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1/ Following on from a chat with @christiplady & @kezdev (from @BukuEndo) here is a tweetorial about night sweats. The first disclaimer is that night sweats are an incredibly non specific symptom with poor correlation to specific pathology in the absence of other signs/symptoms..
2/...and a commonly reported symptom in people with no underlying pathology (data variable but ranges between 10 and 40% of healthy individuals).
Step 1 is to check that these are drenching night sweats-when we see them in the clinic associated with e.g lymphoma or leukaemia...
Step 1 is to check that these are drenching night sweats-when we see them in the clinic associated with e.g lymphoma or leukaemia...
3/...they are 'drenching' with the patient needing to change bedclothes and bedding, or their partner having to move into another bed. It is also incredibly (+++) rare for drenching sweats to be their only symptom.
4/ History and examination and therefore key. Differentials include infections (acute and chronic), inflammatory disorders, malignancy, endocrine disorders e.g hyperthyroidism, diabetes (reported in literature search), tell me if that is wrong @BukuEndo!
5/ Examination should look for stigmata of infection, lymphadenopathy, splenomegaly, signs of connective tissue disease etc. Investigations should then follow, considering those differentials above (see the app for recommended investigations for haem differentials).
6/ After all of this, it is not uncommon to still have no probable differentials which is clearly challenging. No specific national guidelines exist about investigation/referrals for night sweats due to the non-specific nature of the symptoms, and poor correlation to pathology
7/ From a haem perspective, NICE CKS advise haematology 2WW referral if associated with either splenomegaly or lymphadenopathy but not as a 2WW in isolation.
8/ In summary, a thorough history, examination and investigations will give clues for many patients as to an aetiology for their night sweats, but for many it will not, and furthermore, many of those will have no significant pathology...
9/ but differentiating night sweats between 'physiological' and pathological is incredibly hard and a real challenge for community clinicians in particular. #blooducation
#MedEd
#MedEd
