Natural Excessive Sweating Treatment Systems
The first dermatological application of iontophoresis was to treat hyperhidrosis (32). Hyperhidrosis is a condition characterized by pathologically excessive sweating due to abnormal secretion of the eccrine sweat glands in various parts of the body primarily the palms, soles and axillae (33-35) . Iontophoresis of tap water has been very effective ( 90 of patients) in inhibiting palmar and plantar hyperhidrosis, but the results are less rewarding for axillary hyperhidrosis (33,35).
Stimulation of the anterior hypothalamus, especially the preoptic area, causes sweating.2 The firing rate of these neurons may increase as much as tenfold from a 10 C increase in temperature. The signal from the hypothalamus travels through the autonomic pathways in the spinal cord and to the sympathetic outflow to the skin. Sweat glands are innervated by sympathetic cholinergic nerve fibers but can also be directly stimulated by circulating epinephrine or norepinephrine. Sweat glands of the hands and feet also have adrenergic innervation explaining why these areas preferentially sweat during times of stress or emotional states.
These include the use of a range of surface sensors to measure changes in, for example, electrical conductivity (as in measuring changes in sweating), in light transmission (as in measuring changes in finger blood flow), and in volume (as in penile plethysmography). When these physical changes are found to have a close relationship with an underlying change in physiological arousal, they may then be taken as a proxy measure, which may be valuable for both the initial assessment and for monitoring therapeutic change. A major practical limitation of a number of these measures is that external environmental factors, such as changes in air temperature or humidity, may affect the reliability of the measure.
Information concerning the interaction of aluminum with skin has emerged primarily from investigations addressing the antiperspirant and deodorant (bacterio-static) effect of its water-soluble salts. Like several other metal salts, those of aluminum have protein precipitating and astringent properties. Relative to other, similar metals, the inorganic salts of aluminum were found to be the most effective in suppressing eccrine sweating therefore, they have the longest history of use and form the basis of all commercial antiperspirants.
When alcohol is completely withdrawn or substantially reduced a characteristic withdrawal syndrome can develop. It includes autonomic hyperactivity like hand tremor, insomnia, sweating, tachycardia, hypertension, and anxiety. The symptoms generally occur between 6 and 12 h after the last alcohol consumption. Depending on their severity they may last for up to 4 or 5 days. The neurobiological basis for withdrawal is a gradual upregulation of W-methyl-D-aspartate receptors under the influence of chronic alcohol use. As soon as the alcohol, which acts as a central nervous system depressant, is withdrawn, we observe an overwhelming excitatory action on the brain mediated by the glutamatergic system.
Sympathetic fibres descend from the ipsilateral hypothalamus through the lateral aspect of the brain stem into the spinal cord. The pupillary fibres pass out in the anterior roots of C8 and Tl, enter the sympathetic chain and, in the superior cervical ganglion, give rise to postganglionic fibres which ascend on the wall of the internal carotid artery to enter the cranium. The fibres eventually leave the intracranial portion of the internal carotid artery and pass directly through the ciliary ganglion to the iris or join the cranial nerves III, IV, V and VI, running to the eye and iris. Sudomotor fibres (concerned with sweating) run up the external carotid artery to the dermis of the face. 3. Vasoconstrictor fibres to orbit, eyelid and face causes absence of sweating. Interruption of parasympathetic supply affects'.
Pyridostigmine is probably the anticholinesterase of choice in the majority of patients with myasthenia gravis. The half-life of the drug is reasonably long (90 min) but it does not accumulate easily. It can be given orally as a tablet or elixir and has relatively mild cholinergic side-effects. It is frequently used to improve muscle strength, but only produces symptomatic improvement and does not correct the basic pathophysiological problem. If given in too large a dosage, anticholinesterase drugs produce cholinergic neuromuscular blockade and increase muscle weakness. In the longer term, these drugs can damage the neuromuscular junction itself. Anticholinesterase drugs can produce cholinergic side-effects such as excessive salivation, abdominal cramps and diarrhea, sweating, and bradycardia. An average dose of pyridostigmine would be 30 to 60 mg four or five times daily.
Associated with the anxiety and worry, individuals with GAD have a variety of cognitive and somatic symptoms, including trembling, feeling shaky, aching in the back and shoulders, tension headaches, chest tightness, restlessness, exaggerated startle, irritability, insomnia, fatigue, dry mouth, sweating, urinary frequency, trouble swallowing, nausea, and diarrhoea. In addition, GAD may be accompanied by other conditions typically associated with stress, such as irritable bowel syndrome or atypical chest pain.
These antipsychotic drugs are well recognised as having unpleasant extrapyramidal side effects. The most dangerous of these, but fortunately the least frequent, is the neuroleptic malignant syndrome in which extrapyramidal rigidity and akathisia develop abruptly or within a few days.55 Pyrexia is always present, together with autonomic disturbances including profuse sweating, increased salivation, hyperventilation, tachycardia, and labile blood pressure. Laboratory investigations show a leucocytosis and a raised creatinine kinase. The incidence of the condition is not known but is probably well under 1 of cases treated with antipsychotics if strict diagnostic criteria are applied. Antipsychotics should be stopped immediately once the condition is diagnosed. Rapid improvement is seen if a dopamine agonist such as bromocriptine is administered, and the mortality rate has been considerably reduced by this treatment. The newer atypical antipsychotics should be used in the treatment of...
Due to stimulation of the respiratory center, causing hyperventilation which leads to a respiratory alkalosis. Later, a raised anion gap metabolic acidosis supervenes due to increased lactate levels, stimulation of lipid metabolism with ketone body production, and inhibition of aminotransferase. The body compensates by excreting bicarbonate, sodium and potassium ions, and water, reducing the body's buffering capacity, and resulting in an anion gap metabolic acidosis which enhances transfer of the salicylate ion across the blood-brain barrier. Salicylates also uncouple oxidative phosphorylation, decreasing ATP production, increasing oxygen utilization and carbon dioxide and lactate production, and contributing to the metabolic acidosis. The energy which should be used to produce ATP is diverted to mitochondrial heat production, leading to compensatory sweating and flushing, with the body temperature usually remaining normal in adults although pyrexia may occur in children. Vomiting,...
