Night Sweats

Night Sweats: Excerpt from In A Page: Pediatric Signs and Symptoms

Night sweats are an often-underreported symptom that consist of profuse sweating during the night. They may or may not be accompanied by excessive sweating during the daytime, and they can be confused with hot flashes or flushing. They are among the “constitutional” symptoms (fever, malaise, weight loss, etc.), and their frequency is difficult to determine because they are rarely reported spontaneously by patients, even when the amount of sweating is so excessive that it requires changing of bedclothes.

Differential Diagnosis

• Environmental
  –High room temperature, excessive wrapping or too many bed covers may be the most common cause (young children cannot control their environment)
• Tuberculosis
  –The disease most commonly associated with night sweats in the medical literature
  • Malignancy
    –Hodgkin lymphoma is the malignancy most commonly associated with night sweats; night sweats are among the “B” symptoms in staging, but their presence does not adversely affect prognosis
    –Leukemia and solid tumors may also cause night sweats
  • Alcohol or spicy food ingestion
  • Drugs
    –Antidepressants, cholinergics, antitussives, antipyretics, decongestants, insulin, sulfonylurea agents
    • Other infections
      –Indolent chronic infections: Subacute endocarditis, osteomyelitis, abscesses often present with fever, night sweats
      –HIV
      –Histoplasmosis
    • Endocrinologic disorders
      –Nocturnal hypoglycemia
      –Hyperthyroidism
      –Diabetes insipidus
      –Pheochromocytoma
    • Anxiety disorder/panic attacks
    • Sleep disorders
      –Obstructive sleep apnea
      –Nightmares
    • Drug abuse
    • GERD
    • Neurologic disease
      –Hypothalamic lesions
      –Head injury
      –Cerebral palsy
      –Familial dysautonomia
    • Pregnancy
    • Obesity
    • Autoimmune diseases
    • Mercury poisoning

    Workup and Diagnosis

    • History
      –Bedroom temperature, sleep habits
      –Fever, weight loss
      –Fatigue, sleepiness at school
      –Other symptoms: Heartburn, cough, flushing, polydipsia, polyuria
      –Nightmares, palpitations, panic attacks
      –Past medical history and medications
    • Physical exam
      –Vital signs, growth parameters
      –Lymphadenopathy, pallor, petechiae
      –Skin exam (heat rash, erythema nodosum)
      –Hypertrophic tonsils
      –New-onset murmur
    • Labs
      –CBC, ESR if hematologic malignancy or chronic
    • infection is suspected
      –Fasting blood sugar
      –Electrolyte abnormalities for DI
      –Urine VMA for pheochromocytoma
    • Radiology
      –Chest X-ray may show lesions consistent with TB or mediastinal widening due to lymphoma
    • Studies
      –PPD to test exposure to tuberculosis
      –Sleep study if sleep apnea is suspected
      –pH probe if confirmation of GERD is necessary

    Treatment

    • Reassurance of the parents
    • Education concerning “normal” temperature and bed clothing in children's rooms
    • Pulmonary TB is treated with 6 months of isoniazid and rifampin supplemented with 2 months of pyrazinamide initially
    • Chemotherapy for Hodgkin or other malignancies
    • Discontinuation of offending drugs if possible
    • Treatment or control of endocrinologic disorders
    • BiPAP or surgery for obstructive sleep apnea
    • Treatment of specific infections
    • Treatment of GERD with acid blockade and/or prokinetics
    • Behavioral therapy for anxiety disorders

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 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: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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