Skin, clammy
Clammy skin — moist, cool, and usually pale — is a sympathetic response to stress, which triggers release of the hormones epinephrine and norepinephrine. These hormones cause cutaneous vasoconstriction and secretion of cold sweat from eccrine glands, particularly on the palms, forehead, and soles.
Clammy skin typically accompanies shock, acute hypoglycemia, anxiety reactions, arrhythmias, and heat exhaustion. It also occurs as a vasovagal reaction to severe pain associated with nausea, anorexia, epigastric distress, hyperpnea, tachypnea, weakness, confusion, tachycardia, and pupillary dilation or a combination of these findings. Marked bradycardia and syncope may follow.
History and physical examination
If you detect clammy skin, remember that rapid evaluation and intervention are paramount. (See Clammy skin: A key finding, page 564.) Ask the patient if he has a history of type 1 diabetes mellitus or a cardiac disorder. Is he taking medications, especially an antiarrhythmic? Is he experiencing pain, chest pressure, nausea, or epigastric distress? Does he feel weak? Does he have a dry mouth? Does he have diarrhea or increased urination?
Next, examine the pupils for dilation. Also, check for abdominal distention and increased muscle tension.
Medical causes
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.
Special considerations
Take the patient’s vital signs frequently, and monitor urine output. If clammy skin occurs with an anxiety reaction or pain, offer the patient emotional support, administer pain medication, and provide a quiet environment.
Pediatric pointers
Infants in shock don’t have clammy skin because of their immature sweat glands.
Geriatric pointers
Elderly patients develop clammy skin easily because of decreased tissue perfusion. Always consider bowel ischemia in the differential diagnosis of older patients who present with cool, clammy skin — especially if abdominal pain or bloody stools occur.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Numbness
» Next page: Paresthesias (A Pocket Manual of Differential Diagnosis)
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