Conversation: The conversation between human and AI assistant.
[|Human|] My sister has recently been diagnosed with ESLD, stage 4 autoimmune cirrhosis. Her first meld score was 26 and, after two months medication, is 8. She is going through the process to get listed for transplant. She is having severe hand cramps and her finger hands (and sometime toes) cramp and cross over, looking deformed. She says its a pain level 20. Her first GI Doctor said he had no idea what it is, but I suspect it s due to related and/or new renal deficiencies. Do you know what could be causing this and if it could be severe or indicative of an emergency requiring attention?
[|AI|]  Thanks for your question on Chat Doctor. I can understand your sisters situation and problem. ESL (end stage liver disease) patients tend to have nutritional deficiencies. Vitamin b12, vitamin d3, hemoglobin, folic acid, vitamin B 6 etc. are at lower side in such patients. And these can lead to severe musculoskeletal pain. So her cramps are mostly due to nutritional deficiency of these vitamins. Another possibility of autoimmune arthritis of small joints. She is having autoimmune Hepatitis, so this can be the reason for hand cramps. So discuss all these with her doctor and plan treatment accordingly. Hope I have solved your query. Wishing good health to your sister. Thanks.