P-Adrenoceptor antagonists, such as propranolol (Inderal), have been widely used in the treatment of cardiovascular diseases (see Chapters 16 and 20). These p-blockers also are useful in some forms of anxiety, particularly those that are characterized by somatic symptoms or by performance anxiety (stage fright). There is general agreement that p-blockers can lessen the severity and perhaps prevent the appearance of many of the autonomic responses associated with anxiety. These symptoms include tremors, sweating, tachycardia, and palpitations.
Cluster headache and chronic paroxysmal hemicrania are most often related to sleep, and migraine may occur both during sleep and wakefulness. Cluster headache is predominantly noted in men and is a severe unilateral headache which occurs more frequently during sleep at night than during the daytime. The headache is characterized by severe excruciating pain around one eye and on the same side of the temple, accompanied by increased lacrimation, conjunctival injection, nasal stuffiness, rhinorrhea, and increased sweating from the forehead on the same side of the face. Polysomnographic recording documents occurrence of cluster headache out of REM sleep. Attacks usually last a few hours. Sleep apnoea, particularly REM-related sleep apnoea, may trigger cluster headache and there may be an increased prevalence of sleep apnoea in this condition. These patients also suffer from sleep maintenance insomnia because of awakening with cluster headache.
Individuals report some craving for drug during withdrawal from benzodiazepines, but the level is not as great as among those who abuse alcohol. Once the withdrawal syndrome has dissipated, the abusers of benzodiazepines are not as likely to resume drug consumption as are alcoholics. Withdrawal signs appear to be more likely following chronic exposure to short-acting benzodiazepines, such as alprazolam (half-life of less than 15 hours) or lorazepam than long-acting drugs. Despite gradual dose reduction, individuals may have anxiety attacks, confusion, agitation, restlessness, sweating, clouded sensorium, heightened sensory perception, perceptual disturbances, sleep disruption, muscle cramps, muscle twitches, and tremors 2 of addicts may have a seizure during withdrawal. Withdrawal signs peak the second day after abrupt withdrawal and last
Alteration of thermoregulation depends on the level of the cord injury. Distal to the lesion, thermoreception is lost, sweating and vasoconstriction are abolished, and the ability to increase muscle tone or shiver is lost. Patients with cervical cord injuries become poikilothermic, which results in frequent episodes of hypothermia unless appropriate measures are taken. The pyrexial response to infection may be masked, and sepsis may present as hypothermia.
The diagnosis of somatoform autonomic disorder is based on autonomic arousal (palpitation, sweating, tremor), which must be a prominent feature of the clinical picture, together with physical complaints, often pain, referred to specific organs, systems, or parts of the body. As with other somatoform disorders, the patient will be distressed about the possibility of underlying physical disease and is not reassured by negative findings on appropriate assessment and explanation. This diagnosis is sometimes appropriate for syndromes listed in T b. 2
To determine the etiology of hypokalemia, one must first decide which of five primary mechanisms exists redistribution, renal loss, GI loss, other loss (sweating), or inadequate intake. A. Redistribution Hypokalemia. Potassium is primarily an intracellular ion hence a small shift of this ion into the cell can cause a D. Other Loss. Copious sweating is the primary cause of potassium loss other than from kidney and GI tract.
That heat load associated with excessive sweating may lead to hypovolemia and subsequent heatstroke shock. Early signs of heat illness do not seem to be associated with hypovolemia. However, the interactions of pertinent vasoactive forces seem to be more complicated. The skin of heatstroke patients is usually hot and dry. When sweating no longer occurs, this may indicate an ineffective or defective sympathetic response. Experimentally, sympathectomy will increase blood supply through vasodilation. Renin, which stimulates the formation of the potent vasoconstrictor angiotensin, has been found in high concentrations in the plasma of heat
Dissociative symptoms occur in about 15 per cent of victims during the first few seconds to minutes after an accident. Brief symptoms of derealization (e.g. 'unreal', 'like a dream' or 'like a slow movie') are most common, even in relatively minor accidents, while symptoms of depersonalization (e.g. 'out-of-body experiences') are less common and usually indicate a more severe psychological response. Immediate brief symptoms of dissociation do not predict later psychiatric problems, (1) but marked and prolonged dissociative symptoms occurring hours to days after the accident are predictors of increased risk for such problems. If there is a warning period, i.e. a delay between the person consciously detecting impending danger and the actual accident, dissociative symptoms may be present prior to the accident. Some accident victims who have not been injured report marked early psychophysiological symptoms such as (in decreasing frequency) tachycardia, tremor, dry mouth, restlessness,...
How then do we construct criteria for judging normal and abnormal responses Thus far, we have stated that fear is a normal response to a bull that is perceived as a potentially dangerous animal. This can be further clarified with reference to the person's beliefs about bulls, about this bull in relation to bulls in general, beliefs about the self, and information about the person's current circumstances. All of these are relevant to a description of the state of anticipation or readiness of the person in the field. Let us assume that we are observing the man in the field. If he is clearly in a state of fear, as evidenced by sweating, rapid heart rate, or alteration of speech or behaviour, we would be likely to ask no further questions. This is because we have used the information about the situation and our knowledge of the concerns, perceptions, and beliefs of other people in general, and concluded that the response is consistent with the set of rules under which we expect it to take...
