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: ?

[nurscee]

No one has answered so...I researched a little. It seems that leg cramps are common. However this lady has been this way for 2 days. Is it common to have them so bad you can't walk? Is dizziness common?

[classicdame, MSN, EdD]

I think you did the appropriate thing. When the family/patient are that concerned they need to see someone and in this case, if her electrolytes are way off, she could have serious problems. Good for you!

[diabo, RN]

Lots of factors can be in the mix and it's impossible to adaquately address this lady's needs in this format. However it could be that she is being pulled too low ie: shakes and dizziness. Severe cramping can cause pulled muscles which can remain sore for days and sometimes be very painful. Some patients are more prone to them than others. Heating pads seem to help more than anything else.

[caliotter3]

I was dizzy and had severe muscle cramps when I was hypovolemic, anemic, and my electrolytes were off due to blood loss so I can personally testify to those symptoms. Also I was pitching and rolling all over the place and could barely walk. I lost consciousness twice. My mentation left something to be desired also. You can really relate to signs and symptoms when you have had them yourself. I think you took the proper action for what was described to you.

[mo-mo]

Sounds like she could've been very hypovolemic. And/or had electrolyte imbalance...Good call!

[kdhnursern]

Having my share of non-compliant patients, leg cramps are a common complaint. When a patient comes in 10 kg over their target weight and the doctor wants that fluid worked off, we sometimes have to challenge the patients with higher goals than they are used to. Our Braun machines have the UF profiling that we use in these cases. The patients themselves have to do their part. Laying there like a slug with arms and legs bunched up does not do this. We try to teach them to stretch their muscles often and in the right way to fight off the cramping. But when they go home, we don't have any control over them anymore (or did we ever?? )

You could suggest they munch on ice chips, stretch their muscles (pull toes back to stretch the calf, do not point the toes), or massage muscles. Suggest to them to talk to their nephrology team about either adjusting their target weight or things they can do to keep their goals low.

Keep up the good work you do in triage.:yelclap:

[traumaRUs, MSN, APRN]

I'm an APN in two dialysis units and cramping post-dialysis is common. Like above poster, the more fluid we have to pull, the higher the potential is that you will cramp. Giving neurontin is okay but it is dialyzed off so not much use to give pre-HD (hemodialysis). Other meds given for this include Mirapex and Clonazepam. Neither work especially well, but some patients swear by it. Used to be able to give quinine but the FDA removed that from the market for anything but malarial prophylaxis.

I like the non-pharmacologic aides too. They are the most reasonable.

[middlekane]

You can also give 400 IU vitamin every day or oxazepam 5-10 mg two hours before dialysis. If it still continues, you can try 1000-2000 mg IV carnitine during dialysis as a three month trial.

These suggestions are from Kuebler et al's book Palliative Practices, an interdisciplinary approach. They also have specific suggestions on "sodium modeling of dialysate" that look useful.

[dachshundlover]

Leg cramps are a common problem that plagues hemodialysis patients after treatment. We used to give quinine tablets to patients when I first started in dialysis in the 80's to reduce their risk of getting cramps, I'm not sure it worked all that well. Although that isn't available to the patients anymore!! Usually the leg cramps clear up with a little bit of time, some fluids, and some salt. If this person is complaining of dizziness and is as weak as her husband states, she is probably hypotensive due to dehydration. She may also be depleted of potassium or sodium. I wonder if she is taking any B/P meds after treatment? I am not sure what OTC the doctor recommended. We used warm towels or gloves to ease the cramps initially but the cramps typically resolved soon after treatment! I hope that her husband took her to the ER like you advised, she shouldn't be that weak and dizzy after treatment. Sound advice!!

[jnette, ASN, EMT-I]

A teaspoon of vinegar works wonders for some patients with wicked cramps. One of our patients carried his vinegar bottle with him to dialysis.

You can also get regualr club soda with quinine in it at any supermarket.. that may help a bit as well.

[LPN2RNBSN]

Agree with above. The one neph at one unit stated drinking water w/ quinine in it for cramps. But staff alsso need to be aware when patients complain and re evaluate dry weight. I find that some are better than others.