Home Cure for Hyperhidrosis

Sweat Miracle Excessive Sweating Cure

The Sweat Miracle program guide is a 5 steps hyperhydrosis treatment system contained in a book written by Miles Dawson. The treatment system program is equally effective on all types of symptoms. The home remedies work on the palms, face, feet, underarms, back, neck, shoulders and chest. You can easily get rid of this condition by following the simple and natural techniques suggested by Miles Dawson in his eBook. The book explains an exclusive method of five steps to get relieved from the disorder within 48 hours. The time may vary from one person to another. This will be a permanent process with no chances of recurrence in the future. Read more here...

Sweat Miracle Excessive Sweating Cure Summary

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My Sweat Miracle Excessive Sweating Cure Review

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Congestive Cardiac Failure

The most frequent symptoms are feeding difficulties, tachypnea, increased sweating, tachycardia, rales and rhonchi, liver enlargement, and cardiomegaly. Less common signs and symptoms are ascites, gallop rhythm, pulsus alternans, and increase in central venous pressure. Peripheral edema is exceedingly rare. A clear distinction between right heart failure (characterized by liver enlargement, tachycardia, and dependent edema) and left heart failure (cardiomegaly, rales, tachypnea, and tachycardia) is not as obvious in the neonate as in the older child or adult.

Dehydration and Heat Illness

If water loss due to sweating is not replaced during exercise, plasma volume and sweat rate will be decreased (Figure 2). The combination of reduced peripheral blood flow for heat exchange and reduced sweat volume for evaporative cooling leads to an overall reduction in the ability to dissipate heat. 41 or 42 C. Core temperatures higher than 39.5 C reduce the function of motor centers in the brain and subsequently the ability to recruit motor units required for muscular activity. Extertional heat stroke is characterized by cessation of sweating, hot and dry skin, physical deterioration, confusion, collapse, and seizure. Rhabdomyolysis (muscle fiber destruction) may result from exertional heat stroke. In one reported case, an accelerated rhab-domyolysis resulting from exertional heat stroke occurred during an 8-km fun run when the ambient temperature was higher than 37 C. This unfortunate runner collapsed with a rectal temperature of

Treating Different Types of Dehydration

In most instances involving heavy sweating, plain water containing 1.25 g of NaCl per liter is a suitable rehydration solution. Increasing the concentration of NaCl to 5 or 6 g per liter may promote the rate of rehydration but may not be palatable for some individuals. Most commercial sports drinks contain 1.2-1.8 g NaCl per liter and are also good rehydration solutions, especially when both fluid and electrolytes have been lost through sweating. Fruit juices can also provide fluid, energy, and electrolytes (e.g., fresh orange juice contains approximately 10 mg of sodium and 2000 mg of potassium per liter) but may be too concentrated and delay gastric emptying. Diluting fruit juices 1 3 with water may yield a more appropriate rehydration solution. The inclusion of carbohydrate in the rehy-dration solution provides energy for the intestinal sodium pump, which facilitates sodium transport across the intestinal cell wall into the blood, where it in turn exerts a positive osmotic effect...

Major Drug Nutrient Interactions of Clinical Relevance

Sweating, tachycardia Hyponatremia, SIADH No effect may take with meals Affects bioavailability, owing to pH Decreased iron absorption Inhibits phosphorus absorption Inhibits vitamin A absorption Causes renal wasting of these nutrients Decreased absorption owing to delayed

Daily Regulation of Body Water

Environmental conditions will affect the basal water requirement by altering the losses that occur by the various routes (i.e., respiration, sweat, and urine). Water requirements for sedentary individuals living in the heat may be two or threefold higher than the requirement when living in a temperate climate, even when not accompanied by pronounced sweating. Transcutaneous and respiratory losses will be markedly influenced by the humidity of the ambient air, and this may be a more important factor than the ambient temperature. Respiratory water losses are incurred because of the humidification of the inspired air with fluid from the lungs. These losses are relatively small in the resting individual in a warm, moist environment

Acetylcholinesterase Biological Function

Acetylcholinesterase (EC 3.1.1.7) catalyzes the hydrolysis of the neurotransmitter acetylcholine to choline and acetate in the central nervous systems of animals and humans. Ester hydrolysis is chemically more facile than amide hydrolysis, although the mechanism follows a similar course of tetrahedral adduct formation and decomposition. The enzymatic mechanism follows the same course as that of serine proteases such as chymotrypsin. Acetylcholine is released into nerve-nerve and neuromuscular junctions during neurotransmission, where it may interact reversibly with effector cell receptors. Acetylcholinesterase is present in high concentrations in association with the prejunctional and postjunctional cellular membranes, and it functions in the critical clearing of acetylcholine from the synaptic space. Acetylcholinesterase inhibitors slow the hydrolysis of synaptic acetyl-choline, thereby hyperactivating cholinergic neurotransmission. Acetylcholinesterase inhibition can be lethal for...

TABLE 1152 Recognition of Congestive Heart Failure in Infants

Both increased pulmonary blood flow in left-to-right shunts and pulmonary edema decrease lung compliance and thus cause tachypnea in an attempt to maintain minute ventilation. Tachypnea is a cardinal sign of left-sided failure in infants. Unlike tachypnea caused by respiratory viruses, this tachypnea is usually effortless in children with congestive heart failure, due to lack of airway obstruction. Since feeding is the infant's primary form of exertion, dyspnea and sweating during feeding can often be elicited in the history. Peripheral edema, jugular venous distention, and rales are unusual and late signs in infants.

Physiological Factors

Unlike previous theories, the somatization model embraces the idea that normal physical processes (e.g., the physical component of an emotional state) and minor pathological events may contribute to the development of unexplained symptoms. For example, anxiety is typically associated with increased auto-nomic arousal that may result in physical changes such as shaking, sweating, and tachycardia moreover, fear-related hyperventilation can produce symptoms such as breathlessness, chest pain, and fatigue. Similarly, the sleep problems and physical inactivity often associated with depression may give rise to fatigue, pain, and the feeling that increased effort is required to execute everyday tasks. Other physical processes unrelated to emotional states may also contribute to the development of medically unexplained symptoms. For example, muscle wasting resulting from illness-related inactivity may produce fatigue that perpetuates itself by preventing the resumption of physical exercise...

Neurally Mediated Syncope

FAMILIAL DYSAUTONOMIA Abnormalities in heart rate and blood pressure control can be inherited as a primary disorder, such as the Riley-Day syndrome. This disorder results from abnormal development of the sensory and autonomic ganglia, perhaps due to a lack of nerve growth factor during embryogenesis. Manifestations include failure to thrive, developmental delay, temperature instability, abnormal sweating, absent lacrimation, breath-holding spells, and seizures. 14

Objective Nonself Report Pain Assessment

Physiologic changes from pain include tachycardia, tachypnea, crying, sweating, blood pressure elevation, decreased oxygen saturation, pupil dilation, flushing or pallor, nausea, and muscle tension. These parameters can be muted in persistent pain and can be confounded by fear, anxiety, or fever. Specific behaviors associated with pain include withdrawal of the painful part, pulling ears, or refusing to use a body part. The characteristic facial features of an infant in pain have been described brows lowered, drawn together forehead bulge between brows, vertical furrows eyes tightly closed cheeks raised nose broadened, bulging mouth open, squarish.

Organophosphorus compounds

Acute effects of sublethal doses of organopho-sphates in man include sweating, salivation, abdominal cramps, vomiting, muscular weakness, and breathing difficulties. Concern has also been expressed about long-term effects following acute exposure. Research suggests that some victims may show reductions in some neurobehavioral tests when tested some months after exposure. There are also concerns that people who do not appear to have suffered acute poisoning have subsequently developed debilitating illnesses. Symptoms include extreme exhaustion, mood changes, memory loss, depression, and severe muscle weakness.

