Hyperhidrosis (Excessive Sweating)

Hyperhidrosis (Excessive Sweating): Excerpt from In A Page: Pediatric Signs and Symptoms

The common causes of excessive sweating are benign and are the body's natural cooling response or the response to emotional stimuli. The most important cause to keep in mind is congestive heart failure, especially when accompanied by poor feeding in an infant, as well as night sweats which may be an ominous sign.

Differential Diagnosis

• Fever
• Emotional stimuli
  –Sweaty palms and soles is referred to as volar hyperhidrosis
• Exercise
• Increased ambient temperature (heat)
• Spicy foods
• Obesity
• Atopy

• Congestive heart failure
  –May also be accompanied by poor feeding, pallor, cyanosis, tachypnea, lethargy, exercise intolerance
  –Causes include congenital heart disease, cardiomyopathies and viral myocarditis

• Shock, respiratory failure
• Hypoglycemia
• Syncope
  –Vasovagal syncope is commonly preceded by sweating
• Medications/drugs
  –Withdrawal (e.g., alcohol, opioids)
  –Overdose of salicylates, organophosphates
  –Insulin, emetics
• Cluster headaches
• Hyperthyroidism
• Pheochromocytoma
  –An adrenal tumor associated with hypertension and symptoms of excessive catecholamines
• Familial dysautonomia (Riley-Day syndrome)
  –An autosomal-dominant sensory neuropathy
  –Characterized by hypotonia, feeding problems, and poor autonomic control
• Spinal cord injury
• Juvenile rheumatoid arthritis
• Lymphoma
• Raynaud phenomenon
  –Sweating often accompanies the extremity color changes
• Night sweats
  –Most commonly associated with TB and malignancy (see also “Night Sweats” entry)

Workup and Diagnosis

• History
  –Precipitating factors, including emotional stimuli, exercise, heat, spicy foods
  –Fever, associated symptoms
  –Current medications
  –Possibility of ingestions
  –Any problems with feeding or exercise
  –Past medical history including chronic illnesses
  –Family history of any cardiac or sweating problems
• Physical exam
  –Vital signs, including temperature, pulse, respiratory rate, and blood pressure
  –Assessment of airway, breathing, and circulation
  –Cardiac and lung exam, paying special attention to any murmurs, abnormal heart sounds, pulses, irregular rhythms
  –Skin for capillary refill, rashes, pallor, or cyanosis
  –Signs of systemic illness
  • Labs
    –Since most causes of excessive sweating are benign, laboratory evaluation is not usually needed
    –Consider obtaining glucose, drug screen, thyroid function tests
    –Based on history and physical exam, consider an electrocardiogram or echocardiogram

  Treatment

  • If the patient is critically ill, stabilize the patient's airway, breathing, and circulation
  • Remove precipitating factors
    –Put patient in cool environment, remove excessive clothing, and offer cool fluids
  • Treat fever with antipyretics
    –The patient may sweat more with defervescence
  • Treat infections with appropriate medications
  • Address congestive heart failure
    –Consult cardiology
    –Initially, diuretics are used
    –Digoxin, an antiarrhythmic and inotrope, is also used
    –Corrective surgery or cardiac transplantation
  • For excessive sweating that is bothersome to the patient, topical aluminum chloride may be used; anticholinergics work, but have many side effects
  • Surgery, including removal of axillary sweat glands and cervicothoracic sympathectomy, is rarely used

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.

More About Hyperhidrosis

• Back to disease: Hyperhidrosis: Introduction
• Next Book Extract About Hyperhidrosis: HYPERNATREMIA (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Hyperhidrosis

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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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