Preliminary observation: Oral zinc sulfate replacement is effective in treating muscle cramps in cirrhotic patients

Background: While not life threatening, muscle cramps severely affect the q uality of life of patients with cirrhosis. Aim: To determine whether oral zinc sulfate therapy decreases the frequency and severity of muscle cramps in cirrhotic patients. Methods: 12 patients with cirrhosis (5 Child's A, 3 Child's B, and 4 Child' s C), hypozincemia and muscle cramps at least thrice weekly received oral z inc sulfate 220 mg BID for 12 weeks. Patients answered a questionnaire rega rding their muscle cramps symptoms at the beginning and end of the study. Results: Muscle cramps occurred in all patients at rest, mainly while sleep ing (8/12), and in two patients also during exercise. Cramps were located i n calves (10/12), feet (4/12) and hands (4/12) more commonly. Zinc suppleme ntation improved cramps in 10/12 patients, and in seven of these patients t he cramps completely resolved. One patient experienced mild watery diarrhea that resolved upon discontinuation of the zinc sulfate. No other complicat ion of zinc supplementation was noted. Conclusion: A potential relationship between zinc deficiency and muscle cra mps in the setting of cirrhosis has not been suggested before. Zinc supplem entation may lead to improvement in symptoms associated with muscle cramps in cirrhosis.