The situation the person is in, how the situation affects the person (the causal link), and the consequences of the causal process on the person. Each of these three elements can be composed of physical and mental elements. As a crude example, let us take the situation in which a person gets attacked by a robber with a metal club. The relevant physical aspects of the situation consist of the presence of the robber and his actions. Mental aspects of the situation consist of the moral depravity of his actions, his intentions, and so on. The consequences for the victim can also be physical and mental. The immanent attack will probably trigger fear (mental) and sweating (physical), and after the club hits the skull there may be damage to the brain (physical) with altered states of consciousness in its wake (mental). Of central importance for our attempts to constrain simulation theory empirically is the fact that the causation itself the way in which this situation causes these...
Iontophoresis of pilocarpine (28) to induce sweating to measure sweat sodium and chloride concentration is the basis of the ''sweat test'' that is used to diagnose cystic fibrosis (29-31). High concentrations of both sodium and chloride ions in the sweat are considered as unequivocal evidence of the disease. Although essential criteria have been established for a positive test result in both children (30) and adults (31), pilocarpine iontophoresis should be used in conjunction with other clinical features to make a definitive diagnosis. This procedure is particularly useful in children younger than 1 year old because it is essentially painless and takes only 3-5 minutes to complete.
Pharmacokinetics peak plasma level occurs 2 to 4 h after oral dosing, and 1 h after intramuscular injection half-life is 25 h after regular oral use. Side-effects similar to other p-opioids, including mental blunting, sweating, constipation, nausea, and analgesia. Toxic effects acute overdose leads to respiratory depression and pulmonary oedema.
Other clinical manifestations include developmental delay, short stature, ocular, dental and skeletal abnormalities, hyperhidrosis, hyperkeratinization of the palms and soles, bullae on minimal trauma, hair loss, sometimes gonadal failure, and features of premature ageing.
QSART quantitatively measures axon-reflex mediated sweating in response to acetylcholine. Both the afferent and efferent pathways of this test are via sympathetic postganglionic fibers to eccrine sweat glands. The QSART provides a sensitive, reproducible, and accurate measurement of postganglionic sudomotor function. Abnormalities in QSART suggest postganglionic sympathetic dysfunction 12 .
May be difficult to distinguish from anticholinergic syndrome. Sweating and normal to hyperactive bowel sounds are associated with sympathomimetic overdose, whereas anticholinergic toxidrome manifests with dry skin and diminished bowel sounds.
In a recent pilot study of the selective norepinephrine reuptake inhibitor reboxetine to treat depression in Parkinson's disease, increased sweating was noted in 3 of 15 subjects.14 This observation was not appreciated in previous studies of reboxetine in patients without Parkinson's disease.
Problems with thermoregulation may also be seen as in correlation with motor fluctuations. Sage and Mark closely followed four patients with Parkinson disease and severe intermittent drenching sweats.21 In all patients, these tended to be end of dose phenomena. Serial plasma levels were collected in one patient. In this patient, the onset of sweating correlated with levels of L-dopa seen at the threshold of the motor response. The authors conclude that drenching sweats represent an early off sign in some patients. Severe chorea or dystonia may be seen as a peak-dose response in some patients with Parkinson's disease. This activity is intensely physically and may appropriately be associated with tachycardia, shortness of breath, and sweating in proportion to the amount of energy expended in the movements.
It is now well established that TeNT is the sole cause of tetanus, though it took many centuries to establish a direct mechanistic link between the neurotoxin and the disease it causes. In fact, tetanus was first described in medical terms by Hippocrates, who defined this paralysis as tetanus (tetavoo in Greek means contraction). Tetanus may develop in different forms, and the most common one is the generalized tetanus caused by contamination of even minor wounds or skin scratches with spores of toxigenic Clostridium tetani. Between the time of injury and the first symptoms there is a lag phase varying from few days up to four weeks, which corresponds to the time necessary for (1) germination of spores, (2) toxin production and release, and (3) toxin diffusion, binding, transport to its target cells within the spinal cord. Tetanus usually begins with a characteristic lockjaw (risus sardonicus), with difficulty in swallowing and neck stiffness (Bleck 1989). With time, the muscle...
Five per cent glucose is used to supply intravenous water requirements, with 50 g l glucose being present to ensure an isotonic solution. The normal requirement is 1.5 to 2.0 l day. Water loss in excess of electrolytes is uncommon, but occurs in excess sweating, fever, hyperthyroidism, diabetes insipidus, and hypercalcemia.
Fluids lost are invariably salt-containing body fluids, including the plasma component of blood. It is usual to replace excess losses of blood with blood and losses of plasma with plasma or plasma substitutes. However, saline solutions are often used as a temporizing measure. If there are excess losses from the gastrointestinal tract (Table., .2.) or via sweating, saline solutions are again appropriate. Ringer's lactate is often used for these losses but only offers advantages over 0.9 per cent saline (buffering capacity) in cases of massive replacement.
Treatment of hyperthyroidism is directed at reducing the excessive synthesis and secretion of thyroid hormones. This may be accomplished by inhibiting thy-roidal synthesis and secretion with antithyroid drugs, by reducing the amount of functional thyroid tissue, or by both. Unfortunately, only a small proportion of patients treated with antithyroid drugs obtain long-term remission of their hyperthyroidism. Ablative therapy is often necessary. Since many of the signs and symptoms of hy-perthyroidism reflect increased cellular sensitivity to adrenergic stimulation, a p-adrenergic antagonist is often used adjunctively. Propranolol (Inderal), the most widely used p-adrenoceptor blocker, is effective in ameliorating many of the manifestations of thyrotoxicosis. It may reduce thyrotoxicosis-induced tachycardia, palpitations, tremor, sweating, heat intolerance, and anxiety, which are largely mediated through the adrenergic nervous system. Propranolol may also impair the conversion of T4 to...
When a patient is mechanically ventilated, the process of adjusting the respiratory rate (and other variables) is both continuous and repetitive. Alterations in arterial blood gas analysis indicating a respiratory acidosis or alkalosis will often require a change in ventilator settings ( SJutsky.1994). Spontaneous tachypnea, agitation, panic, excessive perspiration, tachycardia, and hypertension are all signs that the ventilation of the patient requires reassessing, although there are other causes that may require attention.
