CLINICAL

CLUE
WHAT ARE THE ENDOCRINE CAUSES OF
SWEATING?
Endocrine causes of sweating include thyrotoxicosis,
pheochromocytoma, diabetes
mellitus, acromegaly, and menopause.
WHAT ARE THE NON – INFECTIUOS CAUSES
OF SWEATING?
Non-infective causes of sweating include alcohol
misuse, anxiety, lymphoma, excessive
heating of the environment, and endocrine causes.
GIVE US EXAMPLES OF DRUGS THAT CAN
CAUSE FEVER
Drugs that cause fever include penicillins,
cephalosporins, antituberculous,
anticonvulsants (particularly phenytoin), and
methyldopa.
PRESENTATION: FEVER
1. Is the fever subjectively felt by the patient or it is
genuine measured by a thermometer?
2. What is the mode of onset e.g. sudden or gradual?
3. What is the character of the fever e.g. continuous,
intermittent, or remittent?
4. What are the relieving factors e.g. cool sponging or
medications?
5. What are the associated symptoms e.g. sweating,
chills, or rigor? If there is sweating determine the time
of
occurrence (day or night time) and its nature whether
profuse (drenching) or slight. Chills mean just bed
shaking
and are encountered in most febrile illnesses.
However, a teeth-chattering, bed-shaking chill
indicative of a true
rigor is usually associated with bacteremia,
pyelonephritis, abscess and biliary tract infection.
Malaise, headache,
and pain in the muscles and joints often accompany
fever.
6. What is the timing of fever e.g. duration and
course? Duration means the time since fever first
noticed and the
course means the progression of fever whether it
started low grade then built up to be high grade or the
fever was
of low grade from the start.
7. What are the exacerbating and precipitating factors
e.g. drugs or heat whether?
8. What is the severity of fever e.g. high, moderate or
low grade? High grade fever made the patient unable
to
perform any activity, interfered with sleeping and
eating and the patients are usually kept in bed.
DEFINITIONS USED TO DESCRIBE THE
CONDITION OF SEPTIC PATIENTS
Bacteremia means the presence of bacteria in blood, as
evidenced by positive blood cultures. Septicemia
means the presence of microbes or their toxins in
blood. Systemic inflammatory response syndrome
(SIRS)
means the presence of two or more of the following
conditions:
1. Fever (oral temperature >38°C) or hypothermia
(<35°C).
2. Tachypnea (>24 breaths/min).
3. Tachycardia (heart rate >90 beats/min).
4. Leukocytosis (>12,000/μL), leukopenia (<4,000/μL),
or >10% bands.
Sepsis means SIRS that has a proven or suspected
microbial etiology. Septic shock means sepsis with
hypotension (systolic blood pressure <90 mmHg, or 40
mmHg less than patient's normal blood pressure) for
at
least 1 h of adequate fluid resuscitation or need for
vasopressors to maintain systolic blood pressure ≥90
mmHg. Refractory septic shock means septic shock
that lasts for >1 h and does not respond to fluid or
pressor
administration. Multiple-organ dysfunction syndrome
means dysfunction of more than one organ, requiring
intervention to maintain homeostasis.
The condition started as a gradual development of low
grade fever for three days that sooner built up
to be high grade made the patient unable to perform
daily activities and kept him in bed, experienced
mainly at night with periods of shivering. At the early
hours of morning time, the patient
experienced profuse sweating. No medications had
been used by the patient as she felt better at day
time, but at night time cool sponging had been applied
to the face and the limbs which some what
helped to improve the condition for certain time. This
condition was associated with back pain that…
WHAT ARE THE ENDOCRINE CAUSES OF
SWEATING?
Endocrine causes of sweating include thyrotoxicosis,
pheochromocytoma, diabetes
mellitus, acromegaly, and menopause.
WHAT ARE THE NON – INFECTIUOS CAUSES
OF SWEATING?
Non-infective causes of sweating include alcohol
misuse, anxiety, lymphoma, excessive
heating of the environment, and endocrine causes.
GIVE US EXAMPLES OF DRUGS THAT CAN
CAUSE FEVER
Drugs that cause fever include penicillins,
cephalosporins, antituberculous,
anticonvulsants (particularly phenytoin), and
methyldopa
HYPERTHERMIA
Although most patients with elevated body
temperature have fever, there are circumstances in
which elevated
temperature represents not fever but hyperthermia
(BOX 1 – 13).
BOX 1 – 13. Distinctions between fever and
hyperthermia
FEVER HYPERTHER
Associated with raised thermostatic set point Not associated
 thermostatic se
Responds to antipyretics Not responds t
Associated with sweating and the skin can be Not associated
cold and the skin is
Respond to da
Dantrolene is not indicated
(according to t
Hyperthermia is characterized by an uncontrolled
increase in body temperature that exceeds the body's
ability to lose
heat and the setting of the hypothalamic
thermoregulatory center is unchanged. Some causes of
hyperthermia are
shown in BOX 1 – 14
BOX 1 – 14. Some causes of hyperthermia
MECHANISM EXAMPLES
Exercise in hig
Heat stroke
and/or humidi
Drug Salicylates, lith
Phenothiazines
Neuroleptic malignant syndrome
domperidone,
Malignant hyperthermia Inhalational an
Endocrinopathy Thyrotoxicosis
Cerebral hemo
CNS damage
hypothalamic i