Causes of Hyperhidrosis
Causes of Hyperhidrosis (Diseases Database):
The follow list shows some of the possible medical causes of Hyperhidrosis
that are listed by the Diseases Database:
Source: Diseases Database
Hyperhidrosis Causes: Book Excerpts
Related information on causes of Hyperhidrosis:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Hyperhidrosis may be found in:
Causes of Hyperhidrosis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Hyperhidrosis.
Hypernatremia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Increased water loss
–GI losses (diarrhea, vomiting, intestinal fistula)
–Drugs (e.g., diuretics, alcohol, amphotericin B, phenytoin, propoxyphene, lithium, demeclocycline)
–Sweating
–Burns
–Fever
–Hyperventilation
–Diabetes insipidus (central versus
nephrogenic)
–Severe burns
–Alcohol use
–Hyperglycemia (resulting in osmotic
diuresis)
–Diuresis phase of acute renal failure
–Peritoneal dialysis
–Thyrotoxicosis
–Hyperthermia
–Adrenal or renal failure
- Decreased water intake
–Poor oral intake (e.g., in the elderly)
–Inability to swallow water due to physical
limitation (e.g., coma, access/mobility problems, swallowing problems)
–Inability to recognize the need for water
due to a hypothalamic lesion (e.g., CVA)
–Impaired thirst
–Inappropriate IV fluids (e.g., renal failure)
–Tube feeding with inadequate free water
- Excessive sodium intake
–Endocrine causes: Cushing's syndrome, ectopic ACTH, primary aldosteronism
–Iatrogenic (e.g., inappropriately administered hypertonic saline, administration of sodium bicarbonate)
–Sea water ingestion/drowning
-
Renal salt retention
–Mineralocorticoid excess (Conn's
syndrome)
–Cushing's syndrome
–Congenital adrenal hyperplasia
–Multiple myeloma
–Sjögren's syndrome
Essential hypernatremia (reset osmostat)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Night Sweats:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Infections
–HIV
–Tuberculosis
–Infectious mononucleosis
–Fungal (e.g., histoplasmosis,
coccidioidomycosis)
–Lung or other abscess
–Endocarditis
–Osteomyelitis -
Neoplasms
–Leukemia
–Hodgkin's disease and other forms of
lymphoma
–Solid tumors (e.g. prostate, adrenal, renal, testicular)
-
Menopause/premature ovarian failure
-
Hyperthyroidism
-
Diabetes mellitus (nocturnal hypoglycemia)
-
GERD
-
Obstructive sleep apnea
-
Chronic fatigue syndrome
-
Anxiety
-
Pregnancy
-
Drugs [e.g., antipyretics (most common), antihypertensives, phenothiazines, antiretroviral agents]
-
Substance abuse (including alcohol)
-
Orchiectomy
-
Endocrine tumors
–Pheochromocytoma
–Carcinoid
-
Chronic eosinophilic pneumonia
-
Prinzmetal's angina
-
Temporal arteritis
-
Takayasu's arteritis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hypernatremia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Dehydration
–GI losses, especially watery diarrhea or profuse vomiting (very common)
–Impaired oral intake and inability to respond to normal thirst mechanisms (e.g., young infants, altered mental status, or iatrogenic administration of IV fluids)
-
Central diabetes insipidus (DI)
–Decreased or absent production of ADH
–Idiopathic
–Head trauma
–Suprasellar or infrasellar tumors
–Langerhans cell histiocytosis
–Granulomatous disease (including
tuberculosis, Wegener granulomatosis and
sarcoidosis)
–Infection
–Cerebral hemorrhage
-
Nephrogenic DI (NDI)
–Inability to respond to ADH
–Primary (congenital abnormality)
–Secondary (acquired renal tubular
dysfunction, e.g., progressive renal insufficiency; medications, e.g., lithium)
-
Severe skin or other insensible losses
–Excessive sweating
–Persistent rapid breathing
–Burns
-
Increased total body sodium (rare in children)
–Salt intoxication from
–Sodium chloride tablets
–IV NaCl or NaHCO3
–Breast milk after significant maternal
sodium load
–Concentrated formula
–Primary hyperaldosteronism
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Night Sweats:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
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
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hyperhidrosis (Excessive Sweating):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
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)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Skin, clammy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, a headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, a headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, a headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hyperhidrosis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Genetic factors may contribute to the development of hyperhidrosis and, in susceptible individuals, emotional stress appears to be the most prominent cause, although most patients aren’t anxious. Increased central nervous system (CNS) impulses may provoke excessive release of acetylcholine, producing a heightened sweat response. Exercise and a hot climate can cause profuse sweating in these patients. Certain drugs (such as antipyretics, emetics, meperidine, and anticholinesterases) and certain foods (such as tomato sauce, chocolate, coffee, and spicy foods) have been known to increase sweating.
