Treatment of Dialysis-Related Muscle Cramps With Hypertonic Dextrose

• Hypertonic dextrose (50% dextrose in water [D₅₀ W]) has been studied as a therapeutic agent to relieve dialysis-related muscle cramps (DMCs). We conducted a double-blind study comparing the effectiveness of 1 mL/kg of D₅₀ W with an identical volume of 5% dextrose in water (D W) administered as an intravenous bolus. Twelve of 36 patients studied experienced DMCs. Thirty-three cramping episodes were studied. Eighteen were treated with D₅₀ W and 15 with D₅ W. Blood glucose levels and blood pressure were measured before infusion and at intervals to one hour. Cramp relief was graded and recorded at the same intervals. Eighty-nine percent of treatments with D₅₀ W resulted in complete relief, compared with 40% of treatments. Partial relief was obtained in 5.5% of treatments with D₅₀ W, compared with 40% relief with D5 W. Twenty percent with D₅ W did not effect relief. In one treatment with D₅₀ W, observations were unsatisfactory to judge relief. There were no important side effects. We have shown D₅₀ W to be a safe effective treatment for DMC. Our data suggest that plasma volume contraction is important in the genesis of DMC, and that relief is related to expansion of plasma volume secondary to increased plasma osmolality. (Arch Intern Med 141:171-173, 1981)