Afebrile, profuse diaphoresis, pleuritic pain: WHY?

1. I am in my first year. My last admit was a 64 y/o female diagnosed in the ED with RLL pneumonia. Sorry, I can't recite the CXR. Her WBCs were 17 and change. I am not familiar enough with presentations for pneumonia. Her temp never went above 98.1 for me in 8 hours. Why the profuse diaphoresis and warm skin?
2. 

   About Sterlink

   Joined: Dec '07; Posts: 62; Likes: 16

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3. 
   Apr 28, '09

   Specialty: ICU/Critical Care ; Joined: Feb '08; Posts: 4,914; Likes: 7,697

   Did they give her tylenol? Maybe her fever broke.
4. 
   Apr 28, '09

   Joined: Dec '07; Posts: 62; Likes: 16

   Quote from TurnLeftSide

   Did they give her tylenol? Maybe her fever broke.

   They gave fentanyl IVP and Toradol IVP. Do these have Antipyretic effects? I don't my drug book handy. According to ED records she had presented with a fever of 101 or 102 (I forget), but if the fever had broken, why the persistent profuse sweating 8 hours later.
5. 
   Apr 28, '09

   Specialty: ICU/Critical Care ; Joined: Feb '08; Posts: 4,914; Likes: 7,697

   Quote from Sterlink

   They gave fentanyl IVP and Toradol IVP. Do these have Antipyretic effects? I don't my drug book handy. According to ED records she had presented with a fever of 101 or 102 (I forget), but if the fever had broken, why the persistent profuse sweating 8 hours later.

   
   Toradol is an NSAID so I'm assuming that it does have anti-pyretic effects. My guess it's an inflammatory response to the pneumonia.
6. 
   Apr 28, '09

   Joined: Apr '00; Posts: 24,611; Likes: 35,448

   if skin is warm but temp not above 98.1, try different thermometer?
   
   also wondering about super imposed infection/process, i.e., pericarditis, pulm edema?
   
   if sweating is profuse and prolonged, caution for dehydration.
   keep doc updated.
   
   leslie
7. 
   Apr 28, '09

   Specialty: ICU/Critical Care ; Joined: Feb '08; Posts: 4,914; Likes: 7,697

   Do you have any other info regarding the patient? The sweating is another way of the body trying to control it's temperature, probably why there is no fever. I'm not entirely concerned about the skin temp unless it was hot to the touch.

   Last edit by RN1982 on Apr 28, '09
8. 
   Apr 28, '09

   Joined: Mar '08; Posts: 3,791; Likes: 3,438

   Could be drugs - my brother reacted to opiates with profuse diaphoresis recently after surgery.
   
   Also, I've seen patients with "cold sweats" - but that's not a scientific explanation!!
9. 
   Apr 28, '09

   Joined: Jan '09; Posts: 113; Likes: 233

   What was her BS. Sometimes sweating is a low sign of BS.
10. 
    Apr 28, '09

    Occupation: school nurse Specialty: 38 year(s) of experience in OB/GYN, peds, school nurse, DD ; Joined: Oct '08; Posts: 1,047; Likes: 1,869

    Have you ever experienced pleuritic pain? it's terrible enough to make you diaphoretic. Perhaps your patient was still in pain despite the pain meds.
11. 
    Apr 28, '09

    Joined: Jul '04; Posts: 631; Likes: 99

    Respiratory illnesses tend to present with "night sweats" and diaphoresis. Did she get checked for TB?
12. 
    Apr 29, '09

    Joined: Apr '09; Posts: 38; Likes: 61

    TB is a real possibility with no fever, but also could be, at age 64, his/her core temp may be lower and 98 or above could be febrile in this patient. Having worked in geriatrics most of my career, I have seen this to be common place.
13. 
    Apr 29, '09

    Occupation: Department of Corrections Radiology Manager Specialty: 39 year(s) of experience ; From: US ; Joined: Apr '09; Posts: 13; Likes: 18

    TB would typically present in RT apex and would look cavernous. Could this person have asperated. Many asperation pneumonias will present in rrl
14. 
    Apr 29, '09

    Occupation: Department of Corrections Radiology Manager Specialty: 39 year(s) of experience ; From: US ; Joined: Apr '09; Posts: 13; Likes: 18

    Sorry that should read rll..

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