In addition, hyperhidrosis commonly occurs as a clinical manifestation of an underlying disorder. Infections and chronic diseases, such as tuberculosis, malaria, or lymphoma, may cause excessive nighttime sweating. A person with diabetes commonly demonstrates hyperhidrosis during a hypoglycemic crisis. Other predisposing conditions include hyperthyroidism, pheochromocytomas; cardiovascular disorders, such as shock or heart failure; CNS disturbances (generally lesions of the hypothalamus); withdrawal from drugs or alcohol; menopause; and Graves’disease.
Hyperhidrosis occurs in up to 1% of the U.S. population.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diaphoresis:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome
Night sweats may be an early feature, occurring either as a manifestation of the disease itself or secondary to an opportunistic infection. The patient also displays fever, fatigue, lymphadenopathy, anorexia, dramatic and unexplained weight loss, diarrhea, and a persistent cough.
Acromegaly
In this slowly progressive disorder, diaphoresis is a sensitive gauge of disease activity, which involves hypersecretion of growth hormone and increased metabolic rate. The patient has a hulking appearance with an enlarged supraorbital ridge and thickened ears and nose. Other signs and symptoms include warm, oily, thickened skin; enlarged hands, feet, and jaw; joint pain; weight gain; hoarseness; and increased coarse body hair. Increased blood pressure, severe headache, and visual field deficits or blindness may also occur.
Anxiety disorders
Acute anxiety characterizes panic, whereas chronic anxiety characterizes phobias, conversion disorders, obsessions, and compulsions. Whether acute or chronic, anxiety may cause sympathetic stimulation, resulting in diaphoresis. The diaphoresis is most dramatic on the palms, soles, and forehead and is accompanied by palpitations, tachycardia, tachypnea, tremors, and GI distress. Psychological signs and symptoms—fear, difficulty concentrating, and behavior changes—also occur.
Autonomic hyperreflexia
Occurring after resolution of spinal shock in a spinal cord injury above T6, hyperreflexia causes profuse diaphoresis, pounding headache, blurred vision, and dramatically elevated blood pressure. Diaphoresis occurs above the level of the injury, especially on the forehead, and is accompanied by flushing. Other findings include restlessness, nausea, nasal congestion, and bradycardia.
Drug and alcohol withdrawal syndromes
Withdrawal from alcohol or an opioid analgesic may cause generalized diaphoresis, dilated pupils, tachycardia, tremors, and altered mental status (confusion, delusions, hallucinations, agitation). Associated signs and symptoms include severe muscle cramps, generalized paresthesia, tachypnea, increased or decreased blood pressure and, possibly, seizures. Nausea and vomiting are common.
Empyema
Pus accumulation in the pleural space leads to drenching night sweats and fever. The patient also complains of chest pain, cough, and weight loss. Examination reveals decreased respiratory excursion on the affected side and absent or distant breath sounds.
Heart failure
Typically, diaphoresis follows fatigue, dyspnea, orthopnea, and tachycardia in patients with left-sided heart failure, and jugular vein distention and dry cough in patients with right-sided heart failure. Other features include tachypnea, cyanosis, dependent edema, crackles, ventricular gallop, and anxiety.
Heat exhaustion
Although this condition is marked by failure of heat to dissipate, it initially may cause profuse diaphoresis, fatigue, weakness, and anxiety. These signs and symptoms may progress to circulatory collapse and shock (marked by confusion, thready pulse, hypotension, tachycardia, and cold, clammy skin). Other features include an ashen gray appearance, dilated pupils, and normal or subnormal temperature.
