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. (SeeWhen diaphoresis spells crisis .) 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 198 and 199.)

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 pleuritic 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 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? patient 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.

Pediatric pointers

Diaphoresis in children commonly results from environmental heat or overdressing; it's usually most apparent around the head. Other causes include drug withdrawal associated with maternal addiction, heart failure, thyrotoxicosis, and the effects of such drugs as antihistamines, ephedrine, haloperidol, and thyroid hormone.

Assess the child's fluid status carefully. Some fluid loss through diaphoresis may precipitate hypovolemia more rapidly in a child than in an adult. Monitor input and output, weigh the child daily, and note the duration of each episode of diaphoresis.

Geriatric pointers

Fever and night sweats, the hallmark of TB, may not occur in elderly patients, who instead may exhibit a change in activity or weight. Also, keep in mind that older patients may not exhibit diaphoresis because of a decreased sweating mechanism. For this reason, they're at increased risk for developing heatstroke in high temperatures.

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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.

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• Back to symptom: Sweating: Introduction (review 746 causes)
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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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