The onset of brucellosis is usually gradual, and the symptoms are vague. Typically, patients complain of mild fever, sweating, weakness, aches and pains, enlarged lymph nodes, and weight loss. The recurrence in some cases of fevers over weeks or months gave rise to the alternative name undulant fever. Even without treatment, most cases recover within 2 months, and only 15 will be symptomatic for more than 3 months.
Brown adipose tissue is important in animals that have a particular need to generate heat, for instance hibernating mammals. During hibernation the body temperature falls and metabolism slows, to preserve fuel stores. Awakening from hibernation is helped by the generation of heat in brown adipose tissue. Large adult mammals such as humans do not usually have a problem in generating heat, since the ratio of body mass (in which heat is generated) to body surface area (through which heat is lost) is in favour of generating too much heat, and instead adult humans have a variety of means of losing excess heat - sweating and dilation of blood vessels in the skin, for example. Correspondingly, there is no good evidence that adult humans have signi ficant amounts of brown adipose tissue. In contrast, infants have a different surface area to body mass ratio and have a need for a mechanism to generate heat, and in infant humans brown adipose tissue has a clear role. It is lost during...
Newly hired workers, and those who first go into dusty cotton-processing areas for a period of a few hours, may experience mill fever (76), which has also been called card room fever, dust chills, dust fever, cotton cold, cotton fever, weaver's fever, and, among flax workers, heckling fever (4). A similar syndrome has been described among those exposed to high concentrations of grain dust (75). Symptoms, which typically occur 8-12 h following heavy dust exposure, consist of chills, headache, thirst, malaise, sweating, nausea, which may be accompanied by vomiting, and a transient fever, followed by fatigue. Without further exposure, these symptoms subside spontaneously within a day or two, but the fatigue may continue for several days. With repeated exposure, such as that experienced by a newly hired textile worker, these symptoms may occur for several days until the worker is seasoned or develops a tolerance (77). This seasoning is well recognized by workers exposed to high dust...
Additional clinical signs of SDB include increased respiratory efforts with nasal flaring, suprasternal or intercostal retractions, abnormal paradoxical inward motion of the chest occurring during inspiration, and sweating during sleep. The sweating may be limited to only the nuchal region particularly in infants it may be severe enough to necessitate changing clothes during the night. The parents may mention the child feeling warm at night or preferring to sleep without a blanket.
For instance, the effects of the sympathetic nervous system on the circulatory system (heart and blood vessels) are brought into play by a fall in blood pressure. This may happen quite often. Think for a moment of the hydrostatic pressure of a column of blood about 2 metres high. Then contemplate the fact that when you get out of bed and stand up, the pressure of blood available to perfuse your brain is going to drop rapidly and dramatically. This is an immediate stimulus to the sympathetic nervous system to maintain blood pressure, which it does, as we shall see in more detail below, by effects both on the heart and the blood vessels. Most people are familiar with a feeling of faintness on standing up too quickly, particularly on a hot day when blood volume may be depleted by sweating. The brain receives the information that blood pressure is beginning to fall from receptors in the great vessels, collates this in the hypothalamus and causes the appropriate responses to be set in...
P. vivax malaria is the most prevalent type of infection and is characterized by periodic acute attacks of chills and fever, profuse sweating, enlarged spleen and liver, anemia, abdominal pain, headaches, and lethargy. Hyperactivity of the reticuloendothelial system and he-molysis are the principal causes of the enlarged spleen and liver these effects often result in anemia, leuko-penia, thrombocytopenia, and hyperbilirubinemia. The cyclical nature of the acute attacks (48 hours for
Mutations in the CFTR gene can lead to an abnormal protein that causes defective electrolyte transport and defective chloride ion transport in apical membrane epithelial cells affecting the respiratory tract, pancreas, intestine, male genital tract, hepatobiliary system, and the exocrine system, resulting in complex multisystem disease. CFTR is a member of an ATP-binding cassette family with diverse functions such as ATP-dependent transmembrane pumping of large molecules, regulation of other membrane transporters, and ion conductance. The loss of CFTR-mediated anion conductance explains a variety of CF symptoms, including elevated sweat chloride because of defective salt absorption by the sweat ducts and meconium ileus because of defective fluid secretion by intestinal crypt cells (11). The malfunction of CFTR as a regulator of amiloride-sensitive epithelia Na+ channel leads to increased Na+ conductance in CF airways, which drives increased absorption of Cl- and water. Most symptoms...
Effect of drugs on the sweat glands by cataphoresis and an effective method for suppression of local sweating Observation on the effect of diaphoretics and adiaphoretics. J. Oriental Med., 25 101-102. 34. Stolman, L. P. (1998). Treatment of hyperhidrosis. Dermatol. Clin., 16 863869. 35. Murphy, R., and Harrington, C.I. (2000). Treating hyperhidrosis Iontophoresis should be tried before other treatments (letter). BMJ, 321 702-703.