Postdrying Treatments

Sweating of dehydrated fruits is a treatment to equalize moisture of the batch. It is usually accomplished by keeping the dried fruit in bins or boxes. Bins are also used for secondary drying to reduce moisture levels of particulate fruits from 10-15 to 3-5 , a range at which drying rates are limited by slow diffusion of water. Temperatures of about 40 C and airflow provided by a blower fan, of about 33 m min, suit the nearly dry product. These conditions minimize the risk of heat damage at a stage when fruit products are most susceptible to degradation.

Clinical Features

Disturbances of the autonomic nervous system, generally a hypersympathetic state, occur during the second week of clinical tetanus and present as tachycardia, labile hypertension, profuse sweating, hyperpyrexia, and increased urinary excretion of catecholamines. 10 The autonomic complications of generalized tetanus are particularly difficult to manage and contribute significantly to the morbidity and mortality of the disease.

Pharmacologic Properties

The signs and symptoms of anticholinergic toxicity are a result of both central and peripheral cholinergic blockade. Muscarinic acetylcholine receptors predominate in the brain, while nicotinic receptors predominate in the spinal cord. Depending on the drug involved, antagonism of muscarinic, nicotinic, or both receptors may occur. 2 The central effects of cholinergic blockade include agitation, amnesia, anxiety, ataxia, coma, confusion, delirium, disorientation, dysarthria, hallucinations, hyperactivity, lethargy, somnolence, seizures, circulatory collapse, mydriasis, and respiratory failure. The peripheral effects include dysrhythmias, tachycardia, decreased bronchial secretions, dysphagia, decreased gastrointestinal motility, hyperthermia, hypo- or hypertension, decreased salivation, decreased sweating, urinary retention, and vasodilation.134

Functional Considerations A Arousal and Alertness

The second part of the Yerkes-Dodson law states that the optimum level of arousal decreases with increasing task difficulty. Tasks that are cognitively more challenging would almost certainly be improved by higher levels of alertness. One way to achieve higher alertness is by increasing arousal. Nevertheless, arousal also increases the probability of physiological effects that might be distracting, such as a racing heart rate, sweating, and an increase in respiratory rate. There might also be distracting cognitive factors, such as anxiety if arousal is induced by aversive stimuli. It is possible that tasks that are more cognitively demanding might also be more susceptible to disruption by such factors. In these circumstances, arousal and alertness conflict Arousal can increase cognitive alertness but, as a side effect, cognitive performance suffers from sympathetic nervous system activation. Thus, the relationship between task difficulty and arousal might depend on the extent to which...

Clinical Features And Diagnosis

The laboratory evaluation should be guided by clinical indications. For example, a healthy young person who presents with an acute cough and streaky hemoptysis does not require routine laboratory testing. A complete blood count should be obtained and serum electrolytes, blood urea nitrogen, creatinine, and glucose measured in patients with massive hemoptysis and in the setting of chronic illnesses. Coagulation studies are indicated in patients with liver disease or using anticoagulants. Arterial blood gas analysis should be performed on patients with respiratory distress or altered mental status. Bacterial sputum cultures are indicated with clinical or radiographic evidence of pneumonia. Mycobacterial sputum cultures are indicated with fever, weight loss, night sweating, and cavitary lung masses.

Animal Research in Fear and Anxiety

In the wide range of approaches used to study fear and anxiety in animal studies, two sets of tests probe their responses. The first set uses models of conditioned fear the second uses models of unconditioned fear. Both models presuppose that aversive stimuli, such as foot shock or novelty, induce a central state of fear, which can be quantified through specific behavioral and physiological measures (restlessness, avoi-dant behaviors, body temperature, body posture, tremor, and sweating). Animals display fear responses to aversive events, such as being forced to swim in cold water, predator exposure, or being given electric foot shock.

Physiologic Response To Heat

The body shows a rapid and remarkable response to heat stress. As the core temperature rises, afferent receptors stimulate the anterior hypothalamus, causing multiple physiologic responses that result in heat loss. The hypothalamus stimulates the autonomic nervous system, resulting in a decrease in vasomotor tone and increased blood flow to the skin. This can cause a marked increase in cutaneous blood flow, from 0.2 to 0.5 L min in cool temperature to 7 to 8 L min in hot temperature. Sweating is stimulated by parasympathetic fibers, with the recruitment of more sweat glands followed by an increase in sweating rate of each gland. Sweating can increase dramatically, from less than 0.5 L day in a temperate environment to 10 to 15 L day in a trained individual exercising in a warm environment. Sweating is an efficient means of cooling. Evaporation of 1 L of sweat consumes 600 kcal of heat. For this reason, dehydration can predispose individuals to heat illness by inhibiting their...

Autonomic Dysreflexia

Autonomic dysreflexia is dramatic paroxysmal hyperactivity of uninhibited sympathetic and parasympathetic nerves in children with spinal cord lesions proximal to thoracic level 6. It is caused by stimulation below the level of the lesion by bladder overdistention, fecal impaction, skin breakdown, or fractures. Presentation is sweating, flushing, pounding headache, hypertension, bradycardia, and piloerection above the level of the lesion. Death or cerebral vascular accident may result. 17

Motor Components of Vomiting

The early stages of vomiting usually start with a sensation of nausea, followed by signs of sympathetic activity including peripheral vasoconstriction, hyperventilation, sweating, pupillary dilatation, tachycardia and reduction in gastric secretion. Salivation occurs in response to parasympathetic activity. Vagal impulses arising from the dorsal motor vagal nucleus cause a profound relaxation of the proximal stomach followed by a retrograde giant contraction beginning in the mid-small intestine which propels small bowel contents proximally back into the stomach in preparation for ejection.

Testicular Development And Descent

The embryonic gonad has the potential to become either a testis or an ovary. After gonadal differentiation, testes remain in the abdominal cavity until they descend into the scrotum. In cattle and sheep, testicular descent occurs in midgestation and descent occurs in late gestation in swine and horses. In contrast, testicular descent occurs postna-tally in rabbits and dogs. Avian testes remain in the body cavity attached to the wall of the kidney, and the testes function at body temperature. Cryptorchidism, the retention of one or both testes in the abdominal cavity, is inherited. In most domestic mammals, the normal temperature of the testes is several degrees cooler in the scrotum compared with body temperature. The cooler environment is essential for sperm production and bilateral cryptorchid males are sterile. Temperature regulation of the testes is controlled by muscular regulation (cremaster muscle) of the distance that the testes is from the body, heat transfer from arterial...

Trimetaphan Camsylate

Trimetaphan reduces systemic vascular resistance and may sensitize the myocardium to catecholamines. It reduces the blood pressure and inhibits any compensatory tachycardia. Trimataphan reduces splanchnic and renal blood flow. It also slightly reduces cerebral blood flow but intracranial pressure is unaffected. Pupillary dilatation occurs and there is a small effect on skeletal muscle nicotinic receptors that may therefore impair respiratory function. In the abdomen, it enhances gastric emptying and gastrointestinal motility while reducing secretions. Bladder detrusor tone is reduced and this may cause retention. The inhibition of sweating may cause hyperthermia.

Acquired neuromyotonia Isaacs syndrome

Acquired neuromyotonia is a rare disorder characterized by widespread muscle twitching (myokymia) and cramps, sometimes associated with muscle hypertrophy, stiffness, weakness, increased sweating and central effects. Onset can be from adolescence to old age. There is an association with thymoma, with myasthenia gravis, and probably also with lung cancer.

