Diaphoresis
Diaphoresis is profuse sweating—at times, amounting to more than 1 L of sweat per hour. This sign represents an autonomic nervous system response to physical or psychogenic stress or to a fever or high environmental temperature. When caused by stress, diaphoresis may be generalized or limited to the palms, soles, and forehead. When caused by a fever or high environmental temperature, it's usually generalized.
Diaphoresis usually begins abruptly and may be accompanied by other autonomic system signs, such as tachycardia and increased blood pressure. (See When diaphoresis spells crisis, page 188.)
However, this sign also varies with age because sweat glands function immaturely in infants and are less active in elderly patients. As a result, patients in these age-groups may fail to display diaphoresis associated with its common causes. Intermittent diaphoresis may accompany chronic disorders characterized by a recurrent fever; isolated diaphoresis may mark an episode of acute pain or fever. Night sweats may characterize intermittent fever because body temperature tends to return to normal between 2 a.m. and 4 a.m. before rising again. (Temperature is usually lowest around 6 a.m.)
When caused by a high external temperature, diaphoresis is a normal response. Acclimatization usually requires several days of exposure to high temperatures; during this process, diaphoresis helps maintain normal body temperature. Diaphoresis also commonly occurs during menopause, preceded by a sensation of intense heat (a hot flash). Other causes include exercise or exertion that accelerates metabolism, creating internal heat, and mild to moderate anxiety that helps initiate the fight-or-flight response. (See Understanding diaphoresis, pages 190 and 191.)
History and physical examination
If the patient is diaphoretic, quickly rule out the possibility of a life-threatening cause. Begin the history by having the patient describe his chief complaint. Then explore associated signs and symptoms. Note general fatigue and weakness. Does the patient have insomnia, headache, and changes in vision or hearing? Is he often dizzy? Does he have palpitations? Ask about chest pain, a cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered bowel or bladder habits. Ask the female patient about amenorrhea and any changes in her menstrual cycle. Is she perimenopausal or menopausal? Ask about paresthesia, muscle cramps or stiffness, and joint pain. Has she noticed any changes in elimination habits? Note weight loss or gain. Has the patient had to change her glove or shoe size lately?
Complete the history by asking about travel to tropical countries. Note recent exposure to high environmental temperatures or pesticides. Did the patient recently experience an insect bite? Check for a history of partial gastrectomy or of drug or alcohol abuse. Finally, obtain a thorough drug history.
Next, perform a physical examination. First, determine the extent of diaphoresis by inspecting the trunk and extremities as well as the palms, soles, and forehead. Also, check the patient's clothing and bedding for dampness. Note whether diaphoresis occurs during the day or at night. Observe the patient for flushing, abnormal skin texture or lesions, and an increased amount of coarse body hair. Note poor skin turgor and dry mucous membranes. Check for splinter hemorrhages and Plummer's nails (separation of the fingernail ends from the nail beds).
Evaluate the patient's mental status and take his vital signs. Observe him for fasciculations and flaccid paralysis. Be alert for seizures. Note the patient's facial expression, and examine the eyes for pupillary dilation or constriction, exophthalmos, and excessive tearing. Test visual fields. Also, check for hearing loss and for tooth or gum disease. Percuss the lungs for dullness, and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus. Look for decreased respiratory excursion. Palpate for lymphadenopathy and hepatosplenomegaly.
Medical causes
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.
Nursing considerations
▪ After an episode of diaphoresis, sponge the patient's face and body and change wet clothes and sheets.
▪ To prevent skin irritation, dust skin folds in the groin and axillae and under pendulous breasts with cornstarch, or tuck gauze or cloth into the folds.
▪ Replace fluids and electrolytes.
▪ Monitor fluid intake and urine output.
▪ Keep the patient's room temperature moderate to prevent additional diaphoresis.
▪ Prepare thepatient for diagnostic tests, such as blood tests, cultures, chest X-rays, immunologic studies, biopsy, a computed tomography scan, and audiometry.
▪ Monitor the patient's vital signs, including temperature.
Patient teaching
▪ Explain proper skin care and the importance of good hygiene.
▪ Discuss the importance of fluid replacement and encourage oral fluids high in electrolytes such as sports drinks.
▪ Explain the underlying disease process and its treatments.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Sweat symptoms
Read excerpts from these other book chapters related to Sweat symptoms:
Medical Books Excerpts
- Anhidrosis
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Anhidrosis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Diaphoresis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, clammy
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Night Sweats
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Anhidrosis
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Anhidrosis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Diaphoresis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Sweating
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Sweat symptoms
» Next page:
Skin, clammy (Nursing: Interpreting Signs and Symptoms)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