Hodgkin’s disease
Especially in elderly patients, early features of Hodgkin’s disease may include night sweats, fever, fatigue, pruritus, and weight loss. Usually, however, this disease initially causes painless swelling of a cervical lymph node. Occasionally, a Pel-Ebstein fever pattern is present—several days or weeks of fever and chills alternating with afebrile periods with no chills. Systemic signs and symptoms—such as weight loss, fever, and night sweats—indicate a poor prognosis. Progressive lymphadenopathy eventually causes widespread effects, such as hepatomegaly and dyspnea.
Hypoglycemia
Rapidly induced hypoglycemia may cause diaphoresis accompanied by irritability, tremors, hypotension, blurred vision, tachycardia, hunger, and loss of consciousness.
Immunoblastic lymphadenopathy
Resembling Hodgkin’s disease but rarer, this disorder causes episodic diaphoresis along with fever, weight loss, weakness, generalized lymphadenopathy, rash, and hepatosplenomegaly.
Infective endocarditis (subacute)
Generalized night sweats occur early in this disorder and are accompanyied by intermittent low-grade fever, weakness, fatigue, anorexia, weight loss, and arthralgia. A sudden change in a murmur or the discovery of a new murmur is a classic sign. Petechiae and splinter hemorrhages are also common.
Liver abscess
Signs and symptoms vary, depending on the extent of the abscess, but commonly include diaphoresis, right-upper-quadrant pain, weight loss, fever, chills, nausea, vomiting, and signs of anemia.
Lung abscess
Drenching night sweats are common in this disorder. Its chief sign, however, is a cough that produces copious amounts of purulent, foul-smelling, and typically blood-tinged sputum. Associated findings include fever with chills, pleuritic chest pain, dyspnea, weakness, anorexia, weight loss, headache, malaise, clubbing, tubular or amphoric breath sounds, and dullness on percussion.
Malaria
Profuse diaphoresis marks the third stage of paroxysmal malaria, preceded by chills (first stage) and high fever (second stage). Headache, arthralgia, and hepatosplenomegaly may also occur. In the benign form of malaria, these paroxysms alternate with periods of well-being. The severe form may progress to delirium, seizures, and coma.
Ménière’s disease
Characterized by severe vertigo, tinnitus, and hearing loss, this disorder may also cause diaphoresis, nausea, vomiting, and nystagmus. Hearing loss may be progressive and tinnitus may persist between attacks.
Myocardial infarction
Diaphoresis usually accompanies acute, substernal, radiating chest pain in this life-threatening disorder. Associated signs and symptoms include anxiety, dyspnea, nausea, vomiting, tachycardia, irregular pulse, blood pressure change, fine crackles, pallor, and clammy skin.
Pheochromocytoma
This disorder commonly produces diaphoresis, but its cardinal sign is persistent or paroxysmal hypertension. Other effects include headache, palpitations, tachycardia, anxiety, tremors, pallor, flushing, paresthesia, abdominal pain, tachypnea, nausea, vomiting, and orthostatic hypotension.
Pneumonia
In patients with pneumonia, intermittent, generalized diaphoresis accompanies fever, chills, and pleuritic chest pain that increases with deep inspiration. Other features are tachypnea, dyspnea, a productive cough (with scant and mucoid or copious and purulent sputum), headache, fatigue, myalgia, abdominal pain, anorexia, and cyanosis. Auscultation reveals bronchial breath sounds.
Relapsing fever
Profuse diaphoresis marks resolution of the crisis stage of this disorder, which typically produces attacks of high fever accompanied by severe myalgia, headache, arthralgia, diarrhea, vomiting, coughing, and eye or chest pain. Splenomegaly is common, but hepatomegaly and lymphadenopathy may also occur. The patient may develop a transient macular rash. Between 3 and 10 days after onset, the febrile attack abruptly terminates in chills with increased pulse and respiratory rates. Diaphoresis, flushing, and hypotension may then lead to circulatory collapse and death. Relapse invariably occurs if the patient survives the initial attack.
