Mehta SS, Fallon MB
Clin Gastroenterol Hepatol. 2013;11:1385-1391

Abstract
Muscle Cramps and Cirrhosis
Muscle cramps are common in liver disease, especially in patients with cirrhosis. Although the reported prevalence of muscle cramps in patients with liver disease (in particular, cirrhosis) ranges from 22% to 88%, the association is not well recognized by clinicians, nor is the workup and treatment of these patients well understood.

This review identifies 3 key areas for pathogenesis in patients with cirrhosis:
• Nerve dysfunction due to structural alterations and oxidative stress with consequent increased excitability of motor neurons;
• Alteration of amino acid and protein metabolism; and
• Shifts in plasma volume.

Viewpoint
Specific detailing of the treatment options is beyond the scope of this viewpoint. All readers should review this article carefully, because Mehta and Fallon provide an excellent algorithm for the approach and diagnostic workup of these patients, as well as specific treatments for different clinical pathways. It’s a must-read for all who take care of cirrhotic patients.

Journal Reference:  http://www.cghjournal.org/article/S1542-3565(13)00414-X/abstract