Flushing
Flushing: Excerpt from Field Guide to Bedside Diagnosis
Differential Overview
❑ Perimenopause
❑ Alcohol/toxic
❑ Rosacea
❑ Palmar erythema
❑ Niacin
❑ Monosodium glutamate
❑ Carcinoid
❑ Pheochromocytoma
❑ Medullary thyroid carcinoma
❑ Scombroid
❑ Mastocytosis
Diagnostic Approach
Clinical Findings
Perimenopause “Hot flashes” may occur spontaneously or may be brought on by hot drinks, alcohol, or emotional upset. Representing a sudden triggering of the cutaneous heat loss mechanism, these flashes often cause profuse perspiration.
Alcohol/toxic Flushing may occur with alcohol alone—probably caused by acetaldehyde accumulation—in Asians, Eskimos, and American Indians. A disulfriam reaction of flushing, nausea, tachycardia, and dyspnea may occur with alcohol ingestion, and has also been reported with use of metronidazole, chlorpropamide, griseofulvin, quinacrine, and some cephalosporins. Occupational exposure to organic solvents such as chloroethylene, carbon disulfide, and dimethylformamide can also cause flushing with dizziness upon ingestion of alcohol.
Rosacea Hereditary predisposition to flushing with alcohol, spicy foods, or heat leads over time to the development of facial telangiectasias and red papules.
Palmar erythema Localized flushing in the palm is associated with pregnancy, liver disease, thyrotoxicosis, rheumatoid arthritis, high output states, and pancreatic cancer.
Niacin Flushing of the face and upper trunk occurs when plasma niacin levels rapidly rise. It may be prevented by aspirin; thus, flushing is presumed to be prostaglandin-mediated.
Monosodium glutamate Food containing MSG produces transient flushing associated with tightness and pressure in the head, neck, and upper torso, headaches, and drowsiness.
Carcinoid The carcinoid syndrome consists of flushing (often a violaceous hue), diarrhea, tachycardia, hypotension, and wheezing. The carcinoid syndrome will occur in 30% to 60% of cases of small bowel carcinoid but only rarely (,5% of cases) in bronchial or appendix carcinoid. A small bowel carcinoid can cause right-sided valvular thickening leading to tricuspid insufficiency or pulmonic stenosis. Left-sided valvular heart disease may develop with a bronchial carcinoid. The flush may be provoked by alcohol as well as foods rich in tyramine, such as red wine and cheeses.
Pheochromocytoma Flushing is associated with paroxysmal high blood pressure and fainting.
Medullary thyroid carcinoma Paroxysmal flushing is mediated by calcitonin.
Scombroid After eating fresh tuna or bonito, the body and conjunctivae flush profusely, and headache, dizziness, nausea, and burning in the mouth develop.
Mastocytosis It presents similarly to carcinoid but has dermatographism and splenomegaly.
Pictures
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
More About Hot flashes
More Medical Textbooks Online about Hot flashes
Review other book chapters online related to Hot flashes:
Medical Books Excerpts
- Menopause
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: FLUSHED FACE (PLETHORA) (Differential Diagnosis in Primary Care)
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