Muscle cramps

Suggest to patients that they record their cramp episodes plus any preceding potential precipitants in a cramp diary.

Encourage athletes reporting exercise-associated cramps:

• Be well-conditioned for their chosen activities

• Routinely conduct periodic stretching

• Maintain a well-balanced diet, including electrolytes and carbohydrates

• Avoid fatigue during exercise

• Reduce the intensity and duration of exercise, if necessary.[42]Maquirriain J, Merello M. The athlete with muscular cramps: clinical approach. J Am Acad Orthop Surg. 2007;15:425-431. http://www.ncbi.nlm.nih.gov/pubmed/17602031?tool=bestpractice.com

Encourage patients with diabetes who are experiencing cramps secondary to hypoglycemic events to:

• Self-monitor blood glucose concentrations in order to make appropriate adjustments of diet and drug therapy

• Avoid precipitants of hypoglycemia (e.g., by moderation/abstinence of alcohol consumption, regular ingestion of meals/snacks, and intake of supplemental calories or adjustment of medication before exercise)

• Determine their blood glucose concentration when cramps do occur and chart it in a cramp diary for evaluation at the next clinic visit.

Advise patients with cramps in pregnancy to ensure that they have an adequate intake of B vitamins and magnesium. Theoretically, using these supplements routinely may even ward off cramp episodes or at least reduce their frequency and/or severity.

Advise patients undergoing hemodialysis:

• Moderate fluid intake between dialysis sessions. This may reduce the need for and degree of ultrafiltration during dialysis, which, in turn, should ameliorate intradialytic cramp risk

• Pay careful attention to dietary phosphate recommendations

• Adhere to drug therapy designed to reduce hyperphosphatemia.

When drugs have been implicated as exacerbating and/or causative factors in muscle cramps and have been discontinued by a physician, advise the patient to:

• Discard remaining supplies of the offending agent

• Inform the pharmacies that they patronize about the causative drug so that an appropriate notation can be made on their individual medication records.

If treatment with quinine is being considered (for severely disabling cramps), inform the patient about the potentially serious adverse effects associated with this agent, and the monitoring that will be required.