Tetanus
This disorder commonly causes profuse sweating accompanied by low-grade fever, tachycardia, and hyperactive deep tendon reflexes. Early restlessness and pain and stiffness in the jaw, abdomen, and back progress to spasms associated with lockjaw, risus sardonicus, dysphagia, and opisthotonos. Laryngospasm may result in cyanosis or sudden death by asphyxiation.
Thyrotoxicosis
This disorder commonly produces diaphoresis accompanied by heat intolerance, weight loss despite increased appetite, tachycardia, palpitations, an enlarged thyroid, dyspnea, nervousness, diarrhea, tremors, Plummer’s nails and, possibly, exophthalmos. Gallops may also occur.
Tuberculosis (TB)
Although many patients with primary infection are asymptomatic, TB may cause night sweats, low-grade fever, fatigue, weakness, anorexia, and weight loss. In reactivation, a productive cough with mucopurulent sputum, occasional hemoptysis, and chest pain may be present.
Other causes
Drugs
Sympathomimetics, certain antipsychotics, thyroid hormone, corticosteroids, and antipyretics may cause diaphoresis. Aspirin and acetaminophen poisoning also cause this sign.
Dumping syndrome
The result of rapid emptying of gastric contents into the small intestine after partial gastrectomy, dumping syndrome causes diaphoresis, palpitations, profound weakness, epigastric distress, nausea, and explosive diarrhea soon after eating.
Envenomation
Depending on the type of bite, neurotoxic effects may include diaphoresis, chills (with or without fever), weakness, dizziness, blurred vision, increased salivation, nausea and vomiting and, possibly, paresthesia and muscle fasciculations. Local features may include ecchymosis and progressively severe pain and edema. Palpation reveals tender regional lymph nodes.
Pesticide poisoning
Among the toxic effects of pesticides are diaphoresis, nausea, vomiting, diarrhea, blurred vision, miosis, and excessive lacrimation and salivation. The patient may also display fasciculations, muscle weakness, and flaccid paralysis. Signs of respiratory depression and coma may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Skin, clammy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diaphoresis/Night Sweats:
Differential Overview
(Field Guide to Bedside Diagnosis)
Diaphoresis
❑ Fever
❑ Hot flashes
❑ Anxiety
❑ Drugs
❑ Gustatory
❑ Thyrotoxicosis
❑ Parkinson disease
❑ Autonomic neuropathy
❑ Central neurologic injury
❑ Pheochromocytoma
❑ Carcinoid
❑ Acromegaly
Night Sweats
❑ Malignancy
❑ Lymphoma
❑ Tuberculosis
❑ HIV
❑ Bacterial endocarditis
❑ Osteomyelitis
❑ Pyogenic abscess
❑ Drugs
❑ Nocturnal hypoglycemia
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hyperhidrosis:
Causes
(Handbook of Diseases)
Possible causes of hyperhidrosis include the following:
❑ Genetic factors may contribute to the development of hyperhidrosis and, in susceptible individuals, emotional stress appears to be the most common cause. Increased central nervous system (CNS) impulses may provoke excessive release of acetylcholine, producing a heightened sweat response.
❑ Exercise and a hot climate can cause profuse sweating in these patients.
❑ Certain drugs, such as antipyretics, emetics, meperidine, and anticholin-esterase, can increase sweating.
❑ In addition, hyperhidrosis may occur as a clinical manifestation of an underlying disorder. Infections and chronic diseases, such as tuberculosis, malaria, and lymphoma, may cause excessive nighttime sweating. Diabetic patients commonly demonstrate hyperhidrosis during a hypoglycemic crisis.
❑ Other predisposing conditions include pheochromocytomas; cardiovascular disorders, such as shock and heart failure; CNS disturbances (most commonly lesions of the hypothalamus); withdrawal from drugs or alcohol; menopause; and Graves’disease.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Skin, clammy:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, hypotension, blurred vision, and loss of consciousness.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Diaphoresis:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Night sweats may be an early feature of acquired immunodeficiency syndrome (AIDS), occurring either as a manifestation of the disease itself or secondary to an opportunistic infection. The patient also displays fever, fatigue, lymphadenopathy, anorexia, dramatic and unexplained weight loss, diarrhea, and a persistent cough.
