DIAPHORESIS

DIAPHORESIS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the following questions:

1. Is there a history of drug or alcohol ingestion? Many drugs can cause diaphoresis, but caffeine and nicotine head the list. Alcohol can be associated with significant diaphoresis also.
2. Is there associated fever? Obviously, infectious disease is a very important cause of diaphoresis, particularly when the fever breaks. Look for tuberculosis, malaria, acute rheumatic fever, and bacterial endocarditis. Thyroid storm can be associated with fever also.
3. Is there associated chest pain or hypotension? Chest pain with diaphoresis would make one think of an acute myocardial infarction, but this combination is also found in coronary insufficiency. Shock, whatever the cause, produces significant diaphoresis.
4. Is there associated weight loss, hypertension, or both? Weight loss and hypertension should make one think of hyperthyroidism and pheochromocytoma. Peripheral neuropathy is also associated with sweating because of involvement of the autonomic nervous system.
5. Is there associated weight gain? The triad of obesity, diaphoresis, and increased appetite is typical of an insulinoma. Diabetics taking excessive insulin will also sweat.
6. Is there a rash? Several skin diseases may cause hyperhidrosis.

DIAGNOSTIC WORKUP

Routine diagnostic studies include a CBC, sedimentation rate, chemistry panel, electrolytes, thyroid profile, blood alcohol level, EKG, and chest x-ray. Serial EKGs and cardiac enzymes should be done if a myocardial infarction is suspected. A 24-hr urine collection for catecholamine can be done if a pheochromocytoma is suspected. A glucose tolerance test, a 36- to 72-hr fast , and insulin tolerance test may be done for an insulinoma. If infectious disease is strongly suspected, a workup for fever of unknown origin can be done .

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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