Physiological Clinical and Nutritional Importance of Sodium

The nutritional requirement is a reflection of obligatory losses (maintenance) and the needs of growth, pregnancy, and lactation. Abnormal losses owing to disease, or in animals such as humans and horses which sweat extensively, raise the requirement. The impact of equine sweating is different from that in humans. Human sweat always contains sodium at concentrations well below plasma levels (and when aldosterone secretion is raised, levels of sweat sodium fall very low) horse sweat is hypertonic but this helps to offset the osmotic effect of the increased respiratory water loss during exertion, i.e.,

Feelings Are Knowledge

If feelings follow behavior, they cannot be the causes of behavior, since causes must precede their effects. If so, what are feelings The answer seems to be that they are information about that behavior (Laird, 1989 Schwarz, 1990). When we feel angry, it is a way of knowing that we are scowling, that we are preparing to attack, that our fists are clenched, that our hearts are pounding, and our palms sweating, as our body prepares itself for attack. When we feel attracted to a political candidate, it is our way of knowing that our actions are leading us toward supporting the candidate. When we experience familiarity or tip of the tongue feelings, it is our way of knowing that we are processing the stimuli fluently and easily, as if we had practiced in the past.

Body Fluid And Sodium Homeostasis

The kidney to ensure that urinary excretion of water is maximally decreased. In addition, the animal will seek out and ingest water when encountered. Analogously, with sodium deficiency, as would occur with diarrhea or profuse sweating, renal mechanisms minimize loss of body sodium. Secretion of the adrenal hormone, aldosterone, is increased and acts on the kidney to ensure that urinary excretion of sodium is maximally decreased. Furthermore, the animal will seek out and ingest sodium-containing substances or fluids when encountered. Behaviorally, thirst and sodium appetite motivate the seeking out and ingestion of water and sodium, respectively.

Oral contraceptive pills OCPs suppress LH and FSH

Danazol (Danocrine) has been highly effective in relieving the symptoms of endometriosis, but adverse effects may preclude its use. Adverse effects include headache, flushing, sweating and atrophic vaginitis. Androgenic side effects include acne, edema, hirsutism, deepening of the voice and weight gain. The initial dosage should be 800 mg per day, given in two divided oral doses. The overall response rate is 84 to 92 percent.

Total Heat Exchange with the Environment

At a given ambient temperature, when other conditions, such as the type of clothing, wind velocity, and relative humidity are constant, Eq. 6 shows that the rate of heat exchange will depend on the temperature of the skin surface (Ts) and the rate of water loss (JH2O). As discussed in the next sections, the temperature of the skin surface is under physiologic control by regulation of cutaneous blood flow, and the loss of water from the body above the normal insensible rate is determined by the rate of sweat production, which is under autonomic control. Thus, the body regulates heat loss or gain with the environment by controlling two variables the cutaneous blood flow, which determines the skin temperature, and the rate of sweating, which, at a given relative humidity, is directly proportional to the rate of evaporative heat loss.

Regulation of Sweat Production

The loss of heat by evaporation is regulated by controlling the rate of sweat production by the eccrine sweat glands. These glands are innervated by sympathetic cholinergic nerves, the firing of which can be stimulated by circulating epinephrine and norepinephrine. The latter hormones produce the sweating associated with stress and anxiety. The rate of sweat production can vary from 0 to about 1.5 L hr in an individual who is not acclimatized and is exercising in a hot environment. When the

Regulation of Heat Production

The rate of heat production by a normal 70-kg person can vary from 75 to 80 kcal hr when sitting still to more than 1400 kcal hr at maximum rates of exercise. To maintain a constant body temperature, this rate of heat production must be matched by an equal rate of heat loss to the environment. Normally, body temperature regulation is accomplished by physiologic regulation of the rate of heat loss by vasomotor activity in the skin and the rate of sweating, as described earlier. However, the rate of heat production may also be varied to contribute to temperature regulation. Many of these changes in heat production are behavioral. When it is very hot, one naturally reduces one's level of activity and thereby decreases heat production. When it is cold, one can increase heat production by such common behavior as clapping hands and stomping feet.

Physiology And Pathophysiology Of Responses To Heat And Cold

Body temperature is regulated by a feedback mechanism that matches net heat loss from the body to the rate of heat production by metabolism. This feedback mechanism is integrated by the hypothalamus, particularly the preoptic anterior area. Although the control of thermo-regulatory processes such as shivering and sweating has been attributed to various other regions of the hypothalamus, discrete localization no longer seems valid. In fact, some thermoregulation occurs even in the absence of brain centers above the medulla. Nevertheless, the most sensitive regulation occurs in the hypothalamus and may be ascribed to an integrative center'' that may or may not have an anatomic correlate. The sensors for the feedback regulation of body heat content or temperature, called thermoreceptors, are located both in the periphery and in the central nervous system. The preoptic anterior hypothalamus contains temperature-sensitive neurons that increase firing with increasing core temperature. Other...

Adaptation to a Hot Environment

When exposed acutely to a hot environment, the hypo-thalamic integrative center acts as described earlier to increase heat loss by causing vasodilation and sweating. Both mechanisms can increase heat output from the body as long as the ambient temperature is below the body core temperature however, when the ambient temperature is higher, the body is constantly gaining heat by radiation and conduction, and the only means of effecting a net heat loss to match the rate of heat production is by evaporation. Thus, sweating is a critical determinant of the body's response to higher environmental temperatures. When the relative humidity is high, however, the amount of heat that can be lost by sweating is limited by the rate of evaporation therefore, body core temperature cannot be kept normal over as high a temperature range in a humid environment. The heat that must be lost is Figure 4 Feedback regulation of body temperature. The integrative center in the hypothalamus compares the body core...

Blood Pressure Is an Unreliable Indicator of the Shock State

In the preceding example the arterial pressure was forced to fall as the dog was bled. Similarly, the arterial pressure invariably falls in the decompensated phase of circulatory shock. Unfortunately, that observation has erroneously caused many to equate shock with hypotension. It must be stressed that an inadequate cardiac output rather than a low blood pressure is the primary lesion in this syndrome. Because the body has many mechanisms for defending the blood pressure (barore-flex, renin-angiotensin system, carotid bodies, anti-diuretic hormone, etc.), the body will meet a sudden drop in cardiac output with an intense peripheral vasoconstriction that may temporarily maintain the blood pressure. The signs of reduced cardiac output can still be seen, however, and will include pale, cold skin as well as low urine production (oliguria) due to reduced renal blood flow. The circulating catecholamines will cause sweating even though the skin is cold. The patient will often complain of...

