How I Healed my Hyperhidrosis
People with diabetes are better at estimating their blood glucose in natural, everyday situations, as opposed to clinical laboratory settings (Cox et al., 1985). In some ways this is surprising as natural hypoglycaemia often occurs at a time when it is unexpected. In this situation, attention toward symptoms will not be as actively directed toward detection as in the laboratory setting where it is usually anticipated. Furthermore, hypoglycaemia in everyday life occurs on the background of other bodily feelings and must be separated from other causes of the same symptoms. For example, exercise and various acute illnesses can provoke sweating in people with diabetes, independently of their association with hypoglycaemia. sweating (82 ) Most, if not all, of the symptoms of hypoglycaemia can be explained by other physical conditions. Therefore, correct symptom detection may be usurped by incorrect attribution of the cause. For example, having completed some strenuous activity, an athlete...
Sudden, severe, central or left-sided chest pain. This is commonly described as pressure, squeezing, breathlessness with sweating, and sometimes sickness and vomiting. Some people pass out. Some people feel as if an elephant is sitting on their chest . The symptoms last at least 20 minutes and the pain in the chest may also be felt in the throat, jaws, and arms.
X-linked recessive form of the hyper-IgM syndrome caused by a mutation in IkB kinase y subunit NF-KB essential modulator (NEMO) and associated with hypohidrotic ectodermal dysplasia (conical teeth, inadequate sweating, and poor antibody production to polysaccharide antigens).
Myocardial infarction causes pain which is similar 10 angina in site, radiation and character but differs in that it is not necessarily precipitated by exertion, persists at rest and is usually much more severe (Table 3.9). Autonomic symptoms such as sweating, nausea and vomiting may be associated with myocardial infarction. Patients may also be breathless, reslless and distressed and may experience a sensation of impending death, angor amini. Conversely, painless myocardial infarction is not uncommon particularly in elderly patients and those with diabetes. Such patients may present with complications such as cardiac failure or an arrhythmia.
Because this group of drugs may have widespread effects, the nurse must closely observe all patients for the appearance of adverse drug reactions. In hot weather, sweating may decrease and may be followed by heat prostration. The nurse observes the patient at frequent intervals for signs of heat prostration (see Adverse Reactions), especially if the patient is elderly or debilitated. The nurse withholds the next dose of the drug and contacts the primary health care provider immediately if heat prostration is suspected. The nurse observes the elderly patient receiving a cholinergic blocking drug at frequent intervals for excitement, agitation, mental confusion, drowsiness, urinary retention, or other adverse effects. If any of these should occur, it is important to withhold the next dose of the drug and contact the
Salagen (pilocarpine hydrochloride) tablets are indicated for the treatment of symptoms of xerostomia from salivary gland hypofunction. As a cholinergic parasympathetic agent, pilocarpine can increase secretion of the salivary glands. The usual initial dose is 5 mg tid. It is contraindicated in patients with asthma, iritis, and narrow angle glaucoma. Side effects include abdominal cramps and sweating. Lubrication of the mouth and mild secretagogs, such as lemon-flavored juice or lubricating agents proper (water, methylcellulose), are useful. More potent secretagogs may exacerbate the signs and symptoms of parotitis. Prevention of states of dehydration in SS is very important, as dehydration may enhance the formation of parotid ductal calculi. Avoidance of drugs that may aggravate oral dryness (e.g., narcotics, antihistamines, anticholinergics) is also important.
Patients with rheumatic fever usually do not have chills. Chills are common in patients with bacterial endocarditis. Symptoms of fever, chills, or sweats in any patient with a heart murmur should lead one to suspect infective endocarditis (see Chap. 73). A history of valvular heart disease is not a prerequisite for a diagnosis of endocarditis, since previously normal valves become infected. A history of recent dental work, genitourinary surgery, or illicit drug use increases the suspicion of infective endocarditis. Fever may accompany pericarditis. Myalgia, chills, and fever on rare occasions may be related to MI, presumably because of some form of immunologic response to the necrotic myocardial tissue. An intracardiac tumor (myxoma) may produce systemic symptoms in the absence of infection. Low-grade fever in a patient with heart failure may be a sign of pulmonary emboli.2 A profuse cold sweat mediated by sympathetic discharge often accompanies early stages of acute MI. Excessive...
Most surgeons rely on a postoperative glucose tolerance test with growth hormone (GH) levels. Unless special arrangements exist most laboratories do not run GH assays every day. As a consequence, the patient has usually been discharged before the results return, because most patients with acromegaly have short in-patient stays. The initial reduction in GH levels to cure or semicure levels (
Other metaphors including warmth, sweating, and so on, may also be used to enhance the sexual response. Cartoon or dramatic representations of the most erotic involvement have also been used (Araoz, 1982) to rehearse, give permission for and enhance involvement in sexual activity. Symbolic transformation of the parts of the anatomy which may be perceived negatively has also been used to remove anxiety-based inhibitory responses (Araoz, 1982) (e.g. the labia are perceived as the petals of a lovely flower or the penis may be represented as a beautiful ivory or marble column, and so on).
