Question about leg cramps

[nurscee]

I am a telephone triage nurse. Very little experience with dialysis.

I had a call yesterday from a man who said his wife gets dialysis 3 times a week.

He said his wife has such bad leg cramps that she cannot walk at all. She also has the shakes and is dizzy. I asked if he called her dr. He said yes, the dr gave her neurontin for the shakes but it isn't helping. He also said the dr told him to buy an OTC for leg cramps.

This man was calling me to ask the name of the OTC! I advised him to take her to ER right away. He said he could not carry her to the car, she cannot even stand up. I said call 911 - he said he would.

I don't know much about dialysis, like I said. I have been a nurse less than 4 yrs. But I think it IS a big deal when they have these kinds of symptoms, right?

Am I off base to think that their doctor is a :monkeydance: ?

[ngingi]

Hie

Tonic water could be the answer

[hairpair]

what kind of vinegar? apple cider vinegar? and how often can the pt take it?

[Juanay]

Our nephrologist is now encouraging our pt to use OTC Vitamin E 400u bid and OTC Carnitine as directed daily especially pre HD

[LPN2RNBSN]

Confused.. if the doctor is ordering something pre dialysis to prevent cramping then doesn't that defeat the purpose, so to speak. When pt cramps that is indicative of something ie too much fluid removed?, therefore, if patient does not cramp, one could be pulling off too much fluid and you might not know? what about cramps after dialysis for several hours? Alot of doctors like to challenge patients?

[sueinga]

When a patient c/o cramps anywhere ( legs, hands, abdomen, back) I turn the UF off , give 100 to 250 of saline and see how they respond- then its a judgement call as to if and when to turn the UF back on. I know its a sin to send a pt out with fluid weight on but if they are cramping??? Thing is- most peoples weight fluctates on a daily basis so is this not also true- even moreso with dialysis patients so that there EDW fluctuates probably more than it is changed?

[LPN2RNBSN]

Carmping, according to our neph can be due to electrolytes and acid/base changes during dialysis .. also, to send a patient out about dry weight, esp one w/ cardiac problems, can be trouble...

also, some doctors like to 'challenge' patients. but then when patients are dehyrdated their hgb goes up then there is the problem of identifying if their epo needs to be decreased, etc. alot goes into this. dont think just about edw.

[diabo, RN]

Cramping doesn't necessarily mean you have reached the dry weight. Some folks can only tolerate a certain amount taken off within the treatment time. We had a muscular, non compliant patient that would frequently come in on a Monday with 7 to 8 kilos over his last post weight. He would tolerate removing 4 1/2 kilos in four hours. Any more than that and he would begin to cramp so bad his eyes would water. Our goal was to have him down to his dry weight by Friday.

I frequently use the UF profile #6 on the Fresenius machines. Most of the other machines out there have similar preset profiles to choose from. This one alternates the UF throughout the treatment between pulling hard and pulling gently. It seems to help as much as anything and the weight still comes off.

[Lacie, BSN, RN]

Initially we tend to go on auto that the cramps are related to fluid removal which in most cases it is. Also to consider is other issues such as CA+ levels, etc. I'll never forget a pt that one of the techs were loading up on the saline only to find out the SNF didnt give him his insulin and his b/p was off the chain on top of that, but here was this LPN hand squeezing NS into the pt because "he didnt feel good" (ACCCCKKKKK) and I am of the school of thought if it can be prevented do it! Treat the cause not just the symptoms. My last facility utilized hypertonic saline which did help most of the time for those who where really overloaded and we needed to challenge them. Look at the whole picture it isnt always "taking off too much fluid". There is an over the counter leg cramp medication(natural of which my Nephro checked and had no issues with) that has quinine in it many of my patients swore by. I believe they found it at Walmart and Walgreens. Another suggestion I've heard my docs tell pts is to drink the quinine water prior to dialysis if not on a very retrictive fluid intake (most do what they want anyway lol). Sometimes I just shut it down for 10-15 min then restart at a lower UF as it could be as simple as it's just pulling it faster than they can tolerate at the time. Look at the pt as a whole and as an individual. I have seen way too many dialysis nurses and PCT's that get such "tunnel" vision that they think giving saline is the solution to everything and think of nothing else but the dialysis aspect!!! Yes we are giving dialysis but it's generally other health issues that resulted in thier renal failure that placed them on dialysis in the first place. We need to see the patient as a whole not just the kidney.

[diabo, RN]

This is an interesting article.

http://jama.ama-assn.org/cgi/content/extract/304/8/846-a

[traumaRUs, MSN, APRN]

Yes, this is why we don't recommend quinine for our dialysis pts.