Methods of search

The following key words were used for a systematic search of the literature hyperhidrosis , focal , localised , palmar , hands , plantar , feet , therapy , treatment , topical , surgery , surgical , aluminiumchloride , anticholinergic drugs , methenamine , bornaprine , methanthelinum bromide , botulinum toxin , triethanolamine , iontophoresis , sympathectomy and sweat . Which interventions reduce sweating efficiently in patients with axillary hyperhidrosis

Surgical interventions sympathectomy

Sympathectomy is the dissection or coagulation of sympathetic nerve nodes and may be done to reduce excessive sweating of the axillae. This procedure is now done by endoscopy (introducing instruments through the skin via a narrow tube) rather than by opening the chest surgically, but a general anaesthetic is still

Other interventions salvia

Salvia is a herb given in the form of tea or tablets. There are no systematic reviews or RCTs of its use, and no evidence for harm. There is insufficient evidence that salvia works in patients with hyperhidrosis. Figure 52.2 Dropping sweat pearls in a 22-year-old woman with grade III hyperhidrosis Figure 52.2 Dropping sweat pearls in a 22-year-old woman with grade III hyperhidrosis Which interventions reduce sweating efficiently in patients with palmar hyperhidrosis

Topical agents Benefits

There are no studies treating patients with palmar hyperhidrosis with exclusively topical agents (10 aluminium chloride, 5 methenamine, 5 glutaraldehyde, 5 propantheline bromide). There was one placebo-controlled RCT of 5 methenamine based on 109 patients with palmar and plantar hyperhidrosis.17 In this study the mean SEM hyperhidrosis score was 1-39 0-11 for patients treated for 28 days with 5 methenamine, compared with 2-52 0-9 in the placebo group (P 0-001). Of the treated patients, 71 109 (65-1 ) rated the result as good or excellent, compared with 19 109 (17 ) of the placebo group. In another study by Phadke et al.,18 60 patients were randomised to treatment with topical 10 methenamine aqueous solution, 5 glutaraldehyde, or tap water iontophoresis with The case series of Ewert et al.11 on the efficacy of 10 aluminium chloride plus 5 propantheline bromide in a solution included patients with axillar hyperhidrosis as well as palmar and plantar hyperhidrosis. In this European study...

Factors Determining the Damage Caused by Electricity

The resistance of the skin varies greatly according to the thickness of the keratin covering the epidermis and the dampness of the skin. The average resistance of skin is between 500 and 10,000 ohms,84 but the soles of the feet and the pads of the hands may offer 1,000,000 ohms resistance when dry. When wet this resistance may be reduced by a factor of 1000.85 Jaffe86 states that sweating can reduce skin resistance from 30,000 to 2500 ohms.

Solid Renal and Juxtarenal Lesions

Wilms Tumor And Child With Nephrectomy

Because of their biologically active nature, neuro-blastomas may secrete a significant amount of cate-cholamines and hence, patients may present with palpitations, tachycardia, hypertension, flushing, and sweating. Intractable diarrhea may result from the secretion of vasoactive intestinal peptide (VIP) (Gesundheit et al. 2004). Another unusual symptom is cerebel-lar ataxia and opsomyoclonus (dancing feet, dancing eyes myoclonic encephalopathy of infants). This syndrome is rare, of unknown etiology, and is usually associated with thoracic lesions (Bousvaros et al. 1986). Malaise, pain, and anemia may be the presenting complaint in up to 60 secondary to metastatic disease.

TABLE 2022 Frequency of Presenting Signs and Symptoms in Hypoglycemia

The term hyperepinephrinemic is a misnomer in that cholinergic factors resulting from autonomic nervous system stimulation are also noted in certain patients. Stimulation of the cholinergic nervous system also occurs and may result in manifestations such as sweating, changes in pupillary size, bradycardia, and salivation.

TABLE 342 Signs and Symptoms of Chronic Pain Syndromes

COMPLEX REGIONAL PAIN Complex regional pain type I, also known as reflex sympathetic dystrophy, and complex regional pain type II, also known as causalgia, may be seen in the ED 2 weeks or more after an acute injury.13 These disorders cannot be differentiated from one another on the basis of signs and symptoms. Type I occurs because of prolonged immobilization or disuse, and type II occurs because of a peripheral nerve injury. These disorders should be suspected when a patient presents with classic symptoms allodynia (pain provoked with gentle touch of the skin), and a persistent burning or shooting pain. Associated signs early in the course of the disease include edema, warmth, and localized sweating. Therefore, it may be difficult to distinguish this disorder from an underlying wound infection or osteomyelitis. Later signs include periods of edema and warmth that alternate with cold, pale, cyanotic skin and eventually atrophic changes. Complex regional pain is an important diagnosis...

Neuroglycopenic Syndromes

This syndrome comprises a collection of vague symptoms such as feelings of alternating hot and cold, feeling unwell, anxiety, panic, inner trembling, unnatural feelings, blurring of vision, and palpitations, any or all of which may be accompanied by objective signs of facial flushing, sweating, tachycardia, and unsteadiness of gait. There is no particular order in which these features occur, nor are they constant. Nevertheless, patients on insulin therapy for diabetes, in whom they are common, rely upon them to warn of more severe neuroglycopenic impairment culminating in loss of consciousness. These patients can be taught to abort progression of symptoms by eating carbohydrate.

Insulinoma Clinical Features

Patients with insulinoma develop profound hypoglycemia during fasting or after exercise. The clinical picture includes the signs and symptoms of neu-roglycopenia (anxiety, tremor, confusion, and obtundation) and the sympathetic response to hypoglycemia (hunger, sweating, and tachycardia). These bizarre complaints initially may be attributed to malingering or a psychosomatic etiology unless the association with fasting is recognized. Many patients eat excessively to avoid symptoms, causing significant weight gain. Whipple triad refers to the clinical criteria for the diagnosis of insulinoma (a) hypoglycemic symptoms during fasting, (b) blood glucose levels less than 50 mg dL, and (c) relief of symptoms after administration of glucose. Factitious hypoglycemia (excess exogenous insulin administration) and postprandial reactive hypoglycemia must be excluded. A supervised, in-hospital 72-h fast is required to diagnose insulinoma. Patients are observed for hypoglycemic episodes and have 6-h...

The Physiology Of Nausea And Vomiting

Emesis Mechanism

In the throat or stomach or as a sinking sensation in the epigastrium the symptoms may include malaise, drowsiness, anxiety, and reduced vigilance. It is invariably accompanied by autonomic changes including vasomotor disturbances, causing vasocon-striction-pallor and pupil dilation, tachycardia, salivation and sweating, and a relaxation of the lower part of esophagus and abdominal muscles. The latter tends to increase tension of the gastric and esophageal muscles, which may directly contribute to the sensation of nausea. In the acute stage it is perceived as an unpleasant and temporary effect that precludes other mental and physical activity. It frequently precedes vomiting (although either may occur alone) and usually is relieved by an emetic episode, which the subject or patient may welcome. The presence of chronic nausea severely reduces the quality of life.

Nature Of The Catecholaminergic Systems

In this condition urinary excretion of free catecholamines is also increased. The major clinical manifestations of this illness are high blood pressure, increased heart rate, sweating, rapid breathing, headaches, and the sensation of impending doom.

Chemicals Increasing Arousal

An additional complication in these studies is that the meaning of drug effects is often unclear. All these drugs were used in Schachterian experiments because they produce peripheral changes that mimic autonomic arousal, but they may also have effects in the central nervous system. For example, there is little dispute that caffeine in substantial doses causes peripheral arousal symptoms, such as increased heart rate, sweating, and flushing, and it also produces anxiety feelings (Newman, Stein, Tretlau, Coppola, & Uhde, 1992). The question is whether the anxiety is mediated by the peripheral symptoms or whether the two are produced in parallel, with the caffeine causing the anxiety directly by its effects in the brain. (In the case of epinephrine, this explanation is less probable, because peripheral epineph-rine is not thought to cross the blood-brain barrier, and epinephrine is metabolized very rapidly, so that the effects probably all occur peripherally.)

History of Neuroanatomical Modeling of Fear and Anxiety

General was hypothesized by Papez in 1937. In 1949, MacLean coined the term limbic system, integrating Papez's original circuit (hypothalamus, anterior thalamus, cingulate gyrus, and hippocampus) and other anatomically and functionally related areas (amygdala, septum, and orbitofrontal cortex). Over the years, various regions have been added or removed from this emotion processing circuit. Papez hypothesized that several telencephalic and diencephalic structures which form a border ( limbic border) around the diencephalon constituted a circuit, which controlled the emotions. He suggested that blockage of information flow at any point along this circuit would cause disorders of affect (i.e., mood). Removal of the cerebral cortex of the cat, leaving only subcortical regions including amygdala, thalamus, hippocampus, and hypothalamus, resulted in accentuated fearful responses to potentially threatening or novel stimuli, accompanied by signs of diffuse sympathetic activation such as...