All the approaches designed to heighten sexual arousal in the female arousal disorders can be applied to the male patient detailed mental rehearsal of successful sexual arousal increased absorption and amplification of initially small sexual responses metaphors of arousal and lubrication such as an analogy with sweating and a healthy journey of discovery through the sexual organs and finding the sites of sexual pleasure.
In discussions of control systems, the words regulation and regulate have meanings distinct from those of the word control (see Chapter 1). The variable that a control system acts to maintain within narrow limits (e.g., temperature) is called the regulated variable, and the quantities it controls to accomplish this (e.g., sweating rate, skin blood flow, metabolic rate, and thermoregulatory behavior) are called controlled variables.
Temperature receptors in the body core and skin transmit information about their temperatures through afferent nerves to the brainstem and, especially, the hypothalamus, where much of the integration of temperature information occurs. The sensitivity of the thermoregulatory system to core temperature enables it to adjust heat production and heat loss to resist disturbances in core temperature. Sensitivity to mean skin temperature lets the system respond appropriately to mild heat or cold exposure with little change in body core temperature, so that changes in body heat as a result of changes in environmental temperature take place almost entirely in the peripheral tissues (see Fig. 29.2). For example, the skin temperature of someone who enters a hot environment may rise and elicit sweating even if there is no change in core temperature. On the other hand, an increase in heat production within the body, as during exercise, elicits the appropriate heat-dissipating responses through a...
Intense exercise may increase heat production within the body 10-fold or more, requiring large increases in skin blood flow and sweating to reestablish the body's heat balance. Although hot environments also elicit heat-dissipating responses, exercise ordinarily is responsible for the greatest demands on the thermoregulatory system for heat dissipation. Exercise provides an important example of how the thermoregulatory system responds to a disturbance in heat balance. In addition, exercise and thermoregulation impose competing demands on the circulatory system because exercise requires large increases in blood flow to exercising muscle, while the thermoregulatory responses to exercise require increases in skin blood flow. Muscle blood flow during exercise is several times as great as skin blood flow, but the increase in skin blood flow is responsible for disproportionately large demands on the cardiovascular system, as discussed below. Finally, if the water and electrolytes lost...
Panic attacks are very common and more common in young people in both men and women. People feel that they are extremely ill, feel their heart beating fast and forcefully in their chest, notice a change in their breathing pattern, and may breathe very fast and deep (hyperventilation). Sweating, having a headache or intense fear, not wanting to leave the house (agoraphobia), wanting to run away into the open air, not being able to tolerate being in a room (claustrophobia), are other features of panic attacks. Some people may hyperventilate and lose consciousness.
Adverse reactions may occur if the dosage is too high or prolonged, or if withdrawal is too rapid. Administration of fludrocortisone may cause edema, hypertension, congestive heart failure, enlargement of the heart, increased sweating, or allergic skin rash. Additional adverse reactions include hypokalemia, muscular weakness, headache, and hypersensitivity reactions. Because this drug has glucocorticoid and mineralocorticoid activity and is often given with the glucocorticoids, adverse reactions of the glucocorticoids must be closely monitored as well (see Display 50-2).
The skin is another site through which water is lost. The sweating which occurs in warm weather is an obvious example. Even during the winter, when the air is cool, insensible perspiration occurs as water diffuses through the skin. Insensible perspiration occurs at all times. The perspiration that can be sensed comes from eccrine glands. They secrete a watery fluid that cools the skin by using body heat to evaporate the liquid. The amount of salts and nitrogenous wastes in perspiration is not large however, when one is working in a hot environment, the loss may be significant.
Produces an effect similar to continuous sympathetic nerve stimulation. The symptoms of this condition are hypertension, elevated metabolism, hyperglycemia and sugar in the urine, nervousness, digestive problems, and sweating. It does not take long for the body to become totally fatigued under these conditions, making the patient susceptible to other diseases.
During the first week, total body water and, especially, plasma volume increase. These changes likely contribute to the cardiovascular adaptations. Later, the fluid changes seem to diminish or disappear, although the cardiovascular adaptations persist. In an unacclimatized person, sweating occurs mostly on the chest and back, but during acclimatization, especially in humid heat, the fraction of sweat secreted on the limbs increases to make better use of the skin surface for evaporation. An unacclimatized person who is sweating profusely can lose large amounts of sodium. With acclimatization, the sweat glands become able to conserve sodium by secreting sweat with a sodium concentration as low as 5 mmol L. This effect is mediated through aldos-terone, which is secreted in response to sodium depletion and to exercise and heat exposure. The sweat glands respond to aldosterone more slowly than the kidneys, requiring several days unlike the kidneys, the sweat glands do not escape the...
Fluid requirements may be higher in some children with DD due to constipation, increased fluid losses (drooling, excessive sweating), and or increased requirements. Standard guidelines for fluid based on body weight should be followed, with adjustment for special considerations as noted above (see Table 17-3, Fluid Requirements).
Clearly a stable balance can be upset by alteration of the amount being gained or lost in any single pathway in the schema for example, severe negative water balance can be caused by increased sweating. Conversely, stable balance can be restored by homeostatic control of water intake and output.
