1. Tetany By: Hannah Gilman

3. What is it? Muscle cramps, spasms or tremors Can occur anywhere ▫Face, fingers, calves Due to low calcium levels: hypocalcemia ▫Ca concentration in extracellular fluids drops ▫Affects the nervous system ▫Sending impulses to skeletal muscles

4. Hyperventilation Removes too much CO2: resulting in respiratory alkalosis (lower H+ and increased pH) Increases Calcium proteinate and lowers free Ca++ Increased excitability causes spontaneous tingling in fingers and toes due to increased sensitivity in the motor axons and peripheral nerves  Parathyroid hormone regulates Ca++  Tetany is a major sign of hypoparathyroidism

5. Causes Diarrhea Kidney disease Thyroid or pancreas problems Pregnancy and breast feeding Malnutrition Vitamin D deficiency Some medications Calcium deficiency

6. Symptoms of Tetany Non-SevereSevere Abdominal pain Chronic diarrhea Muscle pain Tingling in hands or feet Twitching fingers Loss of muscle coordination Loss/change in vision Paralysis Seizures Slurred speech Sudden difficulty with memory, thinking, talking, writing or reading Sudden weakness or numbness on one side

7. Who Does it Affect? Anyone ▫As a consequence of sustained hyperventilation or following excessive vomiting ▫Often from an endocrine disorder Neonatal, children, cows, chickens and dogs Occurs more in temperate zones/winter Marathoners Anorexic or bulimic Old people

8. Treatment Detection of low calcium levels is important ▫Tetany can be fatal if it involves laryngeal or pharyngeal muscles; which blocks the airway IV Treatment ▫Calcium carbonate is used in the initial stage of Hypocalcemia ▫Calcium gluconate is used for muscle cramps or nerve weakness ▫Calcium chloride is for patients in serious condition

9. Calcium Factors enhancing absorptionFactors that limit absorption Parathyroid hormone Glucose and lactose Digestive motility Vitamin D & K Large amounts of phytic acid Excess of phosphorus and magnesium in diet Polyphenols in tea Vitamin D deficiency Diarrhea Old age Age0-6 mo7-12mo1-3 yr4-8 yr9-18 yr19-50 yr Over 50 yr Daily Calcium Intake 210 mg270 mg500 mg800 mg1300 mg 1000 mg 1200 mg * Upper limit 2500 mg

10. How vitamin D & Calcium work together Vitamin D facilitates Ca absorption in the intestine ▫By going thru the intestine and into the blood stream Helps reclaim Ca in kidneys 1% of the body’s Ca is in the blood plasma, the rest is in the bones RDA Calcium: ~1000mg RDA vitamin D: ~600IU

11. Where they can be found CalciumVitamin D Yogurt: 450 mg Parmesan cheese: 390 mg 1% milk: 300 mg Spinach: 250 mg Salmon: 210 mg Chocolate pudding: 160 mg Tofu: 140 mg Others: cheese, kale, soy milk, energy bars The Sun: 400 IU/15min Salmon: 238 IU Sardines: 136 IU Canned tuna: 136 IU 1% milk: 99 IU Mushrooms: 73 IU Special K cereal: 30 IU Others: cheeses, cereal, energy bars, eggs, butter, liver

12. Diet Plan: Day 1 Breakfast FoodCa (mg) VitD (IU) VitK (mg) Kcal Yogurt4190537208 Fortified milk 285105366122 Grape nut flakes 1140199106 Banana60422105 TOTALS7215061424541 FoodCa (mg) VitD (IU) VitK (mg) Kcal Shrimp cocktail 9114723218 Spinach500033414 Swiss cheese 2141221103 Mushrooms1271108 Italian dressing 802814 TOTALS814186516357 Lunch FoodCa (mg) VitD (IU) VitK (mg) Kcal Chocolate milkshake 18858250211 Snack

13. Diet Plan: Day 1 Dinner FoodCa (mg) VitD (IU) VitK (mg) Kcal Brown Rice 000160 Salmon420476704254 Kale90029934 Yam2601224176 Sour cream 400060 Fortified milk 570210732244 TOTALS11466862959928 Ca (mg) VitD (IU) VitK (mg) Kcal 2869143651492037 Totals for the Day

14. Diet Plan: Day 2 Breakfast FoodCa (mg) VitD (IU) VitK (mg) Kcal Cocoa Pebbles 40 42115 Chocolate soy milk 300120350140 Kiwi600552108 Honey peanut bar 10080115200 TOTALS5002401059563 FoodCa (mg) VitD (IU) VitK (mg) Kcal Grilled cheese on whole wheat 43911264431 Chili w/beans 1200934287 TOTALS559111198718 Lunch FoodCa (mg) VitD (IU) VitK (mg) Kcal Vanilla milkshake 20361290185 Snack

15. Diet Plan: Day 2 FoodCa (mg) VitD (IU) VitK (mg) Kcal Tuna28272620312 Spinach500033414 Muenster cheese 203038104 Bell Peppers8015820 Mushrooms1271108 Fortified milk 285105366122 TOTALS10254041626580 Dinner Ca (mg) VitD (IU) VitK (mg) Kcal 228771641732046 Totals for the Day

16. Diet Plan: Day 3 FoodCa (mg) VitD (IU) VitK (mg) Kcal Omelet w/ sausage 6453162167 Fortified milk 285105366122 Whole wheat biscuit 15510200199 Orange52023762 TOTALS556168965550 FoodCa (mg) VitD (IU) VitK (mg) Kcal Banana crème yogurt 20080260170 FoodCa (mg) VitD (IU) VitK (mg) Kcal Power Boost smoothie 600240810280 Tuna salad sandwich 7672168326 Mushrooms37330121 Ranch9118137 TOTALS6883861297764 Breakfast Lunch Snack

17. Diet Plan: Day 3 FoodCa (mg) VitD (IU) VitK (mg) Kcal Salmon420476704254 Baked potato 00070 Swiss cheese 2241322103 Spinach25001677 Mushrooms37330121 Fortified milk 285105366122 TOTALS11826671560577 Ca (mg) VitD (IU) VitK (mg) Kcal 2626130140822061 Dinner Totals for the Day

18. Questions 1.What two components must work together to prevent tetany and osteoporosis? 1.Calcium & Vitamin D 2.What is the best source of vitamin D? 2. Sunshine! 3.What percent of Ca is in the blood plasma? Where is the majority held? 3. 1% in the blood plasma & 99% in the bones

19. Bibliography "Tetany." - Symptoms, Causes, Treatments. Healthgrades, 02 May 2011. Web. 03 Mar. 2012.. Blakemore, Colin. "Tetany." Encyclopedia.com. The Oxford Companion to the Body, 2001. Web. 03 Mar. 2012.. Dr.John. "Hypocalcemia - Causes, Symptoms and Treatment." Current Health Articles and Tips. Howshealth, 04 Sept. 2010. Web. 03 Mar. 2012.. "Calcium Rich Foods, Foods With Calcium.", Calcium Deficiency Symptoms. Fat Free Kitchen, 2005. Web. 03 Mar. 2012.. Food Composition Table. Boston: McGraw-Hill Higher Education, 2009. Print. Wardlaw, Gordon M., and Anne M. Smith. Contemporary Nutrition. New York: McGraw-Hill, 2009. Print. Drezner, Marc, and Kimberly Hoben. "Vitamin D and Calcium Absorption." Sunset Tan. Sunsettan, 17 Sept. 2010. Web. 07 Mar. 2012..