Acromegaly
With acromegaly, a slowly progressive disorder, diaphoresis is a sensitive gauge of disease activity, which involves hypersecretion of growth hormone and increased metabolic rate. The patient has a hulking appearance with an enlarged supraorbital ridge and thickened ears and nose. Other signs and symptoms of acromegaly include warm, oily, thickened skin; enlarged hands, feet, and jaw; joint pain; weight gain; hoarseness; and increased coarse body hair. Increased blood pressure, severe headache, and visual field deficits or blindness may also occur.
Anxiety disorders
Acute anxiety characterizes panic, whereas chronic anxiety characterizes phobias, conversion disorders, obsessions, and compulsions. Whether acute or chronic, anxiety may cause sympathetic stimulation, resulting in diaphoresis. The diaphoresis is most dramatic on the palms, soles, and forehead and is accompanied by palpitations, tachycardia, tachypnea, tremors, and GI distress. Psychological signs and symptoms — fear, difficulty concentrating, and behavior changes — also occur.
Autonomic hyperreflexia
Occurring after resolution of spinal shock in a spinal cord injury above T6, autonomic hyperreflexia causes profuse diaphoresis, pounding headache, blurred vision, and dramatically elevated blood pressure. Diaphoresis occurs above the level of the injury, especially on the forehead, and is accompanied by flushing. Other findings include restlessness, nausea, nasal congestion, and bradycardia.
Drug and alcohol withdrawal syndromes
Withdrawal from alcohol or an opioid analgesic may cause generalized diaphoresis, dilated pupils, tachycardia, tremors, and altered mental status (confusion, delusions, hallucinations, agitation). Associated signs and symptoms include severe muscle cramps, generalized paresthesia, tachypnea, increased or decreased blood pressure and, possibly, seizures. Nausea and vomiting are common.
Heart failure
Typically, diaphoresis follows fatigue, dyspnea, orthopnea, and tachycardia in patients with left-sided heart failure. In patients with right-sided heart failure, diaphoresis follows jugular vein distention and dry cough. Other features of heart failure include tachypnea, cyanosis, dependent edema, crackles, ventricular gallop, and anxiety.
Heat exhaustion
Although heat exhaustion is marked by failure of heat to dissipate, it initially may cause profuse diaphoresis, fatigue, weakness, and anxiety. These signs and symptoms may progress to circulatory collapse and shock (confusion, thready pulse, hypotension, tachycardia, and cold, clammy skin). Other features of heat exhaustion include an ashen gray appearance, dilated pupils, and normal or subnormal temperature.
Hodgkin’s disease
Especially in elderly patients, early features of Hodgkin’s disease may include night sweats, fever, fatigue, pruritus, and weight loss. Usually, however, this disease initially causes painless swelling of a cervical lymph node. Occasionally, a Pel-Ebstein fever pattern is present — several days or weeks of fever and chills alternating with afebrile periods with no chills. Systemic signs and symptoms — such as weight loss, fever, and night sweats — indicate a poor prognosis. Progressive lymphadenopathy eventually causes widespread effects, such as hepatomegaly and dyspnea.
Hypoglycemia
Rapidly induced hypoglycemia may cause diaphoresis accompanied by irritability, tremors, hypotension, blurred vision, tachycardia, hunger, and loss of consciousness. The patient may also experience confusion, motor weakness, hemiplegia, seizures, or coma.
Infective endocarditis (subacute)
Generalized night sweats occur early with subacute infective endocarditis. Accompanying signs and symptoms include intermittent low-grade fever, weakness, fatigue, weight loss, anorexia, and arthralgia. A sudden change in a murmur or the discovery of a new murmur is a classic sign. Petechiae and splinter hemorrhages are also common.
Liver abscess
Signs and symptoms vary, depending on the extent of a liver abscess, but commonly include diaphoresis, right-upper-quadrant pain, weight loss, fever, chills, nausea, vomiting, and signs of anemia. The patient may appear jaundiced and have chalk-colored stools and dark urine.