Tive in the heat of the day and cool themselves by panting, sweating, and licking the latter refers to the fact that they cover their front legs with saliva, which by evaporation cools not only their extremities but also their bodies via a dense network of blood vessels close to the surface. Kangaroos are among the most heat-tolerant of mammals. In addition, they have large, padded feet that compact the soil less than domesticated livestock.
Imals, fish, and amphibians is the same as the temperature of the environment in which they live. Such organisms are called poikilotherms. In poikilothermic organisms, metabolic rate increases as the environmental temperature increases. Such organisms move slowly and grow slowly when the temperature is cold, since their metabolic rate is very low at cold temperatures. To compare the metabolic rates of different poiki-lotherms, one must measure their rate of metabolism under standard conditions. Standard metabolism is usually defined as the rate of energy use when the animal is resting quietly, twelve hours after the last meal, and is at a temperature of 30 degrees Celsius however, for small invertebrates, protists, and bacteria, only temperature is usually controlled. Most reptiles, birds, and mammals can maintain their body temperature at a constant level even when the environmental temperature changes greatly. Such organisms are called homeo-therms. Birds and mammals can maintain...
Clinical features and course of disease are fairly uniform in early-infantile GLD. During the first few months of life the infants are healthy and their psy-chomotor development is normal. The onset of clinical symptoms occurs between 1 and 6 months of age. Hagberg et al. (1969) distinguish three clinical stages. Stage I is characterized by hyperirritability and periods of crying, particularly when the infants are handled and nursed. They seem to be extremely sensitive to light and noise and often have excessive startle responses. Periods of fever often occur without signs of infection. The muscular tone increases. At the onset of the disease the deep tendon reflexes are normal. There is a stagnation of mental and motor development, soon followed by regression. In sporadic cases convulsions, hemiplegia, or predominant signs of peripheral neuropathy are the presenting abnormalities. Within 2-4 months of onset most patients reach stage II. This stage comprises the subsequent period of...
For 90 minutes after euglycaemia is restored (Figure 1.6a) (Fagius et al., 1986). During hypoglycaemia, a sudden increase in skin sympathetic activity is seen, which coincides with the onset of sweating. This sweating leads to vasodilatation of skin blood vessels, which is also contributed to by a reduction in sympathetic stimulation of the vasoconstrictor components of skin arterio-venous anastomoses (Figure 1.6b) (Berne and Fagius, 1986). These effects (at least initially) increase total skin blood flow and promote heat loss from the body.
Sweat glands derive virtually all sweat water from blood plasma and are surrounded by a dense capillary network in the deeper layers of the dermis. As explained in Chapter 29, neural regulation of the sweating mechanism not only causes the formation of sweat but also substantially increases skin blood flow. All the capillaries from the superficial skin layers are drained by venules, which form a venous plexus in the superficial dermis and eventually drain into many large venules and small veins beneath the dermis.
When sympathetic nervous system stimulation causes a substantial increase in precapillary resistance and a proportionately smaller increase in postcapillary resistance, the capillary pressure can decrease up to 15 mm Hg and, thereby, greatly increase the absorption of tissue fluid. This process is important. As mentioned earlier, fluid taken from the interstitial space can compensate for vascular volume loss during sweating, vomiting, or diarrhea. As water is lost by any of these processes, the plasma proteins are concentrated because they are not lost.
Sexual arousal increased absorption and amplification of initially small sexual responses metaphors of arousal and lubrication such as an analogy with sweating and a healthy journey of discovery through the sexual organs and finding the sites of sexual pleasure these may all be used in heightening arousal.
Hydrostatic Pressure in Tissues Can Either Favor or Oppose Fluid Filtration From the Blood to the Tissues
If water is removed from the interstitial space, the hydrostatic pressure becomes very negative and opposes further fluid loss (Fig. 16.6). If a substantial amount of water is added to the interstitial space, the tissue hydrostatic pressure is increased. However, a margin of safety exists over a wide range of tissue fluid volumes (see Fig. 16.6), and excessive tissue hydration or dehydration is avoided. If the tissue volume exceeds a certain range, swelling or edema occurs. In extreme situations, the tissue swells with fluid to the point that pressure dramatically increases and strongly opposes capillary filtration. The ability of tissues to allow substantial changes in interstitial volume with only small changes in pressure indicates that the interstitial space is distensible. As a general rule, about 500 to 1,000 mL of fluid can be withdrawn from the interstitial space of the entire body to help replace water losses due to sweating, diarrhea, vomiting, or blood loss.
A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions. The symptoms show a typically mixed and changing picture and include an initial state of daze with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor - F44.2), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within two to three days (often within hours). Partial or...
The symptoms of malaria are recurrent chills, fever, and sweating. The symptoms peak roughly every 48 h, when successive generations of merozoites are released from infected red blood cells. An infected individual eventually becomes weak and anemic and shows splenomegaly. The large numbers of merozoites formed can block capillaries, causing intense headaches, renal failure, heart failure, or cerebral damage often with fatal consequences. There is speculation that some of the symptoms of malaria may be caused not by Plasmodium itself but instead by excessive production of cytokines. This hypothesis stemmed from the observation that cancer patients treated in clinical trials with recombinant tumor necrosis factor (TNF) developed symptoms that mimicked malaria. The relation between TNF and malaria symptoms was studied by infecting mice with a mouse-specific strain of Plasmodium, which causes rapid death by cerebral malaria. Injection of these mice with antibodies to TNF was shown to...