A 57-year-old medical missionary developed fever, diarrhea, headache, vomiting, and dark urine about 10 days after returning to the United States from a month-long trip to East Africa. The patient has been taking chloroquine and proguanil chemoprophylaxis. On physical examination the patient is feverish, agitated, sweating, weak, and in mild distress, with a blood pressure 95 60 (normal, 120 80), a pulse of 120 (normal, 60-100), and temperature of 104 F (40 C) (normal, 98.6 F, 37 C). Laboratory findings are a hematocrit of 25 (normal for male, 40-54 ) platelet count 29,000 (normal, 150,000-400,000 mm3) parasitemia 6 (P. falciparum) serum creatinine 3.5 mg dL (Normal for male, 0.8-1.5 mg dL) and plasma glucose 39 mg dL (Normal fasting, 65-110 mg dL). What is the best choice of drug therapy
It is possible that, despite a lack of subjective or physiological strain, cognitive impairment remains highly sensitive to helmet use. Neave et al. (2004) investigated the effects of helmet use on teenage cricket batsmen during a 30-min batting session and reported a clear disparity between physiological and subjective responses versus cognitive performance. Oral temperature increased and body weight decreased equally whether a helmet was worn or not, suggesting, despite limited reliability of these measures, no differences in thermal strain or sweating response. In addition, subjective sensations of fatigue, thermal stress, thirst, and alertness were similar with or without a helmet. However, reaction time, attention, and vigilance were significantly impaired following the 30 min batting session when helmets were worn, versus minimal changes when no helmets were used. Unfortunately, batting data were not reported,
One of the most serious drawbacks of opioid anesthesia is the possibility of inadequate anesthetic depth. Signs of inadequate anesthesia include sweating, pupillary dilation, wrinkling of the forehead, and opening of the eyes. Most important, however, awareness or incomplete amnesia may occur. Consequently, additional doses of the opioids are appropriate when signs of light anesthesia manifest. Furthermore, many clinicians supplement the high-dose opioid technique with inhala-tional anesthetics or hypnotics, such as benzodiazepines (midazolam for shorter cases the longer-acting drug lo-razepam for cases longer than 4 hours) or more recently, propofol. Unfortunately, the use of many of these supplemental drugs may result in some loss of cardiovascular stability.
In the latter disorder, features of extrapyramidal system involvement arc also found. Both disorders are characterised by postural hypotension anhidrosis (absent sweating) impotence A tonic pupil (page 140) associated with areflexia and occasionally widespread autonomic dysfunction, e.g. segmental hypohidrosis (absent sweating) and diarrhoea. pressure rise, bradycardia, sweating, reflex penile erection (priapism).
These agents have some preference for the central nervous system but some peripheral anticholinergic effects are to be expected. Blockade of vagal tone in the heart produces tachycardia. Other adverse effects include decreased bladder function and urinary retention and decreased bowel motility leading to constipation and impaction. Decreased saliva and bronchial secretion contribute to dry mouth and increased dental caries while decreased sweating increases the risk of heat stroke. Blockade of muscarinic receptors in the eye cause pupillary dilation and inhibition of accommodation, leading to photophobia and blurred vision. Rarely, narrow-angle glaucoma may ensue. The muscarinic receptors in the basal ganglia are predominantly M 2 whereas those in the periphery are M1. The rank order of the anticholinergic drugs for relative selectivity for the M 2 receptor is biperiden, procycliden, trihexylphenidyl, and benztropine. All these agents can cause dry mouth, blurred vision, urinary...
Exposure and ligation of the sympathetic chain is exceedingly amenable to thoracoscopic intervention. The most common clinical indication for the procedure is palmar hyperhidrosis but can also include axillary sweating, facial sweating (blushing), and upper extremity pain syndromes (46-51). Although the lateral decubitus position is favored for a unilateral sympathectomy, some have advocated a supine approach if bilateral sympathectomies are contemplated (46). A biportal approach is most commonly used with trocars introduced in the third and fifth intercostal spaces as the ipsilateral lung is collapsed by the anesthesiologist. The lung is carefully retracted, and the pleura overlying the vertebra is divided to expose the T2 and T3 ganglia, which supply the sympathetic innervation to the lower trunk of the brachial plexus and ipsilateral upper extremity. Great care is taken to avoid the stellate ganglion and azygos vein located just cephalad to the second rib. Once exposed, the T2...
What are intake and output (I&O) measurements over preceding 24-72 hours Elimination of water in excess of salt through GI (diarrhea), cutaneous (excessive sweating), or renal (obstructive uropathy) losses results in hypernatremia when patients have limited or no access to water. These patients have signs and symptoms of dehydration.
Prodromal pallor, nausea and sweating occur if the patient sits down, the attack may pass off or proceed to a brief loss of consciousness. Amongst other neuroglycopenic manifestations, seizures or intermittent behavioural disturbances may occur. A rapid fall of blood sugar is associated with symptoms of catecholamine release, e.g. palpitations, sweating, etc. In 'atypical' seizures exclude a metabolic cause by blood sugar estimation when symptomatic. EPISODIC CONFUSION
Graves' disease or thyrotoxicosis is the most common type of hyperthyroidism and is caused by a hyperfunctioning thyroid gland. Graves' disease is characterized by a rapid pulse (tachycardia), palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exopthalmos (bulging eyes), and weight loss. Treatment involves surgical removal of a portion of the thyroid gland (subtotal thyroidectomy), radioactive iodine therapy, or antithyroid drugs that inhibit either the synthesis or the release of thyroid hormones.
Ischaemic or, rarely, spasmodic constriction of coronary arteries resulting in pain, usually precordial, pressing or crushing, and with or without radiation to jaw, neck or arms. The sedated, ventilated patient will not usually complain of pain but signs of discomfort may be apparent, e.g. sweating, hypertension, tachycardia. The ECG should be regularly scrutinised for ST segment and or T wave changes.
Growth hormone deficiency is probably the most common endocrine expression of hypopituitarism. Acquired growth hormone deficiency in adulthood results in reduced muscle strength and exercise capacity, reduced thermoregulation and sweating ability, subnormal kidney function, decreased lean body mass and bone mineral density, abnormal thyroid hormone, lipid, and carbohydrate metabolism, myocardial dysfunction, and impaired social well being, and it leads to increased mortality due to cardiovascular disease (De.Boer.et.al 1995). Growth hormone replacement therapy in growth-hormone-deficient adults improves these symptoms.
