What Causes Profuse Sweating, Dizziness, Shortness Of Breath And Nausea?

Posted on Mon, 21 Sep 2015

Question: Hello, (Disclaimer: Feel free you use medical terminology as I work as a trauma RN!) In 2001, I woke up feeling completely out of sorts: sweating profusely, dizzy when standing, slowed digestion, nausea, shortness of breath, flushed face, tachycardia. My GP did several lab tests over the next couple months, everything came back normal aside from some mild polycythemia. An endoscopy and colonoscopy (to assess the slowed digestion) also was unremarkable. I visited a psych doctor just to rule out anything psychological, in which nothing was found and psych thought it was strictly something physiological. My GP stated that due to labs being ok, my sympathetic nervous system must be overactive. He tried me on Effexor, Paxil, Ativan, and Klonopin, none of which made any difference (but had side effects). We came to the conclusion that because my vitals and labs were ok, maybe it was just something I would have to live with. And live with it I have. It has now been 14 years of living with what appears to be some sort of nervous system imbalance, and although I have become use to it, it is now becoming increasingly exhausting. I eat well, I exercise 4 times a week, and try to get proper sleep. I don't take any medications or supplements (and during the 14 years I've tried all supplements and nothing makes a difference). I've also tried yoga and meditation which doesn't have any effect. Mood wise I am great, always happy, people state that I have a calm presence during stressful situations in the hospital yet inside it feels awful. My nervous system is so overactive at this point that even doing things that excite me like playing my guitar or watching sports cause me to sweat, my heart pound, and my face to go bright red. Sometimes these episodes come out of nowhere even at times where nothing is going on... I think it would be wise for me to see my GP again after all these years, but I am wondering if there is any differential diagnosis (aside from hyperthyroidism) that could cause what appears to feel like a constant overactive sympathetic nervous system other than GAD (as this was ruled out by a psych MD). I would like to bring some suggestions to him. Thank you so much!

Answered by Dr. Neeraj Kumar (1 hour later)

Brief Answer:
Require detailed investigations again

Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The symptoms described by you are related to autonomic dysfunction i.e sympathetic over activity.
Generally such presentation should be evaluated for hyperthyroidism, pheochromocytoma and paroxysmal sympathetic hyperactivity syndrome or anxiety disorder.
As you have been investigated previously and nothing came positive then possibility of idiopathic disease is more.
Still after gap of so many years you need to be investigated again as some disease may have normal reports in initial presentation.
You should consult a doctor and undergo autonomic function testing, thyroid profile, evaluation for pheochromocytoma and other necessary blood investigations.
cardiac evaluation with holter may be required for detecting any arrhythmia's.
Another less likely possibility may be complex partial seizures arising from temporal lobe. For this you need a MRI brain epilepsy protocol and EEG.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Neeraj Kumar (20 hours later)

Thanks so much for your reply Dr. Kumar!

I just have one question then and that should be all I believe. So not to bombard him with a request of too many tests to start with, what would be a good start for specific labs to request at my next visit? He most likely wouldn't refer me to a specialist unless there was abnormal results within that area (endocrine, hematology, etc).

I have already had a thyroid profile done which was normal. Are there any specific lab tests that are indicated for autonomic function testing?

Thanks so much!

XXXXX

Answered by Dr. Neeraj Kumar (13 hours later)

Brief Answer:
consult a neurologist and go for autonomic function testing

Detailed Answer:
Hello XXXX,
For starting you may do autonomic nervous testing which is done at special labs or centers dealing with neurology.
Autonomic nervous testing is a comprehensive test evaluating both sympathetic and parasympathetic systems with use of ECg, blood pressure measurements, valsalva, tilt table and sometimes pharmacological interventions.
It's better to get evaluated at a good center by neurologist for proper examination , investigations and treatment.

Hope you found the answer helpful.
Regards
Dr Neeraj Kumar

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Prasad