A sensory neuron may have several terminal branches peripherally that enlarge the receptive area and innervate multiple receptors. As a sensory action potential which originated in one of the terminal branches propagates af-ferently, or orthodromically, it may also enter some other branches of that same axon and then conduct ef-ferently, or antidromically, for short distances. The distal ends of the sensory axons may release neurotransmit-ters in response to the antidromic action potentials. The process of action potential spread can result in a more wide-ranging reaction than that produced by the initial stimulus. If the sensory neuron innervates blood vessels or sweat glands, the response can produce reddening of the skin as a result of vasodilation, local sweating as a result of sweat gland activation, or pain as a result of the action of the released neurotransmitter. This process is called a local axon reflex (see Fig. 6.6). It differs from the usual reflex pathway in that a...
Therefore, sweating or panting are usually cooling methods of last resort for animals adapted to hot environments. Sweating and panting are active processes that require the expenditure of metabolic energy. That is why the metabolic rate increases when the upper critical temperature is exceeded (see Figure 41.14). A sweating or panting animal is producing heat in the process of dissipating heat, which can be a losing battle. Endotherms can survive in environments that are below their lower critical temperature much better than they can in environments above their upper critical temperature.
Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient to a specific organ or system.
Loss of body water through insensible perspiration is not controllable it is obligatory. The sweating that helps regulate body temperature is facultative, and it varies with weather and exercise. If sweating is prevented when the ambient temperature is high, the body temperature can rise explosively. This will cause death as surely as the dehydration which was prevented by not sweating would have.
Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic disorder of neuromuscular transmission which is caused by the production of antibodies to voltage-gated Ca2+ channels at the motor nerve terminals. This results in a marked reduction in acetylcholine release, the failure of neuromuscular transmission and muscle weakness. Muscle weakness is most common in the limbs, so that patients complain that their legs feel stiff or weak and they find difficulty in walking indeed, in some individuals the symptoms of the disease may be sufficiently severe to render them bedbound. Tendon reflexes are also weak or absent. Unlike myasthenia gravis, in LEMS muscle weakness does not increase with exercise in fact, muscle strength and tendon reflexes are briefly enhanced during the first few seconds of maximal effort. LEMS is also associated with symptoms indicative of disturbance of the autonomic nervous system, including decreased salivation and sweating, constipation and impotence. In most, but...
Physiological Thermoregulation Operates Through Graded Control of Heat Production and Heat Loss Responses
The control of heat-dissipating responses is an example of a proportional control system. Figure 29.9 shows how reflex control of two heat-dissipating responses, sweating and skin blood flow, depends on body core temperature and mean skin temperature. Each response has a core temperature threshold a temperature at which the response starts to increase and this threshold depends on mean skin tem
Losses of Na+ occur via the skin, gastrointestinal tract, and kidneys. Skin losses are usually small, but can be considerable with sweating, burns, or hemorrhage. Likewise, gastrointestinal losses are usually small, but they can be large and serious with vomiting, diarrhea, or iatrogenic suction or drainage of gastrointestinal secretions. The kidneys are ordinarily the major routes of Na+ loss from the body, excreting about 95 of the ingested Na+ in a healthy person. Thus, the kidneys play a dominant role in the control of Na+ balance. The kidneys can adjust Na+ excretion over a wide range, reducing it to low levels when there is a Na+ deficit and excreting more Na+ when there is Na+ excess in the body. Adjustments in Na+ excretion occur by engaging many of the factors previously discussed.
Appreciable water loss from the skin, in the form of sweat, occurs at high temperatures or with heavy exercise. As much as 4 L of water per hour can be lost in sweat. Sweat, which is a hypoosmotic fluid, contains NaCl,- excessive sweating can lead to significant losses of salt. Gastrointestinal losses of water are normally small (see Table 24.3), but with diarrhea, vomiting, or drainage of gastrointestinal secretions, massive quantities of water and electrolytes may be lost from the body.
Of course, sweating really does serve a useful purpose during exercise because the excess heat, if not eliminated, might cause sickness or even death. But this is totally different from stating that a need to avoid injury causes the sweating. The cause of the sweating is a sequence of events initiated by the increased heat generation increased heat generation increased blood temperature increased activity of specific nerve cells in the brain increased activity of a series of nerve cells increased production of sweat by the sweat-gland cells. Each step occurs by means of physicochemical changes in the cells involved. In science, to explain a phenomenon is to reduce it to a causally linked sequence of physicochemical events. This is the scientific meaning of causality, of the word because.
Sensory information about body temperatures is an essential part of both behavioral and physiological thermoregulation. The distinguishing feature of behavioral thermoregulation is the involvement of consciously directed efforts to regulate body temperature. Thermal discomfort provides the necessary motivation for thermoregulatory behavior, and behavioral thermoregulation acts to reduce both the discomfort and the physiological strain imposed by a stressful thermal environment. For this reason, the zone of thermoneutrality is characterized by both thermal comfort and the absence of shivering and sweating.