In delirium tremens the symptoms of alcohol withdrawal described earlier are accompanied by a reduced level of consciousness, disorientation in time and place, impairment of recent memory, insomnia, and perceptual disturbances. The latter include misinterpretation of sensory stimuli and hallucinations most are visual, but auditory and haptic hallucinations also occur. The hallucinations may be Lilliputian or of normal size, and may be of complex, frightening, and extremely realistic scenes. The patient is restless and fearful, and may become severely agitated. There is marked tremor, and ataxia when standing. Some patients experience vestibular disturbance. Autonomic disturbance includes sweating, tachycardia, raised blood pressure, and dilated pupils. There may be a mild pyrexia. Patients are usually dehydrated, often with abnormal electrolytes, leucocytosis, and impaired liver function. As in other forms of delirium, symptoms are worse at night.
A child may not be able to give a history and the parent or other caregiver may note snoring, labored or obstructed breathing, or both during the child's sleep. There are a number of witnessed sleep events that may indicate OSA, which include paradoxical inward rib cage motion during inspiration, movement arousals, sweating, or neck hyperextension. In addition, the parent or caregiver may note that the child is excessive sleepy during the day, has hyperactivity or aggressive behavior, has a slow rate of growth, has morning headaches and or enuresis. This is confirmed by a PSG
The increased basal sympathetic tone may manifest as tachycardia and alteration of bladder function and bowel motility. Episodes of marked sympathetic overactivity occur, with increased vascular resistance, increased central venous pressure, increased cardiac output, hypertension, pallor, cyanosis of the digits, pyrexia, and sweating. These sympathetic crises are thought to be mediated by loss of spinal inhibition of the adrenal glands. Therefore epidural anesthesia may attenuate or eliminate them.
Individuals with generalized anxiety disorder endorse higher levels of social anxiety than individuals with anxiety disorders other than social phobia. (24) Although individuals with either social phobia or generalized anxiety disorder may devote excessive amounts of time to worrying and ruminating, the focus of the worries in social phobia is specific to social or performance situations, while the hallmark feature of worry in generalized anxiety disorder is a heightened focus on possible catastrophic consequences across several domains of life. Patterns of anxiety symptoms also differentiate the two. Sweating, flushes, and breathing problems are more common in social phobia, while headaches, insomnia, and fear of dying are more common in generalized anxiety disorder. (2 28
If unrecognized, it is invariably fatal. Thyroid storm is usually abrupt in onset and occurs in patients whose preexisting thyrotoxicosis has been treated incompletely or not at all. Thyrotoxic crisis may be related to cytokine release and an acute immunological disturbance caused by a precipitating condition, such as trauma, surgery, diabetic ketoacidosis, toxemia of pregnancy, or parturition. Although the serum thyroid hormone levels may not be appreciably greater than those in uncomplicated thyro-toxicosis, the clinical picture is severe hypermetabolism with fever, profuse sweating, tachycardia, arrhythmias, and so on. Pulmonary edema or congestive heart failure may also develop. With progression of the disorder, apathy, stupor, and coma may supervene, and hypotension can develop. There are no foolproof criteria by which severe thyrotoxicosis complicated by some other serious disease can be distinguished from thyrotoxic crisis induced by that disease. In any event, the...
One of the central symptoms of posttraumatic stress disorder (PTSD) is hyper-arousal in response to trauma reminders. Such arousal induces physical symptoms, such as racing heart, sweating, and shortness of breath. These symptoms are controlled by the autonomic nervous system and can be measured using psychophysiological equipment. Psychophysiological measurements include recordings of several autonomic nervous system outputs, such as heart-rate, blood pressure, skin conductance, respiratory rate, and body temperature. Thus, these measurements provide an objective way to measure the
Abnormal somatic symptoms can be divided into vegetative symptoms, such as cardiovascular dysregulation, increased sweating, and feelings of cold, and hypochondriacal symptoms, such as headaches and feelings of tightness in the chest, heavy limbs, being choked, or difficulty in swallowing. In Germany, the latter symptoms have been called 'vital' and depressive disorders which include such symptoms are known as 'vitalized'. They are considered to be related to subjective loss of energy, and are different from vegetative symptoms which represent a real somatic dysfunction.
Diuretic therapy is usually inappropriate the vast majority of patients presenting in acute heart failure, and even many with acute-on-chronic failure, are hypovolemic on hospital admission as a consequence of sweating, vomiting, not drinking, and third-space fluid shifts. The beneficial immediate vasodilating effect of a loop diuretic is quickly negated by an often brisk diuresis. This further exacerbates any existing hypovolemia for which the body attempts to compensate by additional vasoconstriction, thereby placing an extra load on the heart which results in further reductions in cardiac output.
Reduction of growth hormone levels results in an early cessation of sweating. Diabetes mellitus becomes easier to control and many patients can be managed on diet or oral hypoglycemic alone. On the second day, it is useful to carry out a glucose tolerance test with GH levels (i.e. before discharge). GH will fall to below 2 mlU l, and ideally below 0.5 mlU l if cured. If the patient is not cured , early re-exploration is often worthwhile.
The child is not going against its own nature by developing a caring, moral attitude any more than civil society is an out-of-control garden subdued by the sweating gardener of Huxley's imagination. Moral attitudes have been with us from the start, and the gardener is, as John Dewey aptly put it, an organic grower. The successful gardener creates conditions and introduces plants that may not be normal for this particular plot ofland but fall within the wont and use of nature as a whole (Dewey 1898, pp. 109-110).
With a downward and outward gaze and a dilated pupil. Partial ptosis may occur in myasthenia gravis, myotonic dystrophy, facio scapulohumeral muscular dystrophy, and syphilis. If ptosis occurs in the presence of a small pupil, absence of sweating, and anophthalmos on the affected side, the cause is a disorder of the sympathetic nervous supply to the eye (Horner's syndrome). The disorder may be located anywhere in the sympathetic chain from the brainstem, the cervical and upper thoracic cord, the sympathetic chain, and the stellate ganglion.
