This sign represents a response of the autonomic
nervous system to physical or psychological stress, or to fever or a high
environmental temperature. The sweat glands are auxiliary organs spread over all
human skin; in other species they are localized only in some organs, as for
example in the dog where they are located only on the pads of the legs. Most are
with eccrine / exocrine secretion. Locally there are large apocrine glands that
in adults also secrete odorous molecules (Moll glands: axilla, circumanal,
circumgenital, nipples, auditory meatus). The man has about 3 million sweat
glands scattered on the skin surface: the maximum concentration is reached on
the soles of the feet, on the palms of the hands, in the armpits and around the
body openings of the face and genitals. The sweat is composed of water, mineral
salts and acidic catabulets that are waste substances.
Sweating has the following functions:
-on the individual "genetic equipment" (invariable base)
-on the sexual hormonal status (e.g. age and cyclical hormonal variations)
-on momentary emotions (eg anxiety, anger, ...).
It is a characteristic of our civilization to "cover" these natural signs (more
or less conscious) with strongly odorant substances in the form of detergents,
shampoos, soaps, perfumes and other cosmetic products and / or to suppress them
with deodorants.
Adult sweating ranges from 0.5 liters per day up to a maximum of 10 liters
depending on physical work and environmental conditions.
The nerve centers for the control of sweating are found:
- in the anterior hypothalamus
- in the medulla oblongata
- in the mediolateral neuronal columns of the spinal cord
When sweating is caused by stress, it can be generalized or restricted to the palms, to the soles of the feet and to the forehead. When caused by fever or a high ambient temperature, it is usually a generalized sweating. The diaphoresis usually begins suddenly and may be accompanied by other signs of relevance of the autonomic nervous system, such as tachycardia and increased blood pressure. However, this sign also varies with age because sweat glands function immature in children and are less active in the elderly. As a result, these age groups may not show sweating associated with its frequent causes. Intermittent diaphoresis can accompany chronic diseases characterized by recurrent fever: an isolated sweating can mark an episode of acute pain or fever. Night sweats may characterize intermittent fever as body temperature tends to return to normal between 2 and 4 am, before increasing again. The temperature is usually lower at around 6 in the morning. When it is caused by the high outside temperature, sweating is a normal bodily response. Acclimatization usually requires several days of exposure to high temperatures; during this process, sweating helps maintain normal body temperature. Diaphoresis usually occurs during menopause, preceded by a sensation of intense heat (a hot flash). Other causes include:-
- Physical activity or an effort that accelerates the metabolism, creating
internal heat production
- mild to moderate anxiety that helps start the attack or escape response
The anamnesis must be initiated by having the patient describe his main
symptomatology. Then investigate associated signs and symptoms. Observe overall
anxiety and weakness. Does the patient report insomnia, headache and changes in
the visus or hearing? Do you often suffer from vertigo? Does it have
palpitations? Check for pleural pain, cough, sputum, dyspnoea, nausea, vomiting,
abdominal pain and changes in intestinal or voiding habits. Is the patient
examined a woman in menopause? Is there amenorrhea? It presents variation of its
menstrual cycle. The patient has paresthesia, cramps, muscle stiffness and joint
pain. Have you noticed any changes in urination or defecation? Did you lose
weight?
Has the patient changed the size of the gloves or shoes lately? In this case we
think of a pituitary adenoma (gigantism).
Complete the anamnesis asking if you have made trips to tropical countries.
Evaluate a recent exposure to high environmental temperature or pesticides. The
patient has recently been affected by an insect. To obtain a medical history of
a partial gastrectomy or abuse of drugs or alcohol. Finally. obtain an accurate
pharmacological medical history. Then you go to the physical exam. First,
however, it is necessary to determine the extent of sweating by observing the
trunk and the extremities, as well as the palm, the plants and the forehead.
Also check the patient's clothing and if the bed is wet. Evaluate whether
sweating occurs during the day or at night. Exclude redness (erythema),
alterations or lesions of the skin tissue and an increase in gross body hair.
Note the poor turgidity of the skin and the dryness of the mucous membranes. To
counteract the presence of sub-nail bleedings and Plummer's nails (separation of
the nail ends from the nail Ietti). Then evaluate the patient's mental state and
monitor the vital signs. Look for the presence of fasciculations and flaccid
paralysis. Pay attention to the possibility of convulsions. Note the patient's
facial expression and examine the eyes to check whether mydriasis or miosis is
present or excessive tearing. Examining the visual field and hearing, and
verifying the presence of dental or gingival pathologies. Perform the percussion
of the chest in search of dullness and auscultate the lungs to detect crackles,
diminished or bronchial respiratory sounds and an increase in tactile vocal
tremor. Search for a reduction in chest expansion. Perform a palpation in search
of lymphadenopathy and hepatosplenomegaly.
-Shock from heat. Although this condition is characterized by an insufficient heat loss, initially it can cause a profuse diaphoresis, asthenia, weakness and anxiety. These symptoms may progress to circulatory collapse and shock (confusion, filiform pulse, hypotension, tachycardia and cold and marbled skin). Other features are a waxy appearance, mydriasis and a temperature compared to the norms or slightly lower.
-lpoglicemia. Rapid onset hypoglycemia can cause sweating accompanied by irritability, tremors, hypotension, blurred vision, tachycardia, sense of hunger and loss of consciousness.
-Stress and anxiety. The patient, usually shy and depressed, sweats under stressful conditions and can present shiny, greasy and sweaty skin on the forehead and an exanthematous eruption called "acne rosacea" on the face.
- Heart failure (see also epa). Generally, diaphoresis follows abstinence, dyspnoea, jeopnea and tachycardia in left heart failure, distension of the neck veins and dry cough in right heart failure. Other aspects include tachypnoea, cyanosis, declining edema, crackles, ventricular gallop and anxiety.
