STUDY - Technical - New Dacian's Medicine
Diaphoresis
(Classical / Allopathic Medicine)
Diaphoresis is
profuse sweating - at times amounting to more than 1 qt (1 L)
of sweat per hour. This sign represents an autonomic nervous
system response to physical or psychogenic stress or to fever
or high environmental temperature. When caused by stress,
diaphoresis may be generalized or limited to the palms of the
hands, soles of the feet, and forehead. When caused by 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. Intermittent diaphoresis may accompany a
chronic disorder characterized by 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.)
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 and creates internal heat
and mild to moderate anxiety that helps initiate the
fight-or-flight response.
ALERT:
If the patient is diaphoretic:
- quickly take his vital signs
- assess him for chest pain or palpitations
- determine his blood glucose level if he complains of light-headedness or weakness or has a change in his level of consciousness.
If the patient isn't diaphoretic, perform a focused assessment.
If the patient is diaphoretic:
- quickly take his vital signs
- assess him for chest pain or palpitations
- determine his blood glucose level if he complains of light-headedness or weakness or has a change in his level of consciousness.
If the patient isn't diaphoretic, perform a focused assessment.
HISTORY:
Ask the patient to explain his chief complaint, then explore associated signs and symptoms. Ask whether diaphoresis occurs during the day or at night.
Note general fatigue and weakness. Ask the patient if has insomnia, headache, or changes in vision or hearing. Is he often dizzy?
Ask the patient if he experiences palpitations.
Ask the patient about pleuritic pain, cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered bowel or bladder habits.
If the patient is a female, ask her about amenorrhea and changes in her menstrual cycle. Is she menopausal?
Ask the patient about paresthesia, muscle cramps or stiffness, and joint pain.
Ask the patient about recent weight loss or gain.
Ask the patient if he has recently traveled to a tropical country, had recent exposure to high environmental temperatures or to pesticides, or experienced an insect bite.
Review the patient's medical history for partial gastrectomy.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient to explain his chief complaint, then explore associated signs and symptoms. Ask whether diaphoresis occurs during the day or at night.
Note general fatigue and weakness. Ask the patient if has insomnia, headache, or changes in vision or hearing. Is he often dizzy?
Ask the patient if he experiences palpitations.
Ask the patient about pleuritic pain, cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered bowel or bladder habits.
If the patient is a female, ask her about amenorrhea and changes in her menstrual cycle. Is she menopausal?
Ask the patient about paresthesia, muscle cramps or stiffness, and joint pain.
Ask the patient about recent weight loss or gain.
Ask the patient if he has recently traveled to a tropical country, had recent exposure to high environmental temperatures or to pesticides, or experienced an insect bite.
Review the patient's medical history for partial gastrectomy.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
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 for dampness.
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.
Evaluate the patient's mental status.
Take the patient's vital signs.
Observe the patient 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.
Check for hearing loss.
Check for tooth and gum disease.
Percuss the lungs for dullness and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus.
Palpate for lymphadenopathy and hepatosplenomegaly.
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 for dampness.
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.
Evaluate the patient's mental status.
Take the patient's vital signs.
Observe the patient 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.
Check for hearing loss.
Check for tooth and gum disease.
Percuss the lungs for dullness and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus.
Palpate for lymphadenopathy and hepatosplenomegaly.
SPECIAL
CONSIDERATIONS:
The patient experiencing profuse diaphoresis will require fluid and electrolyte replacement, especially for children. Encourage oral fluids high in electrolytes or administer I.V. fluids.
The patient experiencing profuse diaphoresis will require fluid and electrolyte replacement, especially for children. Encourage oral fluids high in electrolytes or administer I.V. fluids.
PEDIATRIC
POINTERS:
Diaphoresis in children commonly results from environmental heat or overdressing the child; 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.
Diaphoresis in children commonly results from environmental heat or overdressing the child; 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.
AGING ISSUES:
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.
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.
PATIENT
COUNSELING:
Explain to the patient and his family that diaphoresis signals a return to normal body temperature after it has risen for any reason. It can also occur spontaneously, after taking an antipyretic, or as a sympathetic response to pain or stress.
Explain to the patient and his family that diaphoresis signals a return to normal body temperature after it has risen for any reason. It can also occur spontaneously, after taking an antipyretic, or as a sympathetic response to pain or stress.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)