nocturnal leg cramp
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Etiology
- dehydration & electrolyte imbalance due to diuretics or laxatives
- cancer
- hemodialysis
- pregnancy
- idiopathic (most common)
- myopathy or neuropathy may be accompanied by leg cramps
- metobolic disorders
- alcoholism
- pharmaceuticals
Epidemiology
- prevalence increases with age (30-70% of patients > 50 years)
Clinical manifestations
- sudden nocturnal unilteral painful spasms of the gastrocnemius
Laboratory
- serum K+
- serum Mg+2
- serum Ca+2
- also see muscle cramp
Differential diagnosis
- contractures from myopathy
- tetany
- dystonia
- myalgia
- restless legs syndrome
- intermittent claudication
- compartment syndrome
- peripheral neuropathy
- peripheral vascular disease
- nocturnal myoclonus
Management
- quinine 260 mg PO QHS
- likely effective
- avoid routine use because of potential toxicity
- consider therapeutic trial after addressing potential toxicity[5]
- informed consent form[6] may be prudent
- other agents have been tried without much success
- gabapentin
- verapamil 120 mg QHS
- diltiazem possibly of value[5]
- chloroquine 250 mg QD for 2-3 weeks, then 250-500 mg weekly[2]
- hydroxychloroquine 200 mg QD for 2 weeks, then weekly[2]
- muscle relaxants
- diphenhydramine 12.5-50 mg QHS
- vitamin E
- magnesium oxide of no benefit[8]
- B-vitamins possibly of value[5]
- vitamin K2 (menaquinone-4) 180 ug PO QD[1]
- analgesics (acetaminophen, NSAIDs) may reduce pain, but do NOT stop the leg cramps
- extension of gastrocnemius
- extension at ankle (pull up at toes)
- prevention
- hemodialysis patients Shakuyaku-kanzo-to granule 2.5 g derived from peony root & licorice root[2][4]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Prescriber's Letter 11(4):20 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200410&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 2.2 2.3 UpToDate 14.1 http://www.utdol.com
- ↑ Brunetti LL et al, Treatment of nocturnal leg cramps. Arch Intern Med 1994, 154:1037 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8179448
- ↑ 4.0 4.1 Hyodo T et al, Immediate effect of Shakuyaku-kanzo-to on muscle cramp in hemodialysis patients, Nephron Clni Pract 2006, 104 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16685141
- ↑ 5.0 5.1 5.2 5.3 Katzberg HD et al, Assessment: Symptomatic treatment for muscle cramps (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74:691-696 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20177124 <Internet> http://www.neurology.org/cgi/content/full/74/8/691
- ↑ 6.0 6.1 Prescriber's Letter 17(6): 2010 COMMENTARY: How to Prevent Nighttime Leg Cramps DOCUMENT: SAMPLE Informed Consent Form for Quinine from Prescriber's Letter Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260606&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 8.0 8.1 Roguin Maor N, Alperin M, Shturman E et al. Effect of magnesium oxide supplementation on nocturnal leg cramps: A randomized clinical trial. JAMA Intern Med 2017 Feb 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28241153
- ↑ Tan J, Zhu R, Li Y, Wang L, Liao S, Cheng L, Mao L, Jing D. Vitamin K2 in managing nocturnal leg cramps: A randomized clinical trial. JAMA Intern Med 2024 Oct 28; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39466236 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2825457