Treating Muscle Cramps in Patients with Cirrhosis: A Review
Atif Zaman, MD, MPH Reviewing Mehta SS and Fallon MB., Clin Gastroenterol Hepatol 2013 Nov 11:1385
What causes it, and how should we treat this common corollary of liver disease?
Muscle cramps are common in liver disease, especially in patients with cirrhosis, among whom the prevalence ranges from 22% to 88% based on varying definitions of cramps. A new review summarizes the state of knowledge on biological mechanisms and treatment options.
The underlying mechanism of muscle cramps in cirrhosis is still not fully elucidated, but possibilities include alterations in three overlapping categories: nerve function, energy metabolism, and electrolytes and plasma volume.
Nerve dysfunction in cirrhosis may be due to structural alterations and oxidative stress leading to increased excitability of motor neurons. Treatments such as vitamin E (300 mg three times daily), quinine sulfate (200 mg twice daily), and eperisone hydrochloride (a muscle relaxant; 150–300 mg daily) have been shown to be effective in small studies. However, quinine sulfate is not recommended because of associated risks for thrombocytopenia, hemolysis and cardiac arrhythmias.
Altered regulation of amino acid and protein metabolism in cirrhosis likely contributes to muscle cramps. Supplementation with taurine (3 g daily) and branched-chain amino acids (isoleucine, leucine, and valine) seems effective based on results of small, controlled studies.
Shifts in plasma volume may also contribute to cramps. Serum electrolyte concentrations and use of diuretics cause cramps by indirectly influencing plasma volume. Intravenous albumin at 25% concentration and zinc (220 mg twice daily) have been effective in small studies. However, intravenous albumin cannot be recommended due to the inconvenience of intravenous delivery and its cost.
Comment
As outlined in this excellent review, the first step in managing muscle pain is to exclude other etiologies and correct any electrolyte abnormalities. Once cirrhosis is determined as the cause, the best treatment options include supplementation with vitamin E, zinc, taurine, or branched-chain amino acids because they are safe, are available over the counter, and may improve nutritional parameters.
Editor Disclosures at Time of Publication
Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex
Citation(s):
Mehta SS and Fallon MB.Muscle cramps in liver disease. Clin Gastroenterol Hepatol 2013 Nov; 11:1385. (http://dx.doi.org/10.1016/j.cgh.2013.03.017) 作者: StephenW 时间: 2013-12-7 07:17