CRAMPS, MUSCULAR
CRAMPS, MUSCULAR: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the following questions:
- Is there a history of drug ingestion? Many drugs produce muscular cramps. The most notable are the diuretics.
- Are there absent or diminished peripheral pulses? Absent or diminished peripheral pulses suggest the cramps are due to ischemia from peripheral arteriosclerosis or arterial embolism.
- Are the femoral pulses diminished? Diminished femoral pulses suggest a Leriche syndrome or saddle embolism of the terminal aorta.
- Is there hypertension? Hypertension suggests aldosteronism and chronic glomerulonephritis.
- Are the cramps limited to one extremity? Limitation of the cramps to one extremity suggests an occupational neurosis (professional cramps).
- Is there a positive Chvostek's and/or Trousseau's sign? These are signs of tetany, as might be associated with hypoparathyroidism, uremia, alkalosis, and other causes.
- Is there fever? Fever is associated with dehydration, heat stroke, and many infectious diseases that cause cramps.
DIAGNOSTIC WORKUP
All patients should have a CBC, sedimentation rate, chemistry panel, electrolytes, and urinalysis. If there is associated diminished or absent peripheral pulses, then Doppler studies and arteriography should be done. If the cramps are acute in onset, time should not be wasted in performing these studies. Magnetic resonance angiography is an excellent alternative to invasive angiography, but it is expensive. If there is associated hypertension, then 24-hr urine aldosterone and plasma renin studies should be done. If there are positive Trousseau's and/or Chvostek's signs, a thorough investigation for hypoparathyroidism should be done. A single serum calcium and phosphorus and alkaline phosphatase is not enough, but repeated studies should be done. In addition, 24-hr urine collection for calcium and serum parathyroid hormones should be done. An endocrinologist should probably be consulted if there is any doubt about the existence of hypoparathyroidism or any of the other causes of hypocalcemia.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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