Diaphoresis

Diaphoresis
ICD-10	R61
ICD-9	780.8

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Cold sweat, clammy

Overview

Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. It is distinguished from hyperhidrosis by the "clammy" or "cold state" state of the patient.

Classification of Sweating

There are four types of sweats:

1. Diaphoresis: Diaphoresis is a cold sweat. Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. It is distinguished from hyperhidrosis by the "clammy" or "cold state" state of the patient.
2. Primary Hyperhidrosis: Primary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. This is not a cold sweