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ULY CLINIC

17 Septemba 2025, 12:33:54

Clammy skin

Clammy skin is moist, cool, and usually pale, reflecting a sympathetic nervous system response to stress. It occurs when epinephrine and norepinephrine induce cutaneous vasoconstriction and activate eccrine sweat glands, particularly on the palms, soles, and forehead.

Clammy skin often accompanies shock, acute hypoglycemia, anxiety, arrhythmias, or heat exhaustion. It may also result from vasovagal reactions to severe pain, presenting with nausea, tachycardia, weakness, pupillary dilation, and sometimes syncope.

Pathophysiology

Stress or critical illness activates sympathetic adrenergic pathways, releasing epinephrine and norepinephrine.
Vasoconstriction reduces skin perfusion, producing pallor.
Eccrine sweat gland stimulation causes cold, clammy perspiration.
Accompanies hemodynamic compromise or acute metabolic disturbances.

History and Physical Examination

History:

Onset, duration, and triggers of clamminess
History of diabetes, cardiac disease, or arrhythmias
Medications, especially antiarrhythmics or insulin
Associated symptoms: chest pain, palpitations, epigastric distress, nausea, vomiting, weakness, confusion, syncope
Fluid balance and bowel habits

Physical Examination:

Examine skin color, moisture, and temperature
Assess pupils for dilation or sluggish response
Evaluate vital signs: blood pressure, heart rate, temperature, respiratory rate
Check abdominal distention and muscle tension
Monitor mental status and alertness

Medical causes

Cause	Onset	Key Features	Associated Signs	Pathophysiology	Management
Anxiety	Acute	Cool, clammy palms, forehead, soles	Tachycardia/bradycardia, palpitations, tremor, nausea, headache, hyperventilation	Sympathetic activation	Calm environment, emotional support, analgesics or anxiolytics as indicated
Arrhythmias	Sudden	Generalized clammy skin	Dizziness, hypotension, altered mental status	Cardiac output compromise	Monitor ECG, antiarrhythmic therapy, stabilize hemodynamics
Cardiogenic shock	Acute	Generalized cool, moist, pale skin	Tachycardia, hypotension, cyanosis, confusion, oliguria	Reduced cardiac output → poor tissue perfusion	Oxygen, fluids cautiously, inotropes, ICU care
Heat exhaustion	Acute	Pale, clammy skin, headache, confusion	Syncope, giddiness, nausea, vomiting, tachypnea	Dehydration, electrolyte imbalance, vasodilation	Cool environment, rehydration, electrolyte replacement
Hypoglycemia (acute)	Sudden	Cool, clammy skin, diaphoresis	Hunger, tremors, palpitations, irritability, confusion, blurred vision	CNS glucose deprivation → sympathetic activation	Oral or IV glucose, monitor blood sugar
Hypovolemic shock	Acute	Pale, clammy, cool skin	Hypotension, tachycardia, rapid thready pulse, oliguria, flat neck veins	Low circulating volume → decreased perfusion	Rapid fluid resuscitation, monitor vitals, ICU care
Septic shock (cold shock stage)	Acute	Generalized cold, clammy skin	Hypotension, tachycardia, oliguria/anuria, respiratory failure	Peripheral vasoconstriction in early shock phase	IV antibiotics, fluids, vasopressors, ICU support

Emergency interventions

Recognize clammy skin as a sign of shock, hypoglycemia, or arrhythmia.
Monitor vital signs frequently, assess mental status, and evaluate urine output.
Stabilize airway, breathing, and circulation as appropriate.
Treat underlying cause promptly (e.g., IV glucose for hypoglycemia, fluids for shock, antiarrhythmics).
Provide a quiet environment and emotional support for anxiety or pain-induced clamminess.

Special considerations

Frequent monitoring of vital signs and fluid balance is essential.
Consider ICU admission if clammy skin accompanies hypotension, confusion, or multisystem compromise.
In pain or anxiety, use analgesics or anxiolytics and minimize stressful stimuli.

Patient counseling

Explain that clammy skin is usually a warning sign of serious illness or stress response.
Educate about early recognition of underlying causes: hypoglycemia, shock, or arrhythmia.
Reassure and orient patient/family during ICU care or emergency treatment.

Pediatric pointers

Infants may not develop clammy skin due to immature sweat glands.
Monitor for other signs of shock or hypoglycemia.

Geriatric pointers

Elderly patients develop clammy skin easily due to reduced tissue perfusion.
Consider bowel ischemia in older patients presenting with cool, clammy skin, particularly with abdominal pain or bloody stools.

References

Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.