CIRRHOSIS AND MUSCLE CRAMPS - EVIDENCE OF A CAUSAL RELATIONSHIP

The aim of the study was to define the features, prevalence, and patho physiology of therapy for muscle cramps in cirrhotic patients. The fir st protocol study included 294 cirrhotic patients and 194 age- and sex -matched controls. Controls were defined as inpatients or outpatients without any clinical and laboratory evidence of liver disease. Feature s and prevalence of muscle cramps were defined on the basis of a stand ard questionnaire. As far as the pathophysiological associations of mu scle cramps were concerned, the following parameters were evaluated: m ean arterial pressure (MAP), nutritional status, liver function tests, plasma volume (PV), plasma renin activity (PRA), and electrolyte, min eral, and acid-base status. The prevalence of cramps was higher in cir rhotic patients than in controls, and it was related to the duration o f recognized cirrhosis and to the severity of liver function impairmen t. At a multiple regression analysis, the presence of ascites, low val ues of MAP, and high values of PRA were the independent predictive fac tors for the occurrence of cramps in cirrhosis. In the second protocol study, the effects of a sustained expansion of the effective circulat ing volume induced by intravenous infusion of human albumin were compa red with those of a placebo in 12 cirrhotic patients with more than th ree cramp crises a week. Compared with the placebo, albumin reduced th e cramp frequency (P < .01). In conclusion, an increased prevalence of true muscle cramps occurs in patients with cirrhosis. Our data indica te that the pathophysiological link between cirrhosis and cramps may b e represented by the reduction of the effective circulating volume. Th ey also indicate that weekly infusion of human albumin may be an effec tive treatment for cramps in cirrhosis.