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Muscle Cramps in Cirrhosis — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareMuscle Cramps in CirrhosisSCE Palliative Medicine

A 55-year-old woman with advanced cirrhosis develops severe muscle cramps, particularly at night, causing regular sleep disruption. What is the most appropriate initial management strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Offer non‑pharmacological measures first (e.g., passive stretching, heat); if ineffective, consider quinine sulphate 200–300 mg at night, or alternatives such as baclofen, methocarbamol, or taurine

Explanation lettering: E = shown as B · B = shown as E

Severe, sleep‑disrupting cramps in cirrhosis merit a stepped approach: begin with non‑pharmacological methods such as stretching, in line with NICE/NHS advice, before pharmacological therapy. In the UK, quinine 200–300 mg at night is licensed and may be considered only when cramps are frequent and disruptive, and after non‑drug measures have failed. Recent RCT evidence in cirrhotic patients supports alternatives—baclofen, methocarbamol, or taurine—for cramp frequency and severity reduction. Diuretics (A) may actually provoke cramps. Vitamin B12 (C) and IV calcium (D) have no supporting evidence in this context. Saying ‘‘no treatment exists’’ (E) is incorrect given evidence-based options.

Reference: MHRA Drug Safety Update 2014 (quinine guidance); NHS.uk Leg cramps (2023) (stretching and quinine sequence); Roberts et al. 2025 systematic review (baclofen, methocarbamol, taurine in cirrhosis), https://pubmed.ncbi.nlm.nih.gov/39548657/