Neuroendocrine Autonomic And Motor Responses

Autonomic, and motor response to threat. They also need to account for the pathological reactions that result in anxiety-related signs and symptoms. The organism must rapidly effect peripheral responses to threat, which are mediated by the sympathetic and parasympathetic systems. Structures involved in these responses include the amygdala, LC, hypothalamus, PAG, and striatum. The hypothalamus coordinates the information it receives from various brain regions to patterns of sympathetic responses. Stimulation of the lateral hypothalamus results in sympathetic system activation with increases in blood pressure and heart rate, sweating, piloerection, and pupil dilatation. Activation of the paraventricular nucleus of the hypothalamus promotes release of a variety of hormones and peptides. Its activation in anxiety and fear is thought to rely on stimulation from hypothalamus via projections from the amygdala and LC. The PAG also serves to regulate the sympathetic function, which accounts...

TABLE 1425 Adverse Effects Precautions and Contraindications of Antimalarial Drugs

Quinine and quinidine are potent inducers of insulin release and may cause severe hypoglycemia. Sudden changes in orientation, sweating, tremor, tachycardia, or anxiety should prompt measurement of plasma glucose concentration. Cinchona alkaloids are myocardial depressants, so cardiac monitoring is needed during administration. Terminal treatment with primaquine is not needed in patients with P. falciparum malaria, due to the absence of dormant asexual forms in the liver.

TABLE 1872 Risk Factors for Serious Heat Injury Heatstroke

Extremes of age are risk factors for heat illness. Infants and children are at increased risk of heat illness due to a greater surface area-mass ratio, the production of more metabolic heat per mass unit, and a decreased sweating capacity as compared with adults. The elderly are generally unable to disperse heat as well as younger people due to the frequent presence of neurovascular and cardiovascular disease, the use of multiple drugs that affect heat dispersal, increased obesity, decreased cutaneous blood supply, poorer physical conditioning, and reduced sweat production. By diminishing sweating ability, many skin diseases can decrease the ability to disperse heat. Scleroderma, cystic fibrosis, eczema, psoriasis, and burns decrease sweating ability. Congenital diseases, such as ectodermal dysplasia, involving the sweat glands increase risk of heat injury. Interestingly, even the presence of simple heat rash has been shown to decrease sweating. Histologic studies of skin with heat...

The Meaning of Alternative and Conventional

What is now classified as either conventional or alternative medicine was not always so designated. Formerly alternative medical theories and practices have moved into conventional standing for example, the use of antioxidant vitamins and other dietary remedies for both prevention and therapy (Steinberg Stampfer et al. Rimm et al.). Formerly conventional medicine is in the alternative category this includes most nineteenth-century therapies like baths, massage, and purgatives. Between the Renaissance beginnings of modern orthodoxy and its dominance in the twentieth century, conventional medicine was practiced by relatively few university-trained physicians. Most sick people during these centuries got along on remedies developed under older theories. Even university physicians used bleedings and purgings, sweating, and vomiting in addition to quinine and digitalis not much separated scientific orthodoxy from nonscientific alternative practice when it came to therapeutic interventions....

Traditional Versus Virtual Reality Therapy VRT

During VR exposure treatment, when patients are put into VR environments, their fears get activated patients begin to experience physical reactions when in feared situations, such as sweating, butterflies in the stomach, and weak knees. Although the reactions are initially rather strong, with the help of the virtual reality therapy, most patients usually recover from their fears quite quickly. Progressively, they are also more able to face their fears in real life. Virtual reality exposure therapy places the client in a computer-generated world where they experience the various stimuli related to their phobia. The patient wears a head-mounted display with small TV monitors and stereo earphones to receive both visual and auditory cues. VR Therapy tends to cost less than vivo exposure. The phobic experience is in total control without leaving the therapist's office and the segments of any phobia can be repeated, allowing the patient to gradually reduce fear and anxiety. People once...

Barbiturate Abstinence Syndrome

Abrupt discontinuation of barbiturates in a chronically dependent user will produce minor withdrawal symptoms within 24 h and major life-threatening symptoms within 2 to 8 days. The severity of the withdrawal reflects the degree of physical dependence and drug half-life. Cessation of short-acting barbiturates results in more severe abstinence symptoms than stopping long-acting barbiturates. This is consistent with the clinical observation that the brain has more time to adapt to declining drug concentrations that are gradual. Clinical manifestations of abstinence mimic those described for alcohol withdrawal. Minor symptoms include anxiety, restlessness, depression, insomnia, anorexia, nausea, vomiting, muscle twitching, abdominal cramping, and sweating. Major symptoms include psychosis, hallucinations, delirium, generalized seizures, hyperthermia, and cardiovascular collapse. 3415

TABLE 1221 Differential Diagnosis of Vomiting

Other causes of acute diarrhea are uncommon but must be considered. In agricultural areas, poisoning with anticholinesterase insecticides, organophosphates, and carbamates must be considered, especially if diarrhea is accompanied by profuse sweating, lacrimation, hypersalivation, and abdominal cramps. Vomiting and diarrhea may also be a nonspecific presentation for other infectious diseases, such as otitis media, urinary tract infection, or other more serious conditions, including intussusception, malrotation, increased intracranial pressure, and metabolic acidosis.

Differential Diagnosis

Carcinoma of the thyroid, pheochromocytoma, and primary hyperparathyroidism. Serum calcitonin levels serve as a useful tumor marker for medullary carcinoma of the thyroid. A history of headaches, excessive sweating, tachycardia, palpitations, or hypertension should alert the clinician about the possibility of an associated pheochromocytoma. Measurement of 24-hour urinary levels of catecholamines, metanephrines, and vanillylmandelic acid is the best screening test for pheochromocytoma.

Katie M Castille and Maurice F Prout

A discrete period of intense fear or discomfort, in which at least four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes palpitations, pounding heart, or accelerated heart rate sweating trembling or shaking sensations of shortness of breath or smothering feeling of choking chest pain or discomfort nausea or abdominal distress feeling dizzy, unsteady, lightheaded, or faint derealization (feeling of unreality) or depersonal-ization (being detached from oneself) fear of dying pares-thesias (numbness or tingling sensations) and chills or hot flashes. Limited-symptom attacks require the same criteria, except that fewer than four symptoms of panic are required.

Well Being and Handling

Squeeze chute, sweating in horses when there is little physical exertion, flapping in caged layers, and a horse rearing when he is suddenly startled. Isolation is a strong stressor, and a single cow or lamb may run into a fence or try to jump it when it is separated from its herdmates.

TABLE 2061 Causes of Thyrotoxicosis

Dizziness Wih Hyperthyroid

Classically, patients with hyperthyroidism may complain of heat intolerance, palpitations, weight loss, sweating, tremor, nervousness, weakness, and fatigue ( Table 2.0.6-2). An individual with hyperthyroidism who is exhibiting only mild symptoms may be safely referred for further evaluation as an outpatient. Clinical suspicion of hyperthyroidism is confirmed by thyroid function tests. An elevated free T4 and a low or undetectable TSH level is consistent with a diagnosis of hyperthyroidism. In some cases of Graves' disease, the T4 level may be normal and the TSH level decreased but the patient appears to be thyrotoxic. A T 3 level should be determined to rule out T3 toxicosis. Patients with hyperthyroidism secondary to pituitary adenomas will have elevated TSH.