Lung abscess
Drenching night sweats are common with a lung abscess. Its chief sign, however, is a cough productive of copious purulent, foul-smelling, typically bloody sputum. Associated findings include fever with chills, pleuritic chest pain, dyspnea, weakness, anorexia, weight loss, headache, malaise, clubbing, tubular or amphoric breath sounds, and dullness on percussion.
Malaria
Profuse diaphoresis marks the third stage of paroxysmal malaria; the first two stages are chills (first stage) and high fever (second stage). Headache, arthralgia, and hepatosplenomegaly may also occur. In the benign form of malaria, these paroxysms alternate with periods of well-being. The severe form may progress to delirium, seizures, and coma.
Myocardial infarction
Diaphoresis usually accompanies acute, substernal, radiating chest pain in myocardial infarction (MI), a life-threatening disorder. Associated signs and symptoms of MI include anxiety, dyspnea, nausea, vomiting, tachycardia, irregular pulse, blood pressure change, fine crackles, pallor, and clammy skin.
Pheochromocytoma
Pheochromocytoma commonly produces diaphoresis, but its cardinal sign is persistent or paroxysmal hypertension. Other effects include headache, palpitations, tachycardia, anxiety, tremors, pallor, flushing, paresthesia, abdominal pain, tachypnea, nausea, vomiting, and orthostatic hypotension.
Pneumonia
Intermittent, generalized diaphoresis accompanies fever and chills in patients with pneumonia. They complain of pleuritic chest pain that increases with deep inspiration. Other features are tachypnea, dyspnea, productive cough (with scant and mucoid or copious and purulent sputum), headache, fatigue, myalgia, abdominal pain, anorexia, and cyanosis. Auscultation reveals bronchial breath sounds.
Relapsing fever
Profuse diaphoresis marks resolution of the crisis stage of relapsing fever, which typically produces attacks of high fever accompanied by severe myalgia, headache, arthralgia, diarrhea, vomiting, coughing, and eye or chest pain. Splenomegaly is common, but hepatomegaly and lymphadenopathy may also occur. The patient may develop a transient, macular rash. Between 3 and 10 days after onset, the febrile attack abruptly terminates in chills with increased pulse and respiratory rates. Diaphoresis, flushing, and hypotension may then lead to circulatory collapse and death. Relapse invariably occurs if the patient survives the initial attack.
CULTURAL CUE:Louse-borne relapsing fever is most common in North and Central Africa, Europe, Asia, and South America. Tick-borne relapsing fever is commonly found in the United States, most prevalently in Texas and other western states.
Tetanus
Tetanus commonly causes profuse sweating accompanied by low-grade fever, tachycardia, and hyperactive deep tendon reflexes. Early restlessness and pain and stiffness in the jaw, abdomen, and back progress to spasms associated with lockjaw, risus sardonicus, dysphagia, and opisthotonos. Laryngospasm may result in cyanosis or sudden death by asphyxiation.
Thyrotoxicosis
Thyrotoxicosis commonly produces diaphoresis accompanied by heat intolerance, weight loss despite increased appetite, tachycardia, palpitations, an enlarged thyroid, dyspnea, nervousness, diarrhea, tremors, Plummer’s nails and, possibly, exophthalmos. Gallops may also occur.
Other causes
Drugs
Sympathomimetics, certain antipsychotics, thyroid hormone, corticosteroids, and antipyretics may cause diaphoresis. Aspirin and acetaminophen poisoning also cause this sign.
Dumping syndrome
The result of rapid emptying of gastric contents into the small intestine after partial gastrectomy, dumping syndrome causes diaphoresis, palpitations, profound weakness, epigastric distress, nausea, and explosive diarrhea. This syndrome occurs soon after the patient eats.
Pesticide poisoning
Among the toxic effects of pesticides are diaphoresis, nausea, vomiting, diarrhea, blurred vision, miosis, and excessive lacrimation and salivation. The patient may display fasciculations, muscle weakness, and flaccid paralysis. Signs of respiratory depression and coma may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Skin, clammy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Cardiac arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension. The pulse rate may be rapid, slow, or irregular. The patient may report palpitations, chest pain, diaphoresis, light-headedness, and weakness.
