Thread by @ebtapper

Muscle cramps!

We have all had them
But imagine they woke you up every night
For many people with #cirrhosis, that's life!

A #livertwitter #tweetorial featuring:
1⃣Who
2⃣Why
3⃣What to do

#meded #medtwitter #MedStudentTwitter

1/7

Cramps in #cirrhosis

1⃣Mainly @🌙,in the🦵, intense
2⃣Common: 1 in 3 people
3⃣Risk factors? anyone cramps! No diff in labs!
4⃣Turns quality of life into💩

2/

But why cramps in #cirrhosis⁉️

1⃣⬇️ATP in muscle of ppl w/cirrhosis
🤔ATP needed for myosin to detach from actin

2⃣cramping in cirrhosis associated with
⬇️plasma volume &
⬆️renin activity
🤔Nerve perfusion depends on volume
&⬇️vol also⬆️sympathetic nerve activity

3/

Muscle cramps suck

So let's treat them

Incomplete list:
1⃣⬆️plasma volume
👉Hypertonic IVF works 4 dialysis cramps(Fig1)
some ppl use🥒Juice
👉Albumin works for #cirrhosis cramps(Fig2)
(🥒Juice trial pending)

2⃣Quinine?(Fig3)
3⃣Taurine?(Fig4)
4⃣Baclofen?

4/

QUININE⁉️

1⃣⬇️muscle excitability(Fig1)
2⃣creates a 'refractory period'
3⃣FDA says🚫use (⬆️risk of🩸disorders)

Taurine⁉️
1⃣May reduce Ca2+ influx 2 muscle(Fig2)
2⃣May work(Fig3)
3⃣ #RedBull 4 all?

Baclofen⁉️
1⃣⬆️GABA motorneuron signal
2⃣May work(Fig4)

5/

Cramps in #cirrhosis: a summary

1⃣Common (33%)

2⃣Causes:
-⬇️muscle ATP
-⬇️plasma volume
(⬇️🩸flow2nerves, vasoconstriction)

3⃣Trashes quality of life

4⃣Treatable. But first u have to ask!
6/

This concludes a #tweetorial on cramps in #cirrhosis

Hope you enjoyed!

I also hope

⭐️we⬆️awareness of often overlooked symptoms
⭐️That we can seize this telehealth moment to focus on what matters most 2 patient, use our video visits 2 solicit & address symptoms

Fin