events are needed so that the child during seizures cannot choke on saliva or vomit. If possible, put a tightly rolled tissue between the jaws.
With convulsions, you do not need to try to shove a hard object between the child's jaws, as you can damage his teeth.
If the baby's jaws are closed, in no case should they be unclenched by force. It is important to note the duration of the seizures and observe the baby's breathing.
Further actions to stop the attack are taken by a medical professional. The child is injected with an anticonvulsant drug. The most commonly used for this purpose is diazepam, sodium oxybutyrate in an age-related dosage. Oxygen therapy, artificial lung ventilation, tracheal intubation are possible.
Prevention of spasmophilia
It is similar to the prevention of rickets and should begin in the womb. A pregnant woman must necessarily take multivitamin complexes that contain vitamin D. After the birth of the baby, their intake continues.
At least up to 6 months, the child should receive breast milk, and if impossible, an adapted milk formula. Feeding infants with whole cow's milk is prohibited. It is better to introduce it into the baby's diet after reaching 12 months. You should also promptly and correctly introduce complementary foods to the child.
According to the national program of the Union of Pediatricians of Russia, developed in 2017, all children under 3 years old should receive cholecalciferol. For babies up to 12 months, its dose is 1000 IU per day, from 12 to 36 months - 1500 IU per day. It is also recommended to take vitamin D for older children at 1000 IU per day. For children in the northern regions, the dosages are increased and are up to 6 months - 1000 IU per day, from 6 months - 1500 IU per day.
The vitamin D content in foods is low. They are rich only in cod liver oil and several deep-sea fish, as well as chicken egg yolk and butter.
Vitamin D comes in the form of drops for oral administration. There are modern water and fat-soluble forms of cholecalciferol, one drop of which contains 500 IU of vitamin D.
Currently, adults are also recommended to take vitamin D in order to prevent various diseases, including atherosclerosis.
Prognosis for spasmophilia
In most children, the prognosis for spasmophilia is favorable and the case ends with complete recovery with timely and correct treatment. In very rare cases, laryngospasm can be fatal, and a long-lasting attack of tonic-clonic seizures can affect the state of the baby's central nervous system, followed by a delay in neuropsychic development.
Does spasmophilia happen in adults
Spasmophilia in adults is very rare. It is not associated with a lack of cholecalciferol and can occur with a lack of calcium in the human body, or after surgery to remove the parathyroid glands. In most cases, the cause of spasmophilia in adults cannot be established. It can be provoked by the period of pregnancy and lactation in women, infectious diseases, stress, malignant neoplasms, hemorrhages.
In adults, symptoms of spasmophilia are usually not as severe as in children. Often they are limited only by a feeling of numbness or "creeping" in the upper and lower extremities, impaired sensitivity. Convulsive seizures are possible with complete removal of the parathyroid glands.
Conclusion
Spasmophilia is a life-threatening and dangerous condition for a baby, fortunately rare in the modern world. It develops with advanced rickets and requires differential diagnosis with certain diseases. You can easily avoid troubles if you follow the advice of the pediatrician who is watching the baby. It is enough to carry out the correct prevention of rickets - a satellite of spasmophilia.
