109A 216 Definition Acute painful spasms of the voluntary muscles most strenuously used. The most common muscles affected are those in the extremities however, abdominal and shoulder muscles also may be affected. Cramps can be associated with heat exhaustion. Cramps can be caused from hard work in a hot environment, causing profuse sweating with replacement of fluid losses but not of depleted salt. Cramping usually occurs late in the evening or after the muscles have cooled. The basis for heat cramps is hyponatremia. Elderly individuals, alcohol abusers, and overweight persons are particularly susceptible to heat re- actions. Such medications as phenothiazines and diuretics can predispose to heat stress. Characteristics Nausea, cool and pallid skin, or diaphoresis might be present. Body temperature is usually normal. If onset is delayed, cramping can occur during resting period. Generally it is not a life-threatening condition (unless related to the use of phenothiazines). Policy Evaluate employee in the occupational health unit. Train hazardous materials team or em- ployees required to wear protective clothing (e.g., respirator equipment) regarding preven- tion and signs and symptoms of heat disorders. Objectives Clinical Assessments and Interventions Referral for Medical Action Heat Disorder: Heat Cramps ● Severe nausea and vomiting. ● Progression to more severe form of heat disorder or decreased level of consciousness. ● Low blood pressure or orthostatic hypotension. Follow-up Actions ● Counsel regarding appropriate fluid replacement while working in hot environments. ● Educate regarding acclimation to hot environments. ● Monitor for signs of heat exhaus- tion. ● Caution about use of imperme- able protective clothing that can block evaporation. Assess employee status. Replace fluids and electrolytes. Provide symptom relief. ● Check employee temperature, pulse, and blood pressure. ● Instruct employee to lie down and keep quiet in cool environment, then loosen clothing and monitor. ● Give plain water with adequate concentra- tion of sodium, or diluted orange juice or Gatorade (one 8 oz. glass every 15 minutes for 1 hour), if not contraindicated by health history. ● Start IV solution (normal saline or lactated Ringer’s solution per standing order) if em- ployee is unable to drink fluids. ● Massage affected muscles with firm pres- sure to help relieve spasm. ● Do not allow resumption of strenuous activity. ● Continue rest in cool environment and con- sider medical evaluation, if appropriate. Guideline continues on next page