Benzodiazepines are best avoided in general cases of delirium. They are contraindicated in delirium associated with respiratory failure. They are, however, the treatment of choice in delirium associated with benzodiazepine withdrawal,105 alcohol withdrawal,106 and hepatic failure.107 Delirium tremens begins about 48 hours after acute withdrawal from severe alcohol abuse. They are associated with fever, sweating, prominent visual hallucinations, tachycardia, and a marked tremor. Urgent management is necessary. Benzodiazepines should be prescribed, up to 30 mg of chlordiazepoxide per day in divided doses, gradually reducing to cessation over a 7-10 day period. Chlormethiazole is no longer recommended because of its abuse potential. Convulsions may occur, requiring specially formulated intravenous diazepam. Thiamine replacement is necessary and should be given parenterally. Acute dehydration is usual and intravenous fluids are needed once the patient is sedated.
Botulinum toxin is used clinically in the treatment of blepharospasm, writer's cramp, spasticities of various origins, and rigidity due to extrapyramidal disorders. It is also used to treat gustatory sweating and cosmetically to decrease facial wrinkles. Botulinum toxin A (Botox, Oculinum) injected intramuscularly produces functional denervation that lasts about 3 months. Clinical benefit is seen within 1 to 3 days. Adverse effects range from diplopia and irritation with blepharospasm to muscle weakness with dystonias.
The individual response varies greatly and toxicity correlates poorly with the amount of drug taken. Typical effects following amphetamine ingestion include wakefulness, appetite suppression, talkativeness, hyperactivity, and euphoria. The patient has a dry mouth and dilated pupils and may be sweating. Tendon reflexes are brisk. Cardiovascular effects such as tachycardia and hypertension are common. Signs of moderate toxicity following MDMA use include nausea, increased muscle tone, hyper-reflexia, muscle pain, trismus (jaw-clenching), blurred vision, agitation, anxiety, and a slight rise in body temperature. Vomiting, abdominal pain and diarrhea may also occur. Signs of severe toxicity include delirium, coma, and convulsions.
From the onset of status epilepticus, seizure activity greatly increases cerebral metabolism. Physiological mechanisms are initially sufficient largely to compensate for this perturbation. Cerebral blood flow is increased, and initially the delivery of glucose to the active cerebral tissue is maintained. Later systemic and cerebral lactate levels rise, and a profound lactic acidosis may develop.16 There are massive cardiovascular and autonomic changes. Blood pressure rises, as does cardiac output and rate. The autonomic changes result in sweating, hyperpyrexia, bronchial secretion, salivation, vomiting, and epinephrine (adrenaline) and noradrenaline release. Endocrine and autonomic changes also cause an early rise in sugar levels.
Opposite another passenger or deal with people pushing past him. Such things make him feel sick and shake and panic to such an extent, he usually rushes off and locks himself in the toilet. On the journey down, I had to first go on a search at the station, to see if I could find a pair of scissors as he had a label in his new shirt. I then had to virtually climb on his back and try to cut it out without him removing the shirt an odd looking sight I am sure - but needs must After the trauma of all the sensory upset this label caused him, I guess he was in no fit state to march up and down the train, trying to find a seat - a task that is far more difficult for us because Luke is very particular about where he sits, always at a table and always by a window - not easy to find on a busy train. It all finally got too much for him and I spent the next half an hour trying to persuade him to come out of the toilet. Eventually looking like someone suffering from a bad bout of food poisoning,...
Small bladders often are treated easily with anticholinergic medications. Oxybutynin and tolterodine are among the most popular, but imipramine and propantheline bromide function in a similar manner. Dosing should be such to decrease the bladder spasms, allowing for increased bladder capacity, while not interfering with other cholinergic functions (e.g., sweating, salivation, or tearing).
Malaria is still one of the most prevalent protozoan diseases in the world. The mosquito infects the human and the parasite passes through two phases. The tissue phase causes no clinical symptoms in the human and the erythrocytic phase invades red blood cells and causes chills, fever, and sweating, In the United States the 1000 cases reported annually are almost all from international travel. Quinine was the only antimalarial drug from 1820 to the early 1940s when synthetic antimalarial drugs were developed. Chloroquine is commonly prescribed. If drug resistance develops quinine is used in combination with an antibiotic such as tetracycline.
Pain management for burned patients is often unsatisfactory because of misconceptions about the sources of pain and the optimal use of various analgesic agents in burned patients, and because of such pragmatic factors as unit staffing. A common misconception is that deep burns, which are insensate to touch, are not painful. They frequently produce a severe dull pressure-like pain. Although the presence of pain can usually be recognized from physical signs such as pupillary dilation, sweating, tachycardia, tachypnea, and increased blood pressure, these findings are relatively poor indicators of its severity. Quantitation of pain severity should rely on the patient's own assessment via systems such as the visual analog scale or numerical and graphical rating scales ( Kremer etal 1981).
This infection is produced by micro-organisms of the genus Brucella, and is transmitted by exposure to or ingestion of contaminated animal products, especially unpasteurized milk products, or contact with infected animal tissues. The incubation period is from 7 to 21 days. Onset can be insidious, since it mimics other more common illnesses, with low fever, fatigue, and sweating, but 10 to 20 per cent of cases present with splenomegaly. The psychiatric manifestations of the disease can include depressive or anxious syndromes. Diagnosis can be confirmed by blood or lymph cultures or bone marrow biopsy, although the majority of diagnoses are made serologically.
Adreno-medullary tumours (phaeochromocytomas) tend to present at a younger age when associated with the MEN syndrome, whereas sporadic tumours tend to occur in older patients. Classical symptoms include paroxysmal headaches, palpitations, tremors, and sweating attacks. A few may be diagnosed incidentally and a rare, but occasional case may be diagnosed after a maternal death in an unrecognized MEN family. Intermittent, severe hypertension is a rare but classical presentation.