A 58-year-old man with a history of infrequent angina of effort for the previous 6 years developed retrosternal chest pain radiating to his left arm. The pain appeared suddenly while he was watching television, was crushing in nature and associated with nausea and sweating. It was not relieved by sublingual glyceryl trinitrate used to control his angina but settled spontaneously on his arrival in hospital 2 hours later. Associated symptoms. Symptoms thai develop along with the pain often help towards making the diagnosis. However, part of the body's response to pain or stress is autonomic arousal. As a result, the patient may experience symptoms, such as fairuness. sweating, nausea, vomiting, diarrhoea and increased frequency of micturition. The effects of pain on sleep and appetite should be noted. The persistent disturbance of sleep by pain suggests a physical as opposed to a psychological cause.
Regular physical exercise and heat acclimatization increase heat tolerance and the sensitivity of the sweating response. Aging has the opposite effect,- in healthy 65-year-old men, the sensitivity of the sweating response is half of that in 25- year-old men. Many drugs inhibit sweating, most obviously those used for their anticholinergic effects, such as atropine and scopolamine. In addition, some drugs used for other purposes, such as glutethimide (a sleep-inducing drug), tricyclic antidepressants, phenothiazines (tranquilizers and antipsychotic drugs), and antihistamines, also have some anticholinergic action. All of these and several others have been associated with heatstroke. Congestive heart failure and certain skin diseases (e.g., ichthyosis and anhidrotic ectodermal dysplasia) impair sweating, and in patients with these diseases, heat exposure and especially exercise in the heat may raise body temperature to dangerous levels. Lesions that affect the thermoregulatory structures...
A change in ambient temperature causes changes in the levels of sweating and skin blood flow necessary to maintain any given level of heat dissipation. However, the change in ambient temperature also elicits, via direct and reflex effects of the accompanying skin temperature changes, altered responses in the right direction. For any given rate of heat production, there is a certain range of environmental conditions within which an ambient temperature change elicits the necessary changes in heat-dissipating responses almost entirely through the effects of skin temperature changes, with virtually no effect on core temperature. (The limits of this range of environmental conditions depend on the rate of heat production and such individual factors as skin surface area and state of heat acclimatization.) Within this range, the core temperature reached during exercise is nearly independent of ambient temperature,- for this reason, it was once believed that the increase in core temperature...
Cardiovascular adaptations that reduce the heart rate required to sustain a given level of activity in the heat appear quickly and reach nearly their full development within 1 week. Changes in sweating develop more slowly. After acclimatization, sweating begins earlier and at a lower core temperature (i.e., the core temperature threshold for sweating is reduced). The sweat glands become more sensitive to cholinergic stimulation, and a given elevation in core temperature elicits a higher sweat rate in addition, the glands become resistant to hidromeiosis and fatigue, so higher sweat rates can be sustained. These changes reduce the levels of core and skin temperatures reached during a period of exer-
His heart rate is 105 beats min, his blood pressure is 105 85 mm Hg, and his hands and feet are cool to touch and somewhat bluish. He is sweating and is short of breath. An electrocardiogram indicates an elevated ST segment, which was most noticeable in leads V4 to V6. The attending cardiologist administers streptokinase intravenously. One hour later, the ST segment abnormality is less noticeable. The heart rate is 87 beats min, the arterial blood pressure is 120 85 mm Hg, and the patient's hands and feet are pink and warm. The patient is alert, not sweating, and does not complain of chest pain or shortness of breath.
Diabetic neuropathy typically involves symmetric sensory loss in the distal lower extremities or autonomic neuropathy, leading to impotence, GI dysfunction, or anhidrosis (lack of sweating) in the lower extremities. The diabetic foot is an example of several complicating factors exacerbating one another. About 50 to 70 of non
In addition to expecting a dramatic chest clutching presentation, knowledge of the complex array of heart attack symptoms, even the more common ones, is lacking in the American public. A random-digit-dialed telephone survey conducted among 1294 adult respondents in 20 communities from the REACT research program revealed that knowledge of chest pain as a presenting heart attack symptom was high and relatively uniform (89.7 ). However, knowledge of some of the other associated symptoms was suboptimal. Only two-thirds (67.3 ) identified arm pain as a symptom shortness of breath was cited by half (50.8 ) of the respondents, sweating was named by one-fifth (21.3 ) of those surveyed, and other heart attack symptoms were less common. The median number of correct symptoms reported was 3 (of 11). Significantly higher mean numbers of correct symptoms were reported by non-Hispanic whites than by other racial or ethnic groups, by middle-aged persons than by older and younger persons, by persons...
Temperatures at specific temperature ranges. Although a homeotherm's metabolic heat production is constant when the organism is at rest and when environmental temperature is constant, strenuous exercise produces excess heat that must be dissipated into the environment, or overheating and death will result. Physiological adaptations that enable homeotherms to rid their bodies of heat are the ability to increase blood flow to the skin's surface, sweating, and panting, all of which promote heat loss to the atmosphere.
