Complications
Generally, this rare complication will occur within a few hours of the inciting cramp.
Patients report an intense, severely painful cramp, followed by acute localized swelling, and worsening pain in the area of avulsion.
Diagnosis is made quickly using vascular duplex scan, followed by contrast-enhanced computed tomography and/or angiogram.
Treatment is surgical and the modality is based on the size and location of the avulsed blood vessel.[143]
Cramps occurring at night will wake patients from sleep due to the pain.[3] This may lead to daytime fatigue and/or insomnia.
Cramps are associated with increased electromyogram (EMG) activity but this activity is not correlated with subjective complaints of the duration of pain or its severity. Substantial interindividual variability in EMG activity is seen with leg cramps.
Cramps are not related to electroencephalogram sleep stage and there are no characteristic disturbances in sleep physiology that can be ascribed to muscle cramps.[144]
Quinine salts can cause adverse effects, including cinchonism (tinnitus, nausea, vasodilation and sweating, headache, dizziness, blurred vision, and altered color perception).
Uncommon but life-threatening or severe adverse effects include thrombocytopenia, disseminated intravascular coagulation, acute hemolysis, hepatotoxicity, ocular toxicity, and hypoglycemia.[103]
Follow-up laboratory testing for quinine-associated bone marrow toxicity or hepatotoxicity is not recommended because the onset of these entities is too rapid to be discovered by infrequent screening. Quinine predisposes to polymorphous ventricular tachycardia and ventricular fibrillation.
Quinine should not be considered the drug of choice for idiopathic cramps. The Food and Drug Administration has issued a warning against its use for leg cramps. FDA: drug safety information for quinine sulfate Opens in new window
There are concerns about serious drug-drug interactions, particularly in older adults, with quinine.[103]
Quinine is a cytochrome P450 isozyme 2D6 (CYP2D6) enzyme inhibitor, and quinine co-therapy can interact with other drugs metabolized by CYP2D6. This increases the serum concentrations of the other drugs, predisposing to toxicity. It may be necessary to perform follow-up serum concentration monitoring of other drugs.
Quinine should not be considered the drug of choice for idiopathic cramps. The Food and Drug Administration has issued a warning against its use for leg cramps. FDA: drug safety information for quinine sulfate Opens in new window
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