Another basic problem ... Dialysis Cramps

Aetiology - unclear (likely volume depletion and tissue hypoxia) and usually due to requirement for large volume removal.

Management options :

1) administration of hypertonic fluid, most commonly 50% dextrose (50mls), in order to raise plasma osmolality.

2) Quinine 200-300mg before dialysis or at bedtime can be tried but is unproven

3) Oral agents such as clonazepam, vitamin E, carnitine, or anti-convulsants are sometimes used as prophylaxis.

4)Limitation of inter-dialytic weight gains, ensuring that post-dialysis dry weight is correct and the use of an appropriate dialysate sodium are the best means to prevent this problem. Remember that a higher dialysate sodium will reduce intra-dialytic symptoms at the expense of thirst and weight gains; the converse holds true for a lower dialysate sodium. Sodium profiling may again be of benefit.

5)Patients who experience cramps at night may benefit from muscle-stretching for a minute or two. Heat and massage for the camping muscle can help.

Personally, I haven't tried numbers 2) and 3), and 4) makes you spend a lot of time counselling patients (who still end up not following your advice!)but there are some good obedient patients... usually adjusting dry weight and IDWG helps .... and sodium profiling seems to be useful too. I usually advocate linear sodium profiling for such problematic patients (ie start Na 140 or 145 and end up with 135)and the patients have less problems - not sure if it is just psychological. I wonder if anyone else has encountered same experience with sodium profiling in this situation?