Presenting Complaints

• 37-year-old male presenting with recurrent muscle cramps, primarily affecting his lower extremities.

History of Presenting Complaint

• The patient reports experiencing muscle cramps in his calves, thighs, and feet for the past 2 weeks.
• The cramps typically occur at night or after physical activity, and can last for several minutes.
• He describes the cramps as a sudden, intense tightening or contracting sensation in the affected muscles.
• The cramps are often severe enough to wake him from sleep and interfere with his daily activities.
• He has tried stretching, applying heat, and taking over-the-counter pain medications, but these provide only temporary relief.
• He denies any recent injuries or trauma to the affected muscle groups.

Significant Positives & Negatives For Differentials

Electrolyte Imbalance (Hypokalemia or Hypocalcemia)

Positives:

• Recurrent muscle cramps, especially in the lower extremities
• Symptoms often worse at night or after physical activity
• No history of recent injury or trauma
• No other neurological symptoms or signs of neuromuscular disorder

Negatives:

• Lack of other symptoms associated with severe electrolyte imbalance (e.g., cardiac arrhythmias, altered mental status)
• Normal past medical history and no known conditions predisposing to electrolyte disturbances

Dehydration

Positives:

• Muscle cramps can be a symptom of dehydration
• Increased risk with regular exercise and physical activity
• Potential exacerbation of symptoms with heat or prolonged activity

Negatives:

• No other signs of dehydration (e.g., dry mucous membranes, tachycardia, hypotension)
• Adequate fluid intake reported in the social history

Neuromuscular Disorder (e.g., Myopathy, Neuropathy)

Positives:

• Recurrent muscle cramps can be a symptom of underlying neuromuscular conditions
• No clear precipitating factors or history of injury

Negatives:

• Absence of other neurological symptoms (e.g., weakness, sensory changes)
• Normal past medical history and no known neuromuscular disorders

Medication Side Effects (e.g., Diuretics)

Positives:

• Certain medications, like diuretics, can predispose to electrolyte imbalances
• Lisinopril, the patient's antihypertensive medication, can potentially cause electrolyte disturbances

Negatives:

• No recent changes to the patient's medication regimen
• No other signs of medication side effects

Muscle Overuse or Strain

Positives:

• Muscle cramps can occur with overuse or strain of the affected muscle groups
• Patient reports regular exercise, including running and weight training

Negatives:

• No history of recent injury or trauma to the affected muscle groups
• Symptoms are recurrent and not isolated to a specific activity or event

Past Medical History

• Hypertension, well-controlled on lisinopril
• No history of diabetes, thyroid disorders, or neurological conditions

Drug/Medication History

• Lisinopril 10 mg daily
• No other prescription or over-the-counter medications

Social History

• Works as an office administrator, mostly sedentary job
• Exercises regularly, including running and weight training
• Denies alcohol use, smoking, or recreational drug use

Family History

• No family history of muscle cramps, neuromuscular disorders, or electrolyte imbalances

Systems Review

• Denies any recent fever, chills, or signs of infection
• No changes in bowel or bladder habits
• No unexplained weight loss or fatigue

Ideas, Concerns & Expectations

• The patient is concerned that the muscle cramps may be a sign of a more serious underlying condition and would like to determine the cause.
• He is hoping the doctor can provide a treatment plan to help alleviate the cramps and prevent them from recurring.

Case Presentation

Based on the patient's history and the significant positives and negatives for the differential diagnoses, the most likely diagnosis is an electrolyte imbalance, such as hypokalemia or hypocalcemia, causing the recurrent muscle cramps. The patient's regular exercise and physical activity, along with the timing and characteristics of the muscle cramps, suggest an underlying electrolyte disturbance as the primary driver of the symptoms. Further laboratory testing to assess the patient's electrolyte levels, as well as evaluation for potential underlying conditions predisposing to electrolyte imbalances, would be the next appropriate steps in the diagnostic workup.