Tetany vs Tetanus: Key Differences in Treatment
Tetany and tetanus are completely different conditions requiring entirely different treatments: tetany is treated by correcting underlying electrolyte abnormalities (primarily calcium and magnesium replacement), while tetanus is treated with tetanus immune globulin, wound debridement, antimicrobials, and intensive supportive care.
Tetany Treatment
Pathophysiology and Causes
- Tetany results from neuromuscular hyperactivity caused by electrolyte disturbances including hypocalcemia, hypomagnesemia, hypokalemia, and alkalosis 1
- Clinical manifestations range from mild circumoral paresthesias and carpopedal spasm to severe generalized seizures, laryngospasm, and life-threatening arrhythmias 1
Management Approach
- Correct the underlying electrolyte abnormality through intravenous calcium gluconate for hypocalcemia, magnesium sulfate for hypomagnesemia, or potassium replacement for hypokalemia 1
- Address precipitating factors such as hyperventilation (rebreathing techniques), proton pump inhibitor therapy, dietary deficiencies, alcoholism, or endocrine disorders 1
- Monitor for and treat complications including respiratory compromise from laryngospasm and cardiac arrhythmias 1
Tetanus Treatment
Immediate Management Protocol
Administer human Tetanus Immune Globulin (TIG) immediately at 250 units intramuscularly for prophylaxis or higher doses for established tetanus to neutralize circulating toxin 2, 3
Perform aggressive wound debridement with thorough surgical removal of all necrotic tissue to eliminate the anaerobic environment where Clostridium tetani produces toxin 2, 3, 4
Initiate antimicrobial therapy with metronidazole (preferred agent) or penicillin G to eliminate the bacteria 2, 4
Critical Point: Vaccine Timing
- Do NOT administer tetanus vaccine (tetanus toxoid) to patients with active tetanus infection as it provides no benefit for treating established disease 2
- Tetanus toxoid is only indicated for wound prophylaxis in uninfected patients or for post-recovery immunization 2, 3
Intensive Supportive Care
- Implement early mechanical ventilation for respiratory compromise, as respiratory failure is a leading cause of death 2, 5, 6
- Intensive care unit management reduces mortality from 43.58% to 15% compared to conservative treatment 6
- Monitor closely for autonomic instability (the main cause of unexpected cardiac arrest in ICU-treated patients) and rhabdomyolysis from severe muscle spasms 2, 6
High-Risk Populations
- Elderly patients (>60 years) require prioritized treatment with TIG when supplies are limited, as 40-66% lack protective antibody levels and have higher mortality rates 7, 3
- Immunocompromised patients may require additional TIG doses regardless of vaccination history 2
- The case-fatality rate remains 18-21% even with modern medical care 7, 2, 3
Post-Recovery Immunization
- Tetanus infection does NOT confer natural immunity, so all recovered patients must complete a full primary vaccination series 7, 2
- For previously unvaccinated adults: first dose Tdap (preferred), second dose Td/Tdap at ≥4 weeks, third dose Td/Tdap at 6-12 months 2
Key Distinguishing Features
Etiology
- Tetany: Electrolyte disturbances (hypocalcemia, hypomagnesemia, alkalosis) 1
- Tetanus: Bacterial infection with Clostridium tetani toxin from contaminated wounds 7, 2
Clinical Presentation
- Tetany: Circumoral paresthesias, carpopedal spasm, hyperventilation, anxiety, potentially laryngospasm 1
- Tetanus: Progressive muscle rigidity, trismus (lockjaw), opisthotonus, generalized spasms; 4% of cases have no identifiable wound 7, 4
Treatment Fundamentals
- Tetany: Electrolyte replacement (calcium, magnesium) and correction of underlying cause 1
- Tetanus: TIG, wound debridement, antimicrobials, ICU-level supportive care with mechanical ventilation 2, 3, 4, 6
Common Pitfall
When TIG and tetanus toxoid are administered concurrently for wound prophylaxis (not active tetanus), use separate syringes and separate anatomic injection sites 7, 3