-Tireotossicosi. This pathology generally causes sweating accompanied by heat intolerance, despite increased appetite, tachycardia, palpitations, enlarged thyroid, dyspnoea, irritability, diarrhea, tremors, Plummer's nails and sometimes exophthalmos. Gallop rhythms can also appear.
-Empiema, lung abscess and pneumonia. The accumulation of pus in the pleural cavity or an abscess of the lung cause considerable night sweats and fever. The patient also complains of chest pain, cough, with purulent sputum and weight loss. The physical examination shows a reduced thoracic expansion of the affected side.
- Hodgkin's disease. In the elderly, the first signs of Hodgkin's disease may include night sweats, fever, and asthenia. pruritus and weight loss. Often, however. this disease initially causes a painless swelling of a cervical lymph node. Sometimes, there is a model of Pel-Ebstein fever, several days or weeks of fever and chills that alternate with periods of apathyxia without chills.
-Systemic symptoms, such as weight loss, fever and night sweats indicate a negative prognosis. The ingrevescent lymphadenopathy, in the end, causes very important effects such as hepatomegaly and dyspnoea.
- Drug and alcohol withdrawal symptoms, Alcohol abstinence and narcotic analgesics can cause generalized sweating, pupillary dilatation, tachycardia, tremors and changes in mental status (confusion, delusions, hallucinations, agitation). Signs and associated symptoms may include severe muscle cramps, generalized paraesthesia, tachypnea. increased or decreased pressure, and sometimes, convulsions. Nausea and vomiting are common.
-Lymphoblastic lymphadenopathy. Similar to Hodgkin's disease but more rare, this pathology causes episodic sweats, along with fever, weight loss, weakness, generalized lymphadenopathy, rash and hepatosplenomegaly.
- Infectious endocarditis (sub acute). Generalized noctuma sweating occurs early in this condition. The accompanying signs and symptoms include intermittent febrile, weakness, asthenia, weight loss, anorexia and arthralgias. The sudden change in the characteristics of a cardiac tone or the finding of a new noise is a classic sign. Petechiae and subungual hemorrhages are also common.
- Liver abscess. Signs and symptoms vary depending on the extent of the abscess, but commonly include sweating, pain in the upper right quadrant, weight loss, fever, chills, nausea, vomiting and signs of anemia.
-Acquired immunodeficiency syndrome. It is characterized by nocturnal sweats; the patient has fever serotina, asthenia, lymphadenopathy as an early characteristic, and the manifestation of the disease itself or secondarily to an opportunistic infection. The patient also has anorexia, dramatic and unexplained weight loss, diarrhea and a persistent cough.
-Acromegalia. In this slow-moving pathology, sweating is a sensitive measure of the activity of the disease, which includes a hypersecretion of growth hormone and an increase in basal metabolic rate. The patient has an imposing and awkward appearance with enlargement of the supraorbital ridge and enlargement of the ears and nose. Other signs and symptoms include hot, oily skin. thickened, hands, feet and jaw wider, joint pain, increase in thinking, redness on the forehead and is accompanied by redness. Other findings may include agitation, nausea, nasal congestion and bradycardia.
- Poisoning. Depending on the type of toxin, the neurotoxic effects may include sweating, chills (with or without fever), asthenia, dizziness, blurred vision, sialorrhea, nausea and vomiting and also muscle paresthesias and fasciculations.
- Malaria. A profuse diaphoresis marks the third stage of paroxysmal malaria the first two stages consist of 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 can progress up to delirium, convulsions and coma.
- Ménière's disease. This alteration, characterized by severe vertigo, tinnitus and hypoacusis, can also cause sweating, nausea, vomiting and nystagmus. Hearing loss can be progressive and tinnitus can persist between attacks.
-Feocromocitoma. This pathology usually causes diaphoresis, but its cardinal sign is a persistent paroxysmal hypertension. Other manifestations of pheochromociloma include headache, palpitations, tachycardia, anxiety, tremors, pallor, redness, paresthesias, abdominal pain, tachypnea, nausea, vomiting and orthostatic hypotension.- Autonomic hyperreflexia. If sweating is observed in a patient with spinal cord injury above T6 or T7, ask if he / she accuses pulsating headache, agitation, blurred vision and nasal congestion. Check the patient's parameters, paying attention to bradycardia and extremely high blood pressure. If autonomic hyperreflexia is suspected, the most frequent complications should be ruled out quickly. Search for the presence of ocular pain associated with possible intraocular hemorrhage and facial paralysis, awkward speech or weakness of the limbs that could reveal intracerebral hemorrhage. Reposition the patient quickly to avoid any pressure stimulation. Also, check if the bladder is lying or if there are signs of intestinal obstruction.
-Tuberculosis. Although it is often asymptomatic in primary infection, this
pathology can cause night sweats, fever, asthenia, weakness, anorexia and weight
loss. During the inactivation, there may be a productive cough with mucopurulent
sputum, occasionally hemoptysis and chest pain.
Other causes
-Farrnaci. Sympathomimetic drugs, some antipsychotics, thyroid hormone and
antipyretics may cause sweating. Even acetylsalicylic acid poisoning and
acetaminophen can cause this sign.
-Dumping syndrome. Result of rapid emptying of the gastric contents in the small
intestine after a partial gastrectomy, due to sweating, palpitation, profound
weakness, sense of epigastric discomfort, nausea and significant diarrhea. This
syndrome occurs immediately after food intake.
- Pesticide poisoning. Among the toxic effects of pesticides are sweating,
nausea, vomiting, diarrhea, fading of sight, miosis and excessive tearing and
salivation.
index of the patient's visit