Tetany & Tremors

Question 1

Diseases characterized by tetany

Answer 1

Tetanus
Equine Hypocalcemia

Question 2

Disease characterized by tremors

Answer 2

Botulism
Stringhalt
Shivers

Question 3

Tetanus

Answer 3

Horses are particularly susceptible
Highly important to vaccinate against
Clostridium enters via soft tissue wound or puncture in hoof

Question 4

Pathophys of tetanus

Answer 4

Clostridium Tetani enter systemic circulation and bind to internuncial cells in spinal cord
Exotoxin inhibits the release of glycine & gamma-aminobutyric acid (GABA) from internuncial cells causing generalized increased in muscle stiffness, muscle spams and hypertonia

Question 5

Clinical signs

Answer 5

Severity of signs depends of amt in wound, oxygen tension in wound, amt of exotoxin bound to spinal cord, immunity of animal

Question 6

First 24 hours of tetanus

Answer 6

Intractable colic
Stiffness and lameness in infected limb

Question 7

After 24 hours with tetanus

Answer 7

Generalized muscle stiffness/rigidity of head and neck, limbs & tail
Trismus (locked jaw)
Prolapsed 3rd eyelid
Hyperasethia - visual, tactile, auditory
Dyspnea

Question 8

Hypertonia /spasticity

Answer 8

Muscles of facial expression
Lips drawn back
Ears drains down & caudal
Jaws clamped
Rapid flashing of 3rd eyelid

Question 9

Diagnosis of tetanus

Answer 9

Based off signs, generalized muscle stiffness, history of recent wound or surgery
&or insufficient vaccination history

Question 10

Treatment principles

Answer 10

Relax muscles
Minimize decubital ulceration
Eliminate infection
Neutralize the unbound toxin
Maintain hydration & nutrition
Promote active immunity

Question 11

Muscle relaxation

Answer 11

Sedate
Acepromazine
Diazepam
Trazadone

Question 12

Minimize decubital ulceration

Answer 12

Sling
Deeply bedded stall and roll frequently

Question 13

Eliminate infection

Answer 13

Use hydrogen peroxide to oxidize area
Infiltrate soft tissue wounds with penicillin
Administer procaine penicillin G or potassium penicillin

Question 14

Neutralizing unbound toxin

Answer 14

Administering tetanus antitoxin to neutralized unbound toxin
The higher dose the better chances of recovery

Question 15

Fluid and nutritional support

Answer 15

Alfalfa pellet slurry if patient can drink
Unable to drink:
Sedate, place nasogastric tube, place IV catheter for partial or total parenteral nutrition

Question 16

Promote active immunity

Answer 16

Admin tetanus toxoid at onset and 1-2 months later

Question 17

Progression

Answer 17

Dysphagia
Aspiration pneumonia due to Dysphagia
Pyrexia & profuse sweating
Hypoxia due to impairment of respiratory muscle
Recumbency
Death

Question 18

Clinical course of tetanus

Answer 18

Variable & influenced by amt of irreversibly bound toxin
Signs can persist for a few weeks - 1 month

Question 19

Prevention

Answer 19

Check vaccination with puncture wound, boost
If not vaccinated, admin tetanus toxoid & antitoxin, follow up with second dose of tetanus toxoid in 4-6wks

Question 20

Prognosis for tetanus

Answer 20

Variable, depends on rate of onset & severity
Good prognosis if patient remains ambulatory & eating
Poor prognosis if patient cannot rise or eat
Treatment / survival of 1 week of clinical signs is usually a fair to good prognosis