In many species, the temperature of the hypothalamus itself is the major source of feedback information to the thermostat. Cooling the hypothalamus causes fish and reptiles to seek a warmer environment, and warming the hypothalamus causes them to seek a cooler environment. In mammals, cooling the hypothalamus can stimulate constriction of the blood vessels supplying the skin and increase metabolic heat production. Because it activates these thermoregulatory responses, cooling the hypothalamus causes the body temperature to rise. Conversely, warming the hypothalamus stimulates dilation of the blood vessels supplying the skin and sweating or panting, and the overall body temperature falls (Figure 41.17).
The signs and symptoms of staphylococcal intoxication occur when foods containing enterotoxin are ingested in reasonably small amounts. However, death can occur if large amounts are ingested. The illness is particularly acute (1-7 hr) after the ingestion of toxin-contaminated foods (35), with recovery generally occurring in 1-2 days. The early signs are nausea and possibly abdominal cramping, with resulting primary observable symptoms of vomiting and diarrhea. Secondary symptoms may include retching, dehydration, sweating, weakness, and salivation. In severe cases, the victims may also exhibit headache, sweating, marked prostration, muscular cramping, and a subsequent drop in blood pressure. Fever may occur, or the body temperature may be subnormal. Blood and mucus may be observed in stools and vomit (36).
Figure 7.3 Comparisons between the duration of diabetes and the percentage of 411 type 1 diabetic patients reporting (a) changes in symptoms of hypoglycaemia, (b) sweating and or tremor as one of the two cardinal autonomic symptoms of hypoglycaemia, and (c) severe hypoglycaemic episodes without warning symptoms. Values are medians shaded areas show 95 confidence limits. Reproduced from Pramming et al. (1991) by permission of John Wiley & Sons, Ltd Figure 7.3 Comparisons between the duration of diabetes and the percentage of 411 type 1 diabetic patients reporting (a) changes in symptoms of hypoglycaemia, (b) sweating and or tremor as one of the two cardinal autonomic symptoms of hypoglycaemia, and (c) severe hypoglycaemic episodes without warning symptoms. Values are medians shaded areas show 95 confidence limits. Reproduced from Pramming et al. (1991) by permission of John Wiley & Sons, Ltd
To evaluate the patient's response to therapy, and depending on the drug administered, the nurse may check the patient's blood pressure every hour, inquire whether pain has been relieved, or monitor the pulse every 15 minutes. After evaluation, certain other decisions may need to be made and plans of action implemented. For example, the nurse may need to notify the primary health care provider of a marked change in a patient's pulse and respiratory rate after a drug was administered, or the nurse may need to change the bed linen because sweating occurred after a drug used to lower the patient's elevated temperature was administered.
The state of hydration should be assessed in all cases of fluid loss, including vomiting, diarrhoea, sweating and polyuria. Unless the possibility of dehydration is considered, its existence may be overlooked or its severity underestimated. A detailed history of the nature and the quantity of fluid loss is important bu(, if the patient's usual weight is known, the most satisfactory assessment is
Sweat (perspiration) is made up primarily of water, with various substances dissolved in it. As one of its physical characteristics, water has a relatively high heat-carrying capacity. In addition, it evaporates from the surface of the body. Another physical characteristic of water is that it removes large numbers of calories during evaporation.
The features include weight loss with increased appetite, heal intolerance, pruritus, emotional lability, excessive sweating and palpitations. There may he a change in the menstrua cycle, either oligomenorrhoea or amenorrhoea, and in bowel habit as a consequence of intestinal hurry. In elderly patients many of these features may be missing and the presenting features may relate to the development of atrial fibrillation (see p. 85).
Providers also need to explain that, in addition to chest discomfort, patients may experience a feeling of being short of breath sweating pain in the arms, back, neck, jaw, or stomach a feeling of being sick to your stomach or lightheaded. Providers should promote the notion of, when in doubt, check it out , acknowledging that it is normal to be uncertain about what is wrong or embarrassed or afraid about calling 9-1-1, leading to untoward delays in getting help. In addition, providers can stress that the only way to know for sure is to be evaluated in a hospital emergency department. It is important that they also emphasize that patients will be taken seriously and treated respectfully if they come to the emergency department with possible heart attack signs, even false alarms. Providers should actively address the benefits of artery-opening treatment and the importance of getting treatment quickly to stop a heart attack in its tracks....
Signs and symptoms of excessive catecholamine (VMA HVA) secretion Intermittent attacks of sweating, flushing, pallor, headaches, palpitation, and hypertension. Hypertension is usually renin induced due to renovascular compromise and is seen in 1-5 of patients. Normal levels of VMA and HVA are listed in Table A1-29.
The complaint of cold feet is common in MS, even in the milder forms of the disease. The maintenance of skin temperature is an involuntary process under the control of that portion of the nervous system referred to as autonomic, which controls functions such as heart rate, sweating, and pupil dilation. Short-circuiting in the interconnections that control the diameter of blood vessels and those nerves that sense temperature appears to be responsible for the perception of cold feet.