Cardiogenic shock
With cardiogenic shock, generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria. Associated signs and symptoms include anginal pain, dyspnea, jugular vein distention, ventricular gallop, and a weak, rapid pulse.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
With acute hypoglycemia, generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage of septic shock causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Sweating:
Principal Causes of Sweating
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Physiologiccauses
- Highenvironmental temperature
- Exercise
- Overdressing
- Severe pain
- Anxiety
- Pathologic causes
- Cardiacfailure
- Infection
- Hypoglycemia
- Thyrotoxicosis
- Pheochromocytoma
- Familial dysautonomia
- Drugs and toxins
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Diaphoresis:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Night sweats may be an early feature of AIDS, occurring either as a manifestation of the disease itself or secondary to an opportunistic infection. The patient also displays a fever, fatigue, lymphadenopathy, anorexia, dramatic and unexplained weight loss, diarrhea, and a persistent cough.
Acromegaly.With acromegaly, diaphoresis is a sensitive gauge of disease activity, which involves the hypersecretion of growth hormone and an increased metabolic rate. The patient has a hulking appearance with an enlarged supraorbital ridge and thickened ears and nose. Other signs and symptoms include warm, oily, thickened skin; enlarged hands, feet, and jaw; joint pain; weight gain; hoarseness; and increased coarse body hair. Increased blood pressure, a severe headache, and visual field deficits or blindness may also occur.
Anxiety disorders.Acute anxiety characterizes panic, whereas chronic anxiety characterizes phobias, conversion disorders, obsessions, and compulsions. Whether acute or chronic, anxiety may cause sympathetic stimulation, resulting in diaphoresis. The diaphoresis is most dramatic on the palms, soles, and forehead and is accompanied by palpitations, tachycardia, tachypnea, tremors, and GI distress. Psychological signs and symptoms—fear, difficulty concentrating, and behavior changes—also occur.
Autonomic hyperreflexia.Occurring after resolution of spinal shock in a spinal cord injury above T6, hyperreflexia causes profuse diaphoresis, a pounding headache, blurred vision, and dramatically elevated blood pressure. Diaphoresis occurs above the level of the injury, especially on the forehead, and is accompanied by flushing. Other findings include restlessness, nausea, nasal congestion, and bradycardia.
Drug and alcohol withdrawal syndromes.Withdrawal from alcohol or an opioid analgesic may cause generalized diaphoresis, dilated pupils, tachycardia, tremors, and an altered mental status (for example, confusion, delusions, hallucinations, and agitation). Associated signs and symptoms include severe muscle cramps, generalized paresthesia, tachypnea, increased or decreased blood pressure and, possibly, seizures. Nausea and vomiting are common.
Empyema.Pus accumulation in the pleural space leads to drenching night sweats and fever. The patient also complains of chest pain, a cough, and weight loss. Examination reveals decreased respiratory excursion on the affected side and absent or distant breath sounds.
Heart failure.Typically, diaphoresis follows fatigue, dyspnea, orthopnea, and tachycardia in patients with left-sided heart failure and jugular vein distention and a dry cough in patients with right-sided heart failure. Other features include tachypnea, cyanosis, dependent edema, crackles, a ventricular gallop, and anxiety.
Heat exhaustion.Although heat exhaustion is marked by failure of heat to dissipate, it initially may cause profuse diaphoresis, fatigue, weakness, and anxiety. These signs and symptoms may progress to circulatory collapse and shock (for example, confusion, a thready pulse, hypotension, tachycardia, and cold, clammy skin). Other features include an ashen gray appearance, dilated pupils, and a normal or subnormal temperature.
Hodgkin's disease.Especially in elderly patients, early features of Hodgkin's disease may include night sweats, a fever, fatigue, pruritus, and weight loss. Usually, however, this disease initially causes painless swelling of a cervical lymph node. Occasionally, a Pel-Ebstein fever pattern is present—several days or weeks of fever and chills alternating with afebrile periods with no chills. Systemic signs and symptoms—such as weight loss, a fever, and night sweats—indicate a poor prognosis. Progressive lymphadenopathy eventually causes widespread effects, such as hepatomegaly and dyspnea.