Predisposing Factors for Heat Illness

Certain segments of the population are at greater risk for dehydration and subsequent heat illness than others (Table 5). The predisposing factors for dehydration and heat illness in these populations are obesity (extra exertion, heat production, and sweating are required to move a larger mass), insufficient heat acclimation (associated with reduced sweating and evaporative cooling and increased cardiovascular and renal stress), socioeconomic barriers to cooling methods (fans, air conditioners, etc.), pyrexial illness (fever), drug and alcohol abuse (interferes with fluid balance and thermoregulation), physical work in environments that contribute to dehydration (heat sweating cold respiratory water loss and diuresis altitude respiratory water loss and

Benzodiazepine Abuse And Dependence

Reported withdrawal manifestations include anxiety, irritability, insomnia, nausea, vomiting, tremor, sweating, and anorexia. Serious manifestations, including confusion, disorientation, psychosis, and seizures, also have been reported. For patients with an acute organic brain syndrome, a history of possible benzodiazepine withdrawal should always be pursued. Withdrawal reactions may be avoided by dose tapering. Treatment of withdrawal reactions may be accomplished by drug substitution or by reintroduction of a benzodiazepine and subsequent tapering.

Phencyclidine and related compounds

Both phencyclidine and ketamine are arylcyclohexylamines with stimulant, depressant, hallucinogenic and analgesic properties. In man, small doses produce signs of intoxication, as shown by staggering gait, slurred speech and nystagmus. Higher doses also cause sweating, a catatonic rigidity and disorientation drowsiness and apathy may also be apparent. Such a state is sometimes accompanied by physical aggression. As such drugs are potent amnestic agents, the individual may be unaware of violent acts on recovering from the effects of the drug. Increasing doses lead to anaesthesia and eventually coma. Heart rate and blood pressure are elevated and the individual shows hypersalivation, fever and muscular rigidity. Convulsions may occur at high doses. The effects of a single dose may last 4 to 6 hours perceptual disturbances, disorientation and intense anxiety commonly occur.

Personality Differences by Gender

A young woman who is cutipado (bewitched) may experience a dissociative hysterical episode during which she is obviously out of control, accompanied by writhing, mild seizures, screaming, shaking, clenching her teeth, sweating, moaning, and beyond any social interaction.

The role of consumers

Consumer involvement has been a strong feature of the CSG from the very beginning. This is because skin disease greatly affects the quality of life of the individual and because much of the trial work in skin disease has been dominated by answering questions that are important to the pharmaceutical industry. Consumers help us to redress that imbalance. At present (Autumn 2002) the skin group has 55 groups working on topics, both common and rare, such as acne, alopecia, bullous pemphigoid, eczema, excessive sweating, psoriasis, skin cancer and vitiligo. About 30 active consumers are involved at many

Theoretical Bases

Have been synthesized in the emotional processing model (developed by Edna Foa and Michael Kozak). According to this model, emotions are represented in networks (structures) stored in long-term memory. Consider, for example, the network underlying a person's social phobia. The network contains stimulus information (e.g., authority figures, oneself as a social object), response information (e.g., representations of one trembling, sweating, blushing, and fleeing), and meaning information (e.g., concepts such as danger and threatening ). The elements of information are linked together. For our social phobic, authority figures is linked to threatening (a stimulus-meaning link) self is linked to weak and ineffectual (another stimulus-meaning link) authority figures is linked to blush, trembling, and flee (stimulus-response link) and threatening is linked to fear (meaning-response link). Thus, each emotional network consists of an interconnected matrix of stimulus, response, and meaning...

Other Autonomic Biofeedback Methods

A few other types of feedback have been reported that seem to indicate learned regulation of the ANS. Some reports of control of sweat gland activity at the extremities appear credible. Hyperhydrosis is a disorder of excessive sweating. Biofeedback is used, with the signal usually taken from the palms of the hands, to reduce excessive activity. Whether the reduction is an example of direct autonomic control or is secondary to

Clinical Presentation

When the major illness occurs, most commonly the spinal cord anterior horn cells are affected, causing asymmetric proximal limb weakness, especially in the legs. Spinal polio is characterized by flaccid and weak muscles, absent tendon reflexes, and fasciculations. Although pain, paresthesias, and transient sensory abnormalities are noted by polio patients, sensory deficits are usually not found on clinical examination. Maximal paralysis usually occurs within 5 days, and muscle wasting then occurs over several weeks. Autonomic dysfunction, including sweating disturbances, urine retention, delayed gastric emptying, and constipation, is commonly found. Nearly all spinal polio patients will demonstrate improved motor function, with paralysis resolution occurring within the first year after the acute infection.

Epidemiology and Circumstances

Low-voltage injuries occur under various circumstances (e.g., use of a faulty tool or appliance, repair of electrical equipment, contact with faulty wiring or an energized object 142,163,182,183 ). About two-thirds of the fatalities are to individuals between the ages of 15 and 40 yr, and there is a male predominance (174). Failure to ground tools or appliances (i.e., a conducting connection between an electrical circuit or piece of equipment and the earth or its substitute) and using devices near water are risk factors (142,181). The victim may be unqualified to do electrical work (183). High-voltage injuries typically occur in the workplace, predominantly involving men (142,147, 158,161). Electrocuted workers tend to be younger than victims in other types of occupational fatalities (148,182,184). The highest number of workplace electrocution deaths happen in the summer owing to increased outdoor activity decreased use of heavy insulating clothing, including gloves and boots and...

Polysynaptic Withdrawal Reflex

In a chronic spinal state, seen in paraplegic patients, a mass reflex response will be seen after even minor noxious stimulus applied to the skin (such as pinching). The mass reflex involves the rapid spreading of reflex activity from one centre to another, accompanied by autonomic involvement. Evacuation of bladder and rectum, sweating, pallor and swings of arterial pressure will be seen. This is applied to some effect in chronic spinal patients to give a degree of continence control with variable success.

Potassium K

Elemental K+ is the major intracellular cation of the body. The normal intracellular concentration is 100 to 150 meq L, while the normal extracellular concentration is 3.5 to 5.0 meq L. The total body K+ store ranges from 35 to 55 meq kg or 3500 meq in a healthy 70-kg man. Approximately 70 to 75 percent of total body K+ is found in muscle tissue therefore, in patients with severe muscle wasting, total body stores may be as low as 20 to 30 meq kg. Daily intake of K + ranges from 50 to 150 meq. Foods high in K+ include oranges, grapefruit, tomatoes, bananas, avocados, and raisins. K+ is excreted predominantly by the kidneys (90 percent) and with some loss in the stool and by sweating. K+ is filtered freely through the glomerulus and then reabsorbed in the proximal and ascending tubules. It is secreted in the distal tubule in exchange for Na+. In healthy individuals, the kidneys are able to excrete up to 6 meq kg per day. Even in severe K + deficit, 5 to 15 meq L may be excreted.

Hypochloremia

Hypochloremia usually manifests when levels are less than 95 meq L. It is usually caused by excessive diuresis, vomiting, or nasogastric tube drainage. Volume loss results in alkalosis. When Cl - is lost via the urine or gastrointestinal fluids, there is an increase in both Na + and HCO3- resorption secondary to the volume contraction. Na+ may be resorbed in the kidney with either Cl- or HCO3- acid. When Cl- levels become low, the Na+ is exchanged for H+, and HCO3- is accentuated in the renal tubules. This loss of H+ in the urine further worsens the alkalosis. There is also an increased delivery of Na + to the distal nephron for H+ and K+ exchange. This exchange potentiates the loss of H+ and K+ in the urine, exaggerating the alkalosis further. Secondary skin losses from severe sweating or burns, along with states in which sweat has excessive Cl- (cystic fibrosis), often lead to a metabolic alkalosis also.

