Test Overview

A sweat test measures the amount of salt chemicals (sodium and chloride) in sweat. It is done to help diagnose cystic fibrosis . Normally, sweat on the skin surface contains very little sodium and chloride. People with cystic fibrosis have 2 to 5 times the normal amount of sodium and chloride in their sweat.

During the sweat test, medicine that causes a person to sweat is applied to the skin (usually on the arm or thigh). The sweat is then collected on a paper or a gauze pad, and the amount of salt chemicals in the paper or gauze is measured in a lab. Generally, chloride (sweat chloride) is measured. See a picture of a sweat test .

A sweat test is done on any baby suspected of having cystic fibrosis. An initial test may be done as early as 48 hours of age. But a sweat test done during the first month of life may need to be repeated. Younger babies may not produce enough sweat to give reliable test results. Also, younger babies may naturally have lower sweat chloride levels than older babies and children with cystic fibrosis.

Why It Is Done

The sweat test is done to help diagnose cystic fibrosis. It also may be used to test people with a family history of cystic fibrosis and for anyone with symptoms of cystic fibrosis.

How To Prepare

No special preparation is needed before having this test. Your child may eat, drink, and exercise normally before the test. If your child takes any medicines, he or she may take them on the usual schedule.

You may help with the test and stay with your child during the test. If you cannot stay, you may want to ask a family member or friend to stay with your child. Bring your child's favorite book or toy to help pass the time while the test is done. See if your child might be able to watch a movie during the test.

Talk with your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

How It Is Done

The sweat test is usually done on a baby's right arm or thigh. On an older child or adult, the test is usually done on the inside of the right forearm. Sweat may be collected and analyzed from two different sites.

• The skin is washed and dried, then two small gauze pads are placed on the skin. One pad is soaked with a medicine that makes the skin sweat, called pilocarpine. The other pad is soaked with salt water.
• Other pads called electrodes are placed over the gauze pads. The electrodes are hooked up to an instrument that produces a mild electric current, which pushes the medicine into the skin.
• After 5 to 10 minutes, the gauze pads and electrodes are removed, and the skin is cleaned with water and then dried. The skin will look red in the area under the pad that contained the medicine.
• A dry gauze pad, paper collection pad, or special tubing is taped to the red patch of skin. This pad is covered with plastic or wax to prevent fluid loss (evaporation).
• The new pad will soak up the sweat for up to 30 minutes, then it is removed and placed in a sealed bottle. It is then weighed to measure how much sweat the skin produced, and it is checked to find out how much salt chemical (sodium and/or chloride) the sweat contains. Another testing method collects the sweat into a coil (macroduct technique).
• After the collection pad is removed, the skin is washed and dried again. The test site may look red and continue to sweat for several hours after the test.

The sweat test usually takes 45 minutes to 1 hour.

How It Feels

This test does not cause pain. Some children feel a light tingling or tickling when the electric current is applied to the skin. If the gauze pads are not properly placed, the electric current may produce a burning sensation.

Risks

There is very little risk of complications from this test. But the test should always be done on an arm or leg (not the chest) to prevent the possibility of electric shock.

The electric current may cause skin redness and excess sweating for a short time after the test is done. In rare cases, the current may make the skin look slightly sunburned.

Results

A sweat test measures the amount of salt chemicals (sodium and chloride) in sweat. Generally, chloride (sweat chloride) is measured.

Results are usually available in 1 or 2 days. Normal results vary from lab to lab.

Many conditions can change sodium and chloride levels. Your health professional will discuss any significant abnormal results with you in relation to your symptoms and medical history.

The test results do not indicate how severe the cystic fibrosis is. The test only shows if a person could have the disease.

Abnormal (high) values

High values:

• Usually mean a person has cystic fibrosis. Some people with cystic fibrosis have borderline or even normal sweat chloride levels.
• May be caused by other conditions. But the sweat test is not used to diagnose these conditions, which include:
  • Adrenal gland problems, such as adrenal insufficiency or Addison's disease .
  • Hypothyroidism .
  • Kidney failure .

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• A baby's age. Babies younger than 4 weeks may not produce enough sweat to give reliable test results and may have lower sweat chloride levels than older babies and children. A minimum amount of sweat is needed for accurate test results regardless of the child's age.
• A skin rash or sore on the area of the skin where the gauze pads are attached.
• Acute or severe illness.
• Dehydration or heavy sweating.
• Decreased sweating.
• Normal fluctuations in sodium and chloride during puberty .
• A decrease in the hormone aldosterone.
• Steroid medicines, such as fludrocortisone.

What To Think About

• Usually, two sweat tests are done to confirm a diagnosis of cystic fibrosis .
• Younger babies may not produce enough sweat to give reliable test results and may have lower sweat chloride levels than older babies and children with cystic fibrosis.
• A sweat test cannot identify carriers of the cystic fibrosis gene. If your child is diagnosed with cystic fibrosis, you may wish to talk with your health professional about genetic counseling . For more information, see the topic Cystic Fibrosis Carrier Screening.
• Adults generally have higher salt concentrations in their sweat than children. Also, sweat test results in adults can vary widely. This is especially true in women, because the amount of salt in their sweat can vary with the phase of their menstrual cycle . Enough sweat must be collected to get accurate test results.
• If results of a sweat test are positive or unclear (especially in babies), a blood test may be done to detect changes in the genetic material ( DNA ) that causes cystic fibrosis. Blood test results are usually ready in 10 to 21 days. For more information, see the medical test Genetic Test.
• Sweat tests should be done at labs that are certified by the Cystic Fibrosis Foundation. These labs perform a large number of sweat tests and are skilled at sweat test techniques and interpretation.

References

Other Works Consulted

• Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
• Farrell PM, et al. (2008). Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. Journal of Pediatrics, 153(2): S4–S14.
• Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
• LeGrys VA, et al. (2007). Diagnostic sweat testing: The Cystic Fibrosis Foundation Guidelines. Journal of Pediatrics, 151(1): 85–89.
• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

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