A surgical sympathectomy has completely interrupted the sympathetic nerve supply to a patient's arm. How would one expect the thermoregulatory skin blood flow and sweating responses on that arm to be affected in the Cold in the Heat Sweating Threshold for Core Sweating Cutaneous (C) Sweating rate
The sympathetic nervous system, which is normally linked to pain by spinal and more central reflexes, assumes a more prominent role in pain generation and becomes less able to regulate vascular tone, sweating, and other functions normally. One component of sympathetically mediated pain is the development in nociceptors of a-adrenergic receptors and synaptic connections with sympathetic neurons, so that they become inappropriately activated by sympathetic neuronal activity and circulating catecholamines.
Oxybutynin (Ditropan) acts by relaxing the bladder muscle and reducing spasm. Oxybutynin is used to treat bladder instability (ie, urgency, frequency, leakage, incontinence, and painful or difficult urination) caused by a neurogenic bladder (altered bladder function caused by a nervous system abnormality). Adverse reactions observed in patients taking oxybutynin include dry mouth, constipation or diarrhea, decreased production of tears, decreased sweating, gastrointestinal disturbances, dim vision, and urinary hesistancy.
Biosignal monitoring and recording is the extension of medical investigations taking into consideration the development over time. The usual practice for medical tests is the investigation at one particular time point when the physician sees the patient. Besides the clinical interview the physician checks the pulse, measures blood pressure, takes a blood sample and sometimes urinary sample, and perhaps also measures body temperature and sweating. This collected information is used to develop a diagnosis or if it is not sufficient, to request more investigations. The additional investigations are in many cases functional tests or image-producing examinations. Such examinations can be radiology or ultrasound investigations or endoscopic or angiographic investigations. Functional investigations being requested can be electrocardiography, lung function test or a physical stress test. All these investigations are really point measures even if they involve image generation or a functional...
Estrogen is most commonly used in combination with progesterones as contraceptives or as hormone replacement therapy in postmenopausal women. The estrogens are used to relieve moderate to severe vasomotor symptoms of menopause (flushing, sweating), female hypo-gonadism, atrophic vaginitis (orally and intravaginally), osteoporosis in women past menopause, palliative treatment for advanced prostatic carcinoma, and in selected cases of inoperable breast carcinoma. The estradiol transdermal system is used as estrogen replacement therapy (ERT) for moderate to severe vasomotor symptoms associated with menopause, female hypogonadism, after removal of the ovaries in premenopausal women (female castration), primary ovarian failure, and in the prevention of osteoporosis. Estrogen is given IM or intravenously (IV) to treat uterine bleeding caused by hormonal imbalance. When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, concurrent use of progestin is recommended...
Two mechanisms for cooling the body by increasing water loss are panting and sweating. Zebras, gazelles, and bison are examples of closed-mouth panters. These animals rapidly move air through the nostrils, which cools the tissues lining their upper airways (nasal cavities). Dogs are the best example of open-mouth panters they move air rapidly over the moist tongue to remove heat. In contrast to panting, sweat glands secret a hypotonic salt water over the skin surface. The sweat evaporates and cools the body surface. Both panting and sweating can reduce an animal's
Hot flashes, as a result of the loss of vasomotor tone, osteoporosis, and an increased risk of cardiovascular disease are not uncommon. Hot flashes are associated with episodic increases in upper body and skin temperature, peripheral va-sodilation, and sweating. They occur concurrently with LH pulses but are not caused by the gonadotropins because they are evident in hypophysectomized women. Hot flashes, consisting of episodes of sudden warmth and sweating, reflect temporary disturbances in the hypothalamic thermoregula-tory centers, which are somehow linked to the GnRH pulse generator.
Occur, as in other disorders of the lower motor neuron. Various extrapyramidal features have been described in late-onset GM2 gangliosidosis, either in isolation or in combination with the more common motor neuron and cerebellar syndromes. Dystonia, rigidity, choreiform movements, and athetoid posturing have been noted. Another clinical characteristic of late-onset GM2 gangliosidosis is the high incidence of recurrent psychosis. In addition, psychic changes include anxiety, depression, insomnia, aggressiveness, severe behavioral problems, and disintegration of the personality. The psychic changes may precede all other manifestations or may appear later. Neurovegetative disorders are common and take the form of sweating impairment, loss of libido, impaired esophagus motility, fixed cardiac frequency, and orthostat-ic hypotension. Intellectual deterioration is frequent. Epilepsy may occur, but is not obligatory. Blindness occurs late in the course of the disease. On ophthal-moscopic...