Contributing Factors

Water is lost through a variety of avenues, including urine, feces, breath, and sweat. In illness or disease, excessive diuresis, diarrhea, and or vomiting are the main pathways of water loss. During exercise or heat exposure, sweating is the primary mechanism for dehydration. Significant water loss may be stimulated by cold- or altitude-induced diuresis. Additionally, some prescription drugs and over-the-counter herbal products have diuretic effects that exacerbate water loss. Under normal conditions, the body regulates its water contents tightly over a 24-h period (approximately 200 ml) however, over short periods, water loss can significantly exceed water gain (Figure 3).

Elderly and Children

Aging is associated with decreased thirst, sweating, and renal responses that place the elderly at high risk during periods of extreme shifts in environmental temperature. Dehydration is a common cause for hospitalization and death in the aged population. Statistics from a 1991 U.S. survey of Medicare recipients revealed that almost half of the Medicare beneficiaries hospitalized for dehydration died within 1 year of admission. Older men and women may have a higher osmotic operating point (the point at which the thirst sensation is triggered), which may contribute to hypovolemia. Certain behavioral factors may also influence drinking patterns in older adults who may wish to avoid the physical difficulty associated with trips to the bathroom. Besides contributing to an increased risk for hyperthermia, dehydration also alters the effective dosage of medications through plasma volume changes, leading to further medical complications in the elderly. Dehydration in the elderly often...

Managing the Fever

Studies have shown that sponging and antipyretics used together are more effective than either modality used alone. Acetaminophen, ibuprofen, and aspirin are equally effective and appear to work centrally to block prostaglandin synthesis. Heat is lost through peripheral vasodilatation and sweating.

Thermal Challenges

Thermal challenges, either hot or cold, are common to all animals. Typically, these challenges to homeostasis are nonconsequential. The body's physiologic mechanisms respond appropriately by either evoking mechanisms to create heat, such as increasing metabolism, or to decrease heat load by sweating or diverting blood flow. Behavioral adjustments are made in concert with the physiologic mechanisms. Swine will seek a wallow during periods of elevated temperatures to cause evaporative cooling (swine must use an external water source because they do not sweat), while cattle will seek shade and may stand in water to cool themselves. The inability of livestock to appropriately warm or cool themselves has severe consequences on health. Mortality and morbidity due to hypothermia and hyperthermia can be high. Typically, livestock are most susceptible to these conditions when being transported. Wind chill will greatly reduce the ability of livestock to maintain body temperature during

Observation

Observation of the exerciser by the exercise leader and assistants is a vital aspect of monitoring. The leader and assistants should monitor the CR exerciser continuously for quality of movement, excessive sweating, shortness of breath, skin colour and general fatigue. As part of the teaching skills the leader and assistants should scan the group and also maintain face and eye contact. These can be indicators of overexertion and a need to adapt or reduce exercise intensity. It is important that there is continuity of exercise leader to ensure that the leader s becomes familiar with the participants and how they react to exercise. (Chapter 7 will explore observation further.)

Fluid Requirements

Note that despite a fourfold increase in body weight, the water requirement does not even double this reflects the relatively small increase in body surface area that accompanies the increase in mass in growing babies. Hypermetabolic states increase the requirement for free water. The most common of these are fever (which increases the free water requirement by approximately 12 percent per degree of elevation in temperature centigrade) and increased sweating.

The Adult

Long-standing large goiter may require surgery to reduce pressure in the neck. Long-standing goiter may also be associated with iodine-induced hyperthyroidism (IIH) due to an increase in iodine intake. IIH is associated with nervousness, sweating, and tremor, with loss of weight due to excessive levels of circulating thyroid hormone. This condition no longer occurs following correction of iodine deficiency and therefore is within the spectrum of IDD.

Nomenclature

Iodine deficiency in the diet Hypothyroidism The result of a lowered level of circulating thyroid hormone causing loss of mental and physical energy Hyperthyroidism The result of excessive circulating thyroid hormone with nervousness, sweating, tremor, with a rapid heart rate and loss of weight ICCIDD International Council for Control of Iodine Deficiency Disorders-an international non-government organization made up of a network of 700 health professionals from more than 90 countries available to assist IDD elimination programs in affected countries

Milk Composition

The casein fraction from cow's milk, usually obtained by rennin precipitation, is used in cheese making, whereas the whey has a multiplicity of uses, most notably as the base for infant formula. Urea and other nonprotein nitrogen components of milk are a source of nitrogen for amino acid and protein synthesis. Isotope utilization studies indicate that on average 10-20 of urea nitrogen is converted into protein by breast-fed infants. Significantly higher utilization rates, however, have been measured in children recovering from infection, suggesting that alterations in urea nitrogen utilization may be a homeostatic response. Human and bovine milk differ primarily in their concentrations of lactose, mono- and divalent ions, and casein levels and the existence of antiinfectious agents in human milk (Table 1). These differences are related to the specific needs of these species. Human milk, for example, possesses higher concentrations of lactose and lower divalent ion concentrations than...

Sleep Terrors

Sleep terrors are episodes arising abruptly from sleep of apparent terror. Screaming and agitated behavior with attempts to leave the bed or the room are characteristic, and tachycardia, mydriasis, and sweating are common. The patient is usually inconsolable and partly or completely unresponsive. Injury during the episode is a potentially serious complication due to extreme agitation and escape behavior, and patients may react violently to attempts to restrain them (Kales et al., 1980b). Morning amnesia is characteristic although some patients vaguely recall a terrifying image or situation and occasionally have more detailed recall of dream-like events. Sleep terrors occur once per week or more frequently in about 1-2 of children between the ages of 6 and 14. Some persons continue to have sleep terrors into adulthood and in occasional cases, the onset of the disorder is during the adult years.

Acclimatization

Through acclimatization, the body adapts to a more efficient response to intense heat exposure. Acclimatization results from repeated bouts of moderate exercise in a hot environment. During acclimatization, physiologic changes occur that result in sweating at lower temperatures, a higher sweat rate, an increase in peripheral blood flow, and a decreased sodium chloride concentration in sweat and urine, due to increased aldosterone secretion. The end result of these physiologic changes includes a decreased heart rate, a decreased core body temperature, increased plasma volume, increased exercise tolerance time, and decreased perceived exertion.78 Acclimatization requires repeated exposures to heat usually 1 to 4 h day for 14 days. The results of acclimatization are transient and are lost if heat

Heat Cramps

These are painful, involuntary, spasmodic contractions of skeletal muscles, usually those of the calves, although they may involve the thighs and shoulders. Heat cramps usually occur in individuals who are sweating liberally and replace fluid loss with water or other hypotonic solutions. Cramps may occur during exercise or after a latent period of several hours. Unconditioned or nonacclimatized individuals who are just starting manual labor in a hot environment are at high risk for developing heat cramps. Although heat cramps usually do not cause significant morbidity and are considered to be self-limiting, the pain associated with them can readily result in an emergency department visit. In fact, the pain is commonly recalcitrant to the effects of narcotics alone.

Spinal injuries

Spinal shock is the term used to describe the early phase lasting several weeks after injury muscles are flaccid and there is also paralysis of the bladder and intestinal tract. As spinal shock wears off, distal spinal cord function returns but is shut off from the brain. Spinal cord reflexes return, the major one being the mass reflex, that is limbs reflexively withdraw on stimulation, the rectum and bladder evacuate and there is profuse sweating.

