Night Sweats

Night sweats are common; patients should be reassured that almost everyone sweats at night, particularly during the summer.  

Night sweats may occasionally be associated with nightmares, night terrors, or sleep apnea; these conditions are readily diagnosed clinically.  However, drenching night sweats, which require the patient to change their bedclothes or bedsheets, are abnormal.  

A flu-like illness may result in one or two episodes of drenching night sweats.  Night sweats that persist should suggest either a tumor (particularly lymphomas, which are common in young adults), a chronic infection (such as tuberculosis), and thyroiditis.  These conditions are all diagnosable, treatable, and potentially fatal.  

Other conditions that can result in excessive sweating, but not necessarily nocturnal, include diabetic (autonomic) neuropathy and menopausal “hot flashes”, neither of which should be common in an operational setting.  Some dermatologic conditions result in excess sweating all day long.

History

The history is extremely important.  You must inquire about other concerning symptoms (“B” symptoms: malaise, fatigue, anorexia, and unintentional weight loss [> 5-10% of body weight]). 

•  “B” symptoms suggest either a malignancy or a chronic infection.  

• Persistent, productive sputum suggests either a lung abscess or tuberculosis.  

• A lung abscess can be seen in those with a history of heavy alcohol ingestion (even binge drinking).  

• Diabetes mellitus, either newly diagnosed (“juvenile”, or insulin-dependent) or chronic and now poorly controlled (as seen in older, overweight adults) may manifest as night sweats and weight loss, but anorexia is not seen.  In fact, diabetics have polydipsia, polyphagia, and, consequently, polyuria.  No one should be on active duty with insulin-dependent diabetes mellitus (IDDM), but keep in mind that adult-onset diabetes mellitus (AODM) may arise de novo.

• Patients with an overactive thyroid complain of tachycardia, weakness, hyperthermia, sweats, tremor, and diarrhea.  

• Women may have “hot flashes” prior to the actual cessation of the menses, since premenopausal estrogen levels fall progressively. 

Physical Exam

Hyperthyroidism is suggested by:

• Tachycardia

• Hyperthermia

• Tremors

• Unusually active bowel sounds

• Rapid Deep Tendon Reflexes

• Abnormal thyroid

A patient with lymphoma may have nontender peripheral lymphadenopathy.  

Productive sputum suggests a lung abscess or TB; fetid breath and poor oral hygiene suggests the former; lungs may sound abnormal. 

Labs

If possible:

• CBC w/ differential

• ESR (Erythrocyte Sedimentation Rate)

• TFTs

• CMP

• PPD

• Chest X-ray

• Sputum studies (AFB, Gram stain and culture).

Plan

Treatment is supportive until definitive care is available; reassurance is important.  Activities are as tolerated; excessive “B” symptoms may require earlier referral.

Medevac: The work-up requires referral to a medical center. This referral should be prompt but need not necessarily interrupt the mission.  Your clinical savvy, the patient’s general condition, and your current mission will influence this decision.  A patient with productive sputum should wear a surgical mask (or have a cloth tied around their face) to minimize the spread of respiratory droplets; covering the mouth when coughing is also very useful.  These maneuvers are appropriate even if the patient has TB and is placed on an aerovac.  If the patient cannot wear a mask, the health care provider(s) should..

This section provided by: CDR Wesley Emmons, MC, USNR, Head, Infectious Diseases, Naval Medical Center, Portsmouth VA

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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