Another serious toxic side-effect is the interaction of MAOIs and foods that are high in tyramine and other monoamines. Many of the foods that should be restricted in the diet of patients taking MAOIs are listed in T.a.bIe Z Tyramine has both direct and indirect sympathomimetic actions. The reaction usually develops 20 min to 1 h following ingestion of food and is characterized by nausea, apprehension, occasional chills, sweating, restlessness and hypotension with occipital headache, palpitations, and possibly vomiting. Neck stiffness, piloerection, dilated pupils, fever, and motor agitation are seen on examination. In severe forms the reaction can lead to delirium, hyperpyrexia, cerebral hemorrhage, and death. The interaction of the irreversible MAOIs with certain dietary components leading to the hypertensive reaction is one of the most serious drawbacks to the use of these types of compounds. The reversible MAOIs moclobomide and brofaromine have not been found to interact with...
One half of oral iodine is absorbed two thirds of that amount is excreted in the next 48 to 72 h. Goitrogens (e.g., cabbage, phthlates, resorcinol, rutabaga, thiocyanate, turnips) may inhibit thyroid uptake of iodine. Pulmonary insufficiency and dysphagia should trigger an examination of the thyroid gland and could possibly lead to a goiter. A goiter can occur, however, without hypothy-roidism. Weakness, cold intolerance, weight gain, puffiness of face eyelids, thinning of the hair, and brittle nails combined with pallor, hoarseness, decreased sweating, constipation, and anginal pain may be part of the signs and symptoms of hypothyroidism. Topical administration of iodine complexes has also been associated with thyrotoxicosis.86
Formerly called reflex sympathetic dystrophy. Common in adolescent girls. Cause is unknown. Produces localized swelling, sweating, color changes, and pain with light touch especially of distal extremities. Sickle cell anemia. Vasoocclusive crisis results in ischemia. Bony pain is often severe enough to prevent ambulation. Hemophilia. Patients are at risk for hemarthrosis, especially after trauma.
Al toxicity symptoms include constipation, colic, decreased appetite, nausea, skin ailments, twitching leg muscles, increased perspiration, fatigue, motor paralysis, local numbness, and fatty degeneration of the kidneys and liver, resulting from decreased levels of calcium and phosphorus.
The miotic nature of these drugs must be also be taken into account. In patients with cataracts, miosis can markedly decrease vision. Historically, miotics have been said to increase the risk of retinal detachment and cataracts, though this has not been conclusively established. Systemic adverse effects are similar with all cholinergic drugs and include sweating, salivation, stomach and digestive upset, and decreased heart rate. Miotic therapy has proven efficacy and is an inexpensive option. However, with the possible exception of the gel and sustained-release systems (to be discussed shortly), miotic therapy is usually associated with poor compliance a result of patient discomfort and the frequent administration required (often 4 times a day).
Pheochromocytoma is a rare tumor of the sympathetic nervous system which produces characteristic symptoms of headache, sweating, diaphoresis and palpitations caused by catecholamine overproduction. Usually they present as unilateral intra-adrenal tumors, but bilateral tumors, extra-adrenal or pediatric presentations and metastatic spread occur in about 10 of patients. The diagnostic screening tool is measurement of urinary catecholamines or metanephrines while CT or ultrasound will define the presence of a mass.
Eye movements may be affected with loss of ocular convergence and upward gaze. Excessive sweating and greasy skin (seborrhoea) can be troublesome. Depression, drug-induced confusional states and dementia occur in 30 of patients. Occasionally autonomic features occur - postural hypotension.
(2) Dermatophvtosis (tinea) corporis, capitis, and cruris. These fungous infections are commonly called ringworm. Dermatophytosis (or tinea) cruris is also called jock itch. The diagnosis of ringworm is made by the presence of a few (usually not over two or three) circular, ring-like, red, scaling lesions, clearing at the center, with advancing vesicular margins. Tinea cruris is distinguished by its location on the upper surface of the thighs. Excessive perspiration and friction from clothing are important contributing factors. Therefore, an important part of the treatment consists of exposing the involved parts to the air as much as possible.
Clinical features that suggest increased metabolic rate in children with CHD include tachycardia, tachypnea, increased work of breathing, profuse sweating, early fatigue, and prolonged feedings. One of the reasons for this excess metabolic rate is the greater proportion of lean body mass, which expends greater energy compared to adipose tissue. Increased concentrations of tumor necrosis factor recorded in patients with cardiac cachexia may contribute by enhancing tissue catabolism.125 It is also possible that increased energy expenditures in malnourished children with CHD are related to the malnutrition per se, as suggested by Krieger et al.126 who found no significant differences in oxygen consumption in underweight infants with and without CHD.
Epilepsy is a dysfunction of the electrical activity in the brain. Seizures may involve loss of consciousness or be of a milder form with symptoms such as momentary loss of awareness, rapid heart beat, sweating, and high blood pressure. The illness is not always, but can be, inherited. Children in a study who had both migraine headaches and epileptic seizures had no seizures or had fewer when foods they were allergic to were eliminated from the diet. The common offenders are cow's milk and cheese, citrus fruits, eggs, wheat, corn, pork, tomatoes, and chocolate.
Tinea pedis ( athlete's foot ) is the most common dermatophyte infection. Tinea pedis infection is usually related to sweating, warmth, and oclusive footwear. The infection often presents as white, macerated areas in the third or fourth toe webs or as chronic dry, scaly hyperkeratosis of the soles and heels.
Disturbances in the control of temperature are evident from clinical observations the patients frequently complain of feeling cold, and in the winter they have cold and blue extremities and suffer from chilblains. In the severely malnourished patient hypothermia may be a cause of death. Severe malnutrition is accompanied by a low central body temperature, presumably because of a low metabolic rate. Ingestion of a high-calorie meal can cause a significant increase in the central body temperature(92 which causes some patients to complain of heat in the periphery and sweating after food.
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