Sir, My Sister Is Getting Leg And Body Cramps From

Posted on Tue, 7 May 2019

Question: Sir, my sister is getting leg and body cramps from last six months, on getting blood tests done it was found that her B12 level is >2000, Vitamin D level is 25, Calcium level is low.

Answered by Dr. Dr. Parth Goswami (1 hour later)

Brief Answer:
Leg cramp and body cramp inquiry. Detailed below.

Detailed Answer:
Hello,
Welcome to the 'Ask A Doctor service'.
Kindly answer the following questions to guide you further and to reach up to diagnosis as far as possible.

1. Does she is taking any B12 supplement? Or any history of it's intake in last few days??
(to exclude supplement induced high B12)

2. What is her age??

3. Is there any liver or kidney disease history??(to exclude liver or kidney disease as a causative factor for high B12)

4. Is there any urge to move leg constantly esp. At evening or night??(to exclude restless leg syndrome)

5.What is her serum TSH level, if known ?(to exclude hypothyroidism as a cause of cramp)

6.Any neurological problem??(to exclude neurological history as causative for cramps)

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Parth Goswami (1 hour later)

Sir she not taking any B12 supplement at present

She is 60 years old
She has no known Kidney didease. However her latest test reports show slightly elevated Bilirubin Alt, and other indices of liver funtion test..
Urge to moving legs is not felt. Just cramping of legs..
Tshblevel is 7.6 as per her latest report
Neorological problems are not known.
But she complains of general weakness. Her Vitamin D level is 25.

Follow up: Dr. Dr. Parth Goswami (2 minutes later)

I have her latest test report.

Answered by Dr. Dr. Parth Goswami (19 minutes later)

Brief Answer:
Follow up consultation

Detailed Answer:
Hello,
Welcome back...

Her weakness and cramps could be due to low calcium level primarily. For that, she needs to be given calcium and vitamin D-3 containing tablet or XXXXXXX form.

Before that her serum phosphate level and parathyroid level has to be checked just to exclude hypoparathyroisim.

Liver disease also can lead weakness and high B12 but for that I need to check report.
So, please attach/upload the liver profile report if available.

TSH level is slight high. But based on this one finding no further treatment needed.
You need to repeat her TSH after few days along with free T4 estimation to exclude hypothyroidism.

B12 is water soluble vitamin, so mostly it will be excreted by kidney. However repeat it after few days and if still elevated than will discuss further.

Hope I have answered your question.

Let me know if I can assist you further.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Parth Goswami (13 hours later)

Sending liver and kidney panel report

Answered by Dr. Dr. Parth Goswami (22 minutes later)

Brief Answer:
Follow up with attached report.

Detailed Answer:
Hello,
Welcome back to the 'Ask A Doctor service' again.
I have reviewed your attached report.

The sgpt and sgot slightly increased but it has not been increased two folds means up to 90 unit per liltre.
So no need to worry regarding liver profile reports. All parameters are not altered to level that need further investigations. So don't worry about that.

The kidney profile reports completely normal.

I suggest you to investigate with complete CBC with peripheral smear examination report to exclude anemia and any abnormal cells if present.

Repeat TSH and B12 report after few days.

You can revert back with CBC report once done.
Meanwhile if weakness more than I suggest you consult Neurologist for detailed neurological examination.

Hope I have answered your question.

Let me know if I can assist you further.

Regards

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Above answer was peer-reviewed by : Dr. Kampana