Heat Cramp Kenneth Abbey Basics Description

Brief, intermittent cramps occurring in working muscles during heavy work. Patients typically experience heat cramps following manual labor in a hot climate before they have become acclimatized. Such patients often report having sweated profusely while drinking hypotonic liquids. Heat cramps are largely preventable by encouraging salt consumption in addition to fluid replacement.

Epidemiology Incidence Unknown Prevalence Unknown, but, although most prevalent in manual laborers in the past, today, it is most prevalent in athletes. Pediatric Considerations In child athletes, prevalence is on the rise. Risk Factors

Profession (increased risk): o Roofers o Steel-workers o Boiler operators o Coal miners o Field workers o Athletes (often highly conditioned) Decreased cardiac reserve (due to disease or drug therapy) Volume depletion (due to illness or diuretics) Vasoconstriction due to illness Anhidrosis (e.g., due to anticholinergics or phenothiazines) Febrile state Cystic fibrosis Gastrointestinal infections Diabetes Caloric malnutrition Anorexia nervosa Mental retardation Young age

Genetics Unknown Pathophysiology

Three factors are believed to contribute to muscle-cell depolarization and cramping: o Heavy work o Hemodilution (and, therefore, electrolyte imbalance) o Cooling of the muscle Cooling of the muscle slows sodium transport and depolarizes the cell, predisposing it to reach its excitation threshold. Golgi tendon organ units, which normally inhibit the muscle stretchcontraction reflex, may have diminished activity in fatigued muscles, leading to unopposed reflex contraction.

Etiology Caused by electrolyte depletion, especially sodium chloride General Prevention

During periods of strenuous activity in hot climates, patients should be encouraged to maintain hydration and increase salt intake. Electrolyte-containing sports drinks may be substituted for water to enhance salt intake. Patients must drink beyond satisfying thirst, because only 50% of fluid deficit is replaced in response to thirst.

Associated Conditions

Hyperventilation tetany Heat stroke Exertion-induced syncope Heat exhaustion Diagnosis Signs and Symptoms History

Heat cramps: o Involve heavily worked muscles o Most often occur after exertion, during rest or during a cool shower o Are associated with profuse sweating and copious hypotonic fluid replacement o Are not associated with hyperventilation (presence of hyperventilation suggests hyperventilation tetany) Associated symptoms include: o Nausea o Vomiting o Fatigue o Giddiness Brief, intermittent, and sometimes excruciating pain: o In voluntary muscles (typically in thigh or buttocks) that were previously heavily worked

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Generally localizes to a few muscle bundles at a time for 1 to 3 minutes and then wanders to adjacent bundles in the muscle group Not relieved by massage

Tests Lab

Serum: hyponatremia and hypochloremia Urine: low sodium and chloride

Differential Diagnosis

Hyperventilation Tetany Heat stroke Exertion-induced cramp Heat exhaustion Malignant hyperthermia Neuroleptic seizure Drug overdose

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Medication (Drugs) Mild cases: o Water and 2 to 4 10-grain salt tabs (56 to 112 mEq) or 1/4- to 1/2-teaspoon salt dissolved in 1 L water (avoid ingesting undissolved salt tablets because they are gastric irritants) o Sports drinks containing electrolytes Severe cases: o Normal sale, 1 to 1.5 L IV initially, followed by standard fluid and electrolyte therapy

Mental Health/Behavioral

In acute episodes, rest is indicated, along with appropriate hydration and salt intake. For prevention, education regarding hydration and electrolyte balance is essential. Follow-Up