Prolonged or repeated exposure to stressful environmental conditions elicits significant physiological changes, called acclimatization, that reduce the resulting strain. (Such changes are often referred to as acclimation when produced in a controlled experimental setting.) Some degree of heat acclimatization occurs either by heat exposure alone or by regular strenuous exercise, which raises core temperature and provokes heat-loss responses. Indeed, the first summer heat wave produces enough heat acclimatization that most people notice an improvement in their level of energy and general feeling of well-being after a few days. However, the acclimatization response is greater if heat exposure and exercise are combined, causing a greater rise of internal temperature and more profuse sweating. Evidence of acclimatization appears in the first few days of combined exercise and heat exposure, and most of the improvement in heat tolerance occurs within 10 days. The effect of heat ac-
This largely arises from apocrine sweat contaminated by diphtheroid bacteria and may be reduced by deodorants or concealed with perfume, Excessive sweating causes an increase in body odour, which becomes pungent. Poor personal hygiene results in an exaggeration of this smell, which may be compounded by the odour of dirty and soiled clothing and the smell of dried-out urine. Where washing and toilet facilities are available, malodour usually occurs only in
Coronary artery disease (CAD), which results from atherosclerosis of the vessels that supply blood to the heart muscle, is a leading cause of death in industrialized countries (see Fig. 9-8). An early sign of CAD is the type of chest pain known as angina pectoris. This is a feeling of constriction around the heart or pain that may radiate to the left arm or shoulder, usually brought on by exertion. Often there is anxiety, diaphoresis (profuse sweating), and dyspnea (difficulty in breathing).
Above the upper critical temperature, the animal must expend energy to lose heat by panting or sweating, which makes its metabolic rate increase. Above the upper critical temperature, the animal must expend energy to lose heat by panting or sweating, which makes its metabolic rate increase.
Water is essential for the functioning of cells and any environmental stress that disrupts the cell's water balance is a serious problem for an organism. Exposure to desiccation is the most obvious cause of water loss, but water is also lost, or has the potential to be lost, during exposure to other types of environmental stress. Osmotic stress produces the movement of water, resulting in the loss of some water if the concentration of salts outside the cell is higher than that inside (since the concentration of water is lower outside than it is inside). Heat increases the rate of evaporation of organisms exposed to desiccation and this results in increased rates of water loss from the surface of terrestrial plants and animals. Mechanisms for cooling the organism (such as sweating, panting and transpiration) also produce increased rates of water loss. Water loss from cells is also a problem during freezing. Freezing of the liquid surrounding the cells raises its osmotic concentration....
When hot, endotherms keep muscular activity to a minimum, increase ventilation rates (panting), and expand superficial blood vessels (vasodi-lation). Rates of heat dissipation in some mammals are enhanced by sweating. Sweating and panting rely on evaporative cooling, the same principle involved in using radiators to prevent hot automobile engines from overheating. Endo-therms adapted to hot climates produce concentrated urine and dry feces to conserve water, since much is lost in cooling.
Sweating also causes water loss and thus decreases urine flow. Intake of large amounts of fluid will dilute the body fluids and cause an increased urine output. There is a constant adjustment, because water is lost by breathing, through the skin, and through excretions, and the kidney must make the proper corrections. Losses have been reduced to a minimum in animals such as the kangaroo rat, which lives in the desert and must conserve water. All of its water intake is from seeds and other foods containing some water, and excretion is almost zero. The desert rat is able to concentrate urine to a level about five times that of the human.
Capsaicin is a common ingredient of Indian, Indonesian and Mexican food. Tucked innocuously away inside prettily coloured peppers it explodes within the mouth like a volcano, creating a severe burning sensation (some people actually like it ). Attempts to douse the fire with water only succeed in spreading it further around the mouth and the initial pain is often followed by an outbreak of sweating. I imagine most people are familiar with this unfortunate scenario. The capsaicin content differs between different varieties
Many members of the Ephedra family have been used medicinally (ie, E. sinica and E. intermedia). Ephedra preparations have traditionally been used to relieve cold symptoms, improve respiratory function, as an adjunct in weight loss, and to treat a variety of conditions from headaches to sexually transmitted disease. Large doses may cause a variety of adverse reactions, such as hypertension, irregular heart rate, tremors, epigastric pain, nausea, vomiting, sweating, weakness, and possible dependence. Ephedra is contraindicated in patients with hypertension, glaucoma, hypertrophy of the prostate, urinary tract problems, clotting disorders, anxiety, anorexia, colitis, thyroid disease, or diabetes. Ephedra should not be used with the cardiac glycosides, halothane, guanethi-dine, MAOIs, oxytocin, and in patients taking St. John's wort. Weight loss preparations containing ephedra should be avoided.
When exploring a dry river-bed in Mwabvi game reserve, looking for bushpig and hyrax, accompanied by a Malawian game guard, I was viciously attacked by the bees, and stung about ten times. I was quite unaware of their nest, and spent the night sweating, intensely itching and experiencing a kind of out-of body feeling which lasted about six hours. Several deaths of young children stung by a swarm of bees have been recorded from Malawi, and the newspapers regularly report bees attacking mourners at a funeral - which usually take place in a wooded graveyard (manda) - so that the ceremony has had to be abandoned. One report described how the bees had 'launched' their attack from a hive in a nearby tree, and many people 'ran for their lives including the flower carrying women'. The bees, it noted, landed on the coffin, putting an end to the whole of the proceedings (Daily Times 28 August, 1998).
Phenoxybenzamine is presented for historical perspective it no longer indicated in clinical treatment of BPH. A long-acting, nonselective a-blocker with affinity for both a1- and a2-receptors, its current indication is for treatment of hypertension and sweating associated with pheochromocytoma. Demonstrable pharmacologic effects may persist for 3-4 d after intravenous administration (19).
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