Hypoglycemia.Rapidly induced hypoglycemia may cause diaphoresis accompanied by irritability, tremors, hypotension, blurred vision, tachycardia, hunger, and loss of consciousness.
Infective endocarditis (subacute).Generalized night sweats occur early with infective endocarditis. Accompanying signs and symptoms include an intermittent low-grade fever, weakness, fatigue, weight loss, anorexia, and arthralgia. A sudden change in a murmur or the discovery of a new murmur is a classic sign. Petechiae and splinter hemorrhages are also common.
Lung abscess.Drenching night sweats are common with lung abscess. Its chief sign, however, is a cough that produces copious purulent, foul-smelling, and typically bloody sputum. Associated findings include a fever with chills, pleuritic chest pain, dyspnea, weakness, anorexia, weight loss, a headache, malaise, clubbing, tubular or amphoric breath sounds, and dullness on percussion.
Malaria.Profuse diaphoresis marks the third stage of paroxysmal malaria; the first two stages are chills (first stage) and a high fever (second stage). A headache, arthralgia, and hepatosplenomegaly may also occur. In the benign form of malaria, these paroxysms alternate with periods of well-being. The severe form may progress to delirium, seizures, and coma.
Myocardial infarction (MI).Diaphoresis usually accompanies acute, substernal, radiating chest pain in MI, a life-threatening disorder. Associated signs and symptoms include anxiety, dyspnea, nausea, vomiting, tachycardia, an irregular pulse, blood pressure changes, fine crackles, pallor, and clammy skin.
Pheochromocytoma.Pheochromocytoma commonly produces diaphoresis, but its cardinal sign is persistent or paroxysmal hypertension. Other effects include a headache, palpitations, tachycardia, anxiety, tremors, pallor, flushing, paresthesia, abdominal pain, tachypnea, nausea, vomiting, and orthostatic hypotension.
Pneumonia.Intermittent, generalized diaphoresis accompanies a fever and chills in patients with pneumonia. They complain of pleuritic chest pain that increases with deep inspiration. Other features are tachypnea, dyspnea, a productive cough (with scant and mucoid or copious and purulent sputum), a headache, fatigue, myalgia, abdominal pain, anorexia, and cyanosis. Auscultation reveals bronchial breath sounds.
Tetanus.Tetanus commonly causes profuse sweating accompanied by a low-grade fever, tachycardia, and hyperactive deep tendon reflexes. Early restlessness and pain and stiffness in the jaw, abdomen, and back progress to spasms associated with lockjaw, risus sardonicus, dysphagia, and opisthotonos. Laryngospasm may result in cyanosis or sudden death by asphyxiation.
Thyrotoxicosis.Thyrotoxicosis commonly produces diaphoresis accompanied by heat intolerance, weight loss despite increased appetite, tachycardia, palpitations, an enlarged thyroid, dyspnea, nervousness, diarrhea, tremors, Plummer's nails and, possibly, exophthalmos. Gallops may also occur.
Tuberculosis (TB).Although many patients with primary infection are asymptomatic, TB may cause night sweats, a low-grade fever, fatigue, weakness, anorexia, and weight loss. In reactivation, a productive cough with mucopurulent sputum, occasional hemoptysis, and chest pain may be present.
Other causes
Drugs.Sympathomimetics, certain antipsychotics, thyroid hormones, corticosteroids, and antipyretics may cause diaphoresis. Aspirin and acetaminophen poisoning also cause this sign.
Dumping syndrome.The result of rapid emptying of gastric contents into the small intestine after partial gastrectomy, this syndrome causes diaphoresis, palpitations, profound weakness, epigastric distress, nausea, and explosive diarrhea. This syndrome occurs soon after eating.
Pesticide poisoning.Among the toxic effects of pesticides are diaphoresis, nausea, vomiting, diarrhea, blurred vision, miosis, and excessive lacrimation and salivation. The patient may display fasciculations, muscle weakness, and flaccid paralysis. Signs of respiratory depression and coma may also occur.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Skin, clammy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anxiety.An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias.Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock.Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion.In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute).Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock.With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock.The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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