Cirrhosis and muscle cramps: Evidence of a causal relationship

Angeli, Paolo; Albino, G.; Carraro, Paolo; Pria, M. Dalla; Merkel, Carlo; Caregaro, L.; Bei, E. De; Bortoluzzi, Andrea; Plebani, Mario; Gatta, Angelo

doi:10.1002/hep.510230211

Cited by 130 publications

(59 citation statements)

References 26 publications

(16 reference statements)

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“…For those with severe incapacitating muscle cramps, diuretics should be decreased or stopped. Therapies that have been shown to be effective in muscle cramps include albumin, 54 quinidine, 55 quinine, 56 and possibly zinc sulfate. 57 Contraindications of diuretic therapy.…”

Section: Treatment Of Uncomplicated Ascitesmentioning

confidence: 99%

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

et al. 2003

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Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well-being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis. (HEPATOLOGY 2003;38:258-266.)

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Section: Treatment Of Uncomplicated Ascitesmentioning

confidence: 99%

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

et al. 2003

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“…However, additional analysis in their cohort for pathophysiologic associations revealed that the presence of ascites, lower mean arterial pressure, and higher plasma renin activity were independent predictive factors for the occurrence of cramps. 3 Although muscle cramps are benign in nature, their occurrence is associated with bodily pain and decreased physical and social functioning. General health-related quality of life, measured by instruments such as the Medical Outcome Study Short Form-36 and the Nottingham Health Profile questionnaires, is diminished in cirrhotic patients with cramps.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance.…”

mentioning

confidence: 99%

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Chatrath¹,

Ghabril²,

Tandra³

et al. 2011

Gastroenterology

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PURPOSE-Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.METHODS-A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.RESULTS-A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL, P = .04) and CLDQ scores (107 ± 37 vs 137 ± 34, P < .0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score > 12). Muscle cramps (P < .001) and hepatic encephalopathy (P = .009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0 ± 8.9 ng/mL vs 19.6 ± 9.5 ng/mL, P = .49).CONCLUSIONS-Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment. KeywordsChronic liver disease questionnaire; Cirrhosis; Muscle crampsThe association of muscle cramps with cirrhosis was first reported by Konikoff and Theodor 1 in 1986 when they made their observation of repeated painful muscle cramps by patients with cirrhosis. They proposed that the strikingly high incidence and uniformity of the phenomenon may justify the inclusion of painful muscle cramps among the recognized symptoms of cirrhosis. 1 Subsequently, several studies have confirmed that muscle cramps are a common symptom of cirrhosis. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript them as sudden, uncomfortable squeezing or contraction of a muscle, lasting seconds to minutes. An electromyogram of a cramping muscle reveals involuntary repetitive firing of motor unit action potentials at high rates (up to 150 per second) producing a sustained muscle contraction. 5,6 These cramps are not associated with any progressive motor neuron disease or chronic neuromuscular disability and are different from muscle contracture, dystonia, and tetany. 5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps thro...

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“…Other complications of diuretic therapy include hepatic encephalopathy, electrolyte disorders, gynaecomastia, and muscle cramps [13, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. If cramps are severe, diuretic dose should be decreased or stopped, and albumin infusion [37], baclofen, and l-carnitine may relieve symptoms [23][24][25][26][27]37]. …”

Section: Diet and Diureticsmentioning

confidence: 99%

Pharmacological Therapy of Ascites

Ajlan¹,

Al–Hamoudi²,

Elsiesy³

2017

Ascites - Physiopathology, Treatment, Complications and Prognosis

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Ascites refer to accumulation of fluids in the peritoneal cavity. Ascites is caused by multiple causes, among which liver cirrhosis is the commonest. Confirming the etiology is the first and most important step toward proper management. Assuming that ascites is always caused by cirrhosis can lead to unnecessarily sending patients with different etiologies for liver transplantation, particularly patients with non-cirrhotic portal hypertension. Calculating serum albumin ascitic gradient is important in differentiating ascites due to portal hypertension from other etiologies. The first-line therapy for ascites in cirrhosis is low salt diet and diuretics. It is important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and nephrotoxic medications in these patients.

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Cirrhosis and muscle cramps: Evidence of a causal relationship

Cited by 130 publications

References 26 publications

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Pharmacological Therapy of Ascites

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