Peripheral

Nicotine is the most prevalent exogenous agent active at the nicotinic receptors. It preferentially affects autonomic ganglia rather than the neuromuscular junction, and causes central stimulation. When an excess of acetylcholine occurs such as when acetylcholinesterase is blocked by an anticholinesterase such as neostigmine or organophosphorus compounds there will be nicotinic stimulation of the ganglia. Stimulation of autonomic ganglia has no clinical application but the following effects will be seen vasoconstriction, hypertension, sweating and salivation. Gut motility may increase or decrease.

Clinical Effects

Drugs causing ganglion blockade reduce blood pressure by a combination of vasodilatation and inhibition of compensatory effects such as tachycardia. The vasodilatation affects both arterioles (after-load) and venules (pre load). The effect on the capacitance vessels reduces venous pressure and consequently intra-operative venous oozing. In general, use, ganglion blockade causes postural hypotension as the venous tone does not increase to compensate for the upright position. Ganglion blocking drugs also reduce sweating, secretions and gut motility. They interfere with bladder emptying and may cause urinary retention.

Excited Delirium

The violent and bizarre behavior associated with this disorder often results in police attendance with subsequent attempts at restraint. When death occurs during such attempts, the inevitable questions arise as to the degree to which the restraint, the injuries resulting from the violent behavior, or the condition itself contributed to the mechanism of death. Similarities have been noted between excited delirium and neuroleptic malignant syndrome, leading some authors to propose that the processes are related to similar abnormalities of dopamine receptors. However, Karch16 suggests that different processes are responsible because excited delirium can occur in schizophrenic patients and in those with bipolar effective disorder, even when they are not taking dopaminergic agents. It is interesting to note that some of the features of neuroleptic malignant syndrome, including altered consciousness, sweating, hyperthermia, and autonomic instability, overlap with the serotonin syndrome.37...

Fever

Endogenous pyrogens released from leukocytes in response to exogenous pyrogens released by infectious microorganisms cause the local release of products of arachidonic acid metabolism such as prostaglandin E2 and thromboxanes. In the hypothalamus, these products cause an increase in the set-point temperature. Because the core temperature is then less than the set-point, the integrative center responds by increasing heat production through shivering, decreasing heat loss by cutaneous vasoconstriction and suppressing sweating. The increased heat production and decreased heat loss lead to an increase in core temperature until the new set-point is reached.

Background

Sweating helps control body temperature.1 However, excessive sweating (hyperhidrosis) can cause physical and social problems. People with excessively sweaty palms may not be able to handle paper without soaking it. They may also experience social stigmatism and discrimination, especially when shaking hands, since their hands may be wet and clammy. People who suffer from excessive underarm sweating have to change clothes frequently. Their clothes may show stains and may not last long (Figure 52.1). Since sweating is commonly associated with insecurity, people with excessive localised sweating may be stereotyped as lacking in confidence. Figure 52.1 A 24-year-old man with excessive axillary hyperhidrosis. Note the significant sweat stains around the axillae. Figure 52.1 A 24-year-old man with excessive axillary hyperhidrosis. Note the significant sweat stains around the axillae.

Diagnostic tests

Focal hyperhidrosis is a clinical diagnosis, diagnosable by a hand shake or stained clothes. In severe localised excessive sweating, pearls of sweat form even when the person is resting. In addition, the amount of sweat and the area affected can be measured. The amount of sweat can be measured by gravimetry (milligrams of sweat produced over a period of time). However there is no standardisation on the time period for which sweat should be collected. In the two randomised clinical trials (RCTs) on botulinum toxin A, Heckmann et al.6 report the sweat rate in mg minute whereas Naumann et al.7 used units of mg 5 minutes. In other trials a volume per 10 minutes has been used.8,9 The area that is affected by increased sweating can be defined by the ninhydrin test or the iodine starch test. Both tests use a change in colour to indicate the hyperhidrotic area. Studies on validity or reproducibility are not available for either test.

Tinea Pedis

The incidence of tinea pedis in industrialized countries has been estimated at 10 percent of the population. It has been estimated that in high-risk patients as many as 70 percent are affected. In the United States, 240 million per year is spent on products used to treat tinea pedis. Factors that predispose to infection include hot and humid climate, occlusive footwear, infrequent changes of socks or shoes, hyperhidrosis of the feet, conditions that lead to maceration of the feet, and repeated exposure of the feet to fungi combined with some form of minimal trauma. In high-risk groups, such as the elderly and immunocompromised patients, infections can become chronic and resistant to treatment and can disseminate. Tinea pedis can usually be prevented with proper hygiene. These measures include daily bathing and drying of feet, wearing absorbent socks and changing them daily, wearing shoes that breathe and changing them daily, wearing different footwear for sporting activities, and...

Pheochromocytoma

Pheochromocytoma Skin

Pheochromocytomas account for approximately 0.1-1 of hypertensive patients. While hypertension is the most common clinical feature of a pheochromocytoma, hypertension may be episodic in one third of patients and absent in one fifth.17 In a hypertensive patient, the triad of paroxysms of headache, palpitations and sweating is classic but not diagnostic because the prevalence in this group of patients is only 5.9 .18 The clinical picture, however, may be obscure. A significant proportion of patients may present with atypical symptoms including anxiety, tremulousness, abdominal pain and vomiting, weight loss, visual disturbances, shortness of breath or cardiac failure. The initial finding may be the consequence of hypertension such as a myocardial infarction or stroke.19,20 For some patients with pure epinephrine-producing tumors the initial presentation may be hypotension or shock due to epinephrine-mediated peripheral vascular dilation.21 Death from unsuspected pheochromocytomas is not...

Insulin

Hypoglycemia may be an end product of an endocrinopathy (e.g., adrenal insufficiency, hyperthyroidism, or hypopituitarism) or the result of an exogenous substance, such as ethanol, salicylate, oral hypoglycemics, and insulin. Hypoglycemia may result from a common stress pathway of decreased gluconeogenesis, as seen during sepsis or Reye syndrome. Adrenergic signs of palpitations, hunger, and sweating are seen at levels less than 60 mg dL. Irritability, confusion, seizures, and coma occur at levels of 40 mg dL or less. Infants and children are prone to develop ketotic hypoglycemia with fasting, especially with infections in early infancy. AMS from hyperglycemia is rare in children. The most common cause of hyperosmolar central nervous system dysfunction is diabetic ketoacidosis.

Diabetes

Up to 45 percent of insulin-dependent diabetics will require evaluation for severe hypoglycemia at some time during the course of their pregnancy. 2 Hypoglycemia generally presents as sweating, tremors, blurred or double vision, weakness, hunger, confusion, paraesthesias, anxiety, palpitations, nausea, headache, or stupor. Hypoglycemic episodes are generally well tolerated by the fetus. Mild hypoglycemia that is, a glucose

Case study

John, aged 37, was admitted from his place of work to the hospital A&E department at 10am complaining of severe abdominal pain and nausea, tachycardia and sweating. He was examined by a doctor from the colorectal team who decided that John had an acute appendicitis and would be prepared for theatre immediately.

Nervemuscle junction

Ness, usually bilateral, is noted in half the cases. In 20 of cases weakness becomes so profound that respiratory assistance is required. Tendon reflexes are generally abolished. Ataxia may be prominent early in the disease and can cause confusion as to the diagnosis. Sensory symptoms are in general less prominent than motor ones, although almost all patients complain of subjective tingling or numbness, usually in a distal symmetric glove- and stocking-like distribution. Objectively demonstrable sensory loss is less extensive than the subjective complaints would lead one to anticipate. Significant muscular or neuropathic pain occurs in 30 of cases. Autonomic function is frequently abnormal and may cause wide fluctuations in blood pressure, pulse, abnormalities of sweating, and gastric atony.

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