Incidental Hyperguanidinemia as a Cause of Clinical Tetany

The majority of evidence indicates that the clinical condition known as tetany results from a lack of the physiologic effect of calcium ions. The types of tetany in which the relationship to a deficiency of calcium is most apparent are parathyroid tetany and so-called "infantile tetany." In these conditions the most constant chemical change in the blood is a marked reduction in the calcium content. Tetany may also accompany a condition of alkalosis in which the total calcium is not reduced, but in which there is a lack of effective or ionized calcium. The same symptoms can be produced experimentally by the injection into the blood stream of solutions of sodium phosphate, which cause a reduction in the calcium of the blood and also by the injection of citrates or oxalates which form unionized complexes with the calcium of the blood. It has been argued by some investigators¹that