Cool extremities

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: Cold extremities; cold feet; cold hands and feet; cold hands

Overview

Cool extremities refers to a condition where the hands and feet are colder than the core of the body.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	Acute limb ischemia, aortic dissection, arterial insufficiency, Buerger’s disease, cardiac tamponade, cardiogenic shock, chronic venous disease, circulatory disorders, claudication, coarctation of the aorta, congenital heart disease, congestive heart failure, coronary heart disease, embolization, heart attack, heart failure, hemothorax, hypoplastic left heart syndrome, hypovolemia, hypovolemic shock, idiopathic systemic capillary leak syndrome, myocardial infarction, neonatal shock, neurogenic shock, peripheral artery disease, postural orthostatic tachycardia syndrome, pulmonary embolism, shock, ST elevation myocardial infarction, syncope, systemic vasoconstriction, Takayasu arteritis, vasospasm, vasovagal syncope, wide complex tachycardia
Chemical/Poisoning	Marine turtle poisoning, snakebite
Dental	No underlying causes
Dermatologic	Acrocyanosis, burns, hyperhidrosis, lupus, meningococcal disease, Pratesi syndrome, scleroderma
Drug Side Effect	Acebutolol, alprenolol, amlodipine, atenolol, beta blockers, Butorphanol, caduet, carteolol, esmolol, isocarboxazid, meperidine, metoprolol, nalbuphine, oxprenolol, oxymorphone, pentamidine, phenelzine, pindolol, propranolol, rasagiline, rilmenidine, selegiline, sotalol, timolol, tranylcypromine, vasopressors, vicodin, ziac
Ear Nose Throat	No underlying causes
Endocrine	Diabetes insipidus, diabetes mellitus, hypothyroidism, myxedema coma, myxedema, thyroid disease, glycogen storage disease type I
Environmental	Cold exposure, frostbite, hypothermia
Gastroenterologic	Glycogen storage disease type I, scleroderma
Genetic	Cockayne syndrome, glycogen storage disease type I
Hematologic	Anemia, bleeding, disseminated intravascular coagulation, meningococcal disease
Iatrogenic	Hemodialysis
Infectious Disease	Bacterial sepsis, septic shock, meningococcal disease
Musculoskeletal/Orthopedic	Acute limb ischemia, burns, Raynaud’s disease, tarsal tunnel syndrome, scleroderma
Neurologic	Chronic fatigue syndrome, Cockayne syndrome, hyperhidrosis, meningococcal disease, restless legs syndrome, subclavian steal syndrome
Nutritional/Metabolic	Dehydration, glycogen storage disease type I, malnutrition, starvation
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	Acetylsalicylic acid overdose, alcohol withdrawal, drug overdose, hydrocodone overdose
Psychiatric	Alcohol withdrawal, anxiety, chronic fatigue syndrome, emetophobia, night terror, nightmare, panic attack
Pulmonary	Hemothorax, scleroderma
Renal/Electrolyte	Acute kidney injury, acute tubular necrosis, dehydration, lactic acidosis, lupus, scleroderma
Rheumatology/Immunology/Allergy	Buerger’s disease, chronic fatigue syndrome, lupus, Raynaud’s disease, Raynaud’s phenomenon, scleroderma, Sjogren’s syndrome
Sexual	No underlying causes
Trauma	Trauma
Urologic	No underlying causes
Miscellaneous	Hypothermia

Causes in Alphabetical Order

Drug overdose
Embolization^[3]
Emetophobia
Esmolol
Frostbite
Glycogen storage disease type I
Heart attack
Heart failure
Hemodialysis
Hemothorax
Hydrocodone overdose
Hyperhidrosis
Hypoplastic left heart syndrome
Hypothermia
Hypothyroidism
Hypovolemia
Hypovolemic shock
Idiopathic systemic capillary leak syndrome
Isocarboxazid
Lactic acidosis
Lupus
Malnutrition
Marine turtle poisoning
Meningococcal disease
Meperidine
Metoprolol
Myocardial infarction
Myxedema
Myxedema coma
Nalbuphine
Neonatal shock
Neurogenic shock
Night terror
Nightmare
Oxprenolol
Oxymorphone
Panic attack

Differential Diagnosis of the Patient with Cool Extremities and Sweating or Diaphoresis, or “A Cold Sweat”

In contrast to the patient with cardiogenic shock and hypovolemic shock, the patient with septic shock will often have warm extremities.

References

↑ Patel H, Krishnamoorthy M, Dorazio RA, Abu Dalu J, Humphrey R, Tyrell J (1994). “Thrombosis of abdominal aortic aneurysms”. Am Surg. 60 (10): 801–3. PMID 7944047.
↑ Sharma VK, Fraulin FO, Dumestre DO, Walker L, Harrop AR (2013). “Beta-blockers for the treatment of problematic hemangiomas”. Can J Plast Surg. 21 (1): 23–8. PMC 3891114. PMID 24431932.
↑ Loh FK (1985). “Embolization of a sciatic artery aneurysm an alternative to surgery: a case report”. Angiology. 36 (7): 472–6. PMID 4025951.
↑ Quietzsch D (1982). “[Pheochromocytoma and shock]”. Z Gesamte Inn Med. 37 (1): 32–4. PMID 6280403.
↑ Dabrowski GP, Akers DL (1997). “Takayasu’s arteritis: management of a complex case and literature review”. J La State Med Soc. 149 (6): 250–3. PMID 9231628.

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[pmid7944047-1] Patel H, Krishnamoorthy M, Dorazio RA, Abu Dalu J, Humphrey R, Tyrell J (1994). “Thrombosis of abdominal aortic aneurysms”. Am Surg. 60 (10): 801–3. PMID 7944047.

[pmid24431932-2] Sharma VK, Fraulin FO, Dumestre DO, Walker L, Harrop AR (2013). “Beta-blockers for the treatment of problematic hemangiomas”. Can J Plast Surg. 21 (1): 23–8. PMC 3891114. PMID 24431932.

[pmid4025951-3] Loh FK (1985). “Embolization of a sciatic artery aneurysm an alternative to surgery: a case report”. Angiology. 36 (7): 472–6. PMID 4025951.

[pmid6280403-4] Quietzsch D (1982). “[Pheochromocytoma and shock]”. Z Gesamte Inn Med. 37 (1): 32–4. PMID 6280403.

[pmid9231628-5] Dabrowski GP, Akers DL (1997). “Takayasu’s arteritis: management of a complex case and literature review”. J La State Med Soc. 149 (6): 250–3. PMID 9231628.

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