Sweating
The clinical dilemma with excessive sweatingis to determine whether it is due to a physiologic or pathologiccause.
Principal Causes of Sweating
- Physiologiccauses
- Highenvironmental temperature
- Exercise
- Overdressing
- Severe pain
- Anxiety
- Pathologic causes
- Cardiacfailure
- Infection
- Hypoglycemia
- Thyrotoxicosis
- Pheochromocytoma
- Familial dysautonomia
- Drugs and toxins
Clinical Features and Diagnosis
Physiologic Causes
Physiologic causes of sweating (e.g., highenvironmental temperature, exercise, overdressing, severe pain,and anxiety) are most common, and history and physical exam arediagnostic.
Pathologic Causes
Cardiac Failure
Stimulation of sympathetic cholinergic fibersproduces sweating, which may be prominent around head and nape ofneck in infants with cardiac failure (see Chap. 7, Cardiac Failure).
Infection
In individuals with infections who have fever,increased sweating may occur, especially when body temperature decreasestoward normal.
Hypoglycemia
Hypoglycemia triggers increased adrenergicstimulation, which produces sweating and tachycardia. Low bloodglucose confirms presence of hypoglycemia. See Chap. 59, Seizures.
Thyrotoxicosis
Most commoncause of thyrotoxicosis in pediatric population is diffuse thyroidhyperplasia (Graves disease).Clinical manifestations include tachycardia,sweating, tremor, nervousness, emotional lability, poor school performance,heat intolerance, increased appetite, systolic hypertension, weightloss, enlarged thyroid gland, exophthalmos, and lid lag.Elevated serum or free thyroxine andlow thyroid-stimulating hormone (TSH) levels signify hyperthyroidism.Measurement of TSH receptor stimulatingantibodies helps confirm diagnosis of Graves disease. Pheochromocytoma
Neural cresttumor that produces excessive amounts of catecholamines. May arise fromadrenal medulla or sympathetic ganglia.Systolic BP may be as high as 250 mmHg with corresponding increase in diastolic pressure.Characteristic features include headache,palpitations, nausea, vomiting, abdominal pain, profuse sweating,and visual disturbances. Paroxysmal attacks may occur several times/dayor less frequently.See Chap.32, Hypertension. Familial Dysautonomia
Autosomal-recessive disorder characterizedby lack of tearing, increased sweating, episodic vomiting, emotionallability, paroxysmal hypertension, corneal anesthesia, blotchingof skin, and absence of fungiform papillae on the tongue. See Chap. 65, Sucking and Swallowing Difficulty.
Drugs and Toxins
Acute andchronic salicylate ingestion may present with fever, vomiting, hyperpnea, sweating,seizures, and alteration in consciousness.History and physical exam often arediagnostic. Elevated serum salicylate level confirms diagnosis.Organophosphate poisoning inactivatesacetylcholinesterase, and excess acetylcholine accumulates at cholinergicnerve endings.Clinicalmanifestations include sweating, headache, blurred vision, dizziness,confusion, rhinorrhea, lacrimation, profuse salivation, abdominalcramps, diarrhea, excessive bronchial secretions, wheezing, seizures,miosis, areflexia, bradycardia, hypertension, and coma.Therapeutic trial of atropine leadsto disappearance of miosis, relief of wheezing, acceleration ofheart rate, and decrease in salivation.History, physical findings, low redcell concentration of cholinesterase, and therapeutic improvementwith atropine confirm diagnosis. Maternal use of heroin or methadonecan cause neonatal drug withdrawal syndrome.Onset is during first week of lifewith usual resolution at 1–3 wks of age.Clinical features include poor feeding,irritability, high-pitched cry, sweating, fever, insomnia, vomiting,diarrhea, apnea, tachypnea, sneezing, excessive tearing, and seizures.History and physical exam are usuallydiagnostic. Qualitative drug analysis may be performed on maternalurine, infant urine, or meconium samples. Diagnostic Approach
Historyand physical exam are often diagnostic when excessive sweating isthe presenting complaint. In many cases, physiologic causes areimplicated.With suspected hypoglycemia, bloodglucose concentration should be determined.Although fever suggests infection,it also can occur with salicylate poisoning and neonatal drug withdrawalsyndrome.Hypertension may occur with thyrotoxicosis,pheochromocytoma, and familial dysautonomia. References
- Behrman RE, et al., eds. Nelson textbookof pediatrics, 16th ed. Philadelphia: WB Saunders, 2000.
- Illingworth RS. Common symptoms of disease in children,7th ed. Oxford: Blackwell Scientific, 1982.
- Online Mendelian Inheritance in Man (OMIM). McKusick-NathansInstitute for Genetic Medicine, Johns Hopkins University (Baltimore,MD) and National Center for Biotechnology Information, NationalLibrary of Medicine (Bethesda, MD), 2001. World Wide Web URL: http://www.ncbi.nlm.nih.gov/omim.
- Ostrea EM Jr, et al. The infant of the drug-dependentmother. In: Avery GB, et al., eds. Neonatology: pathophysiologyand management of the newborn, 5th ed. Lippincott Williams & Wilkins, 1999:1407–1445.
- Rowe MI, et al. Essentials of pediatric surgery. St.Louis: Mosby-Year Book, 1995.
- Rudolph AM, ed. Rudolph's pediatrics, 20thed. Stamford, CT: Appleton & Lange, 1996.
- Tunnessen WW Jr. Signs and symptoms in pediatrics,3rd ed. Baltimore: Lippincott Williams & Wilkins, 1999.
Book Source Details
- Book Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
- Author(s): Paul S. Bellet
- Year of Publication: 2006
- Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2008 Williams & Wilkins.
More About Causes of Sweating
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