Cool extremities

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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


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


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

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.


  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.
  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.
  3. Loh FK (1985). "Embolization of a sciatic artery aneurysm an alternative to surgery: a case report". Angiology. 36 (7): 472–6. PMID 4025951.
  4. Quietzsch D (1982). "[Pheochromocytoma and shock]". Z Gesamte Inn Med. 37 (1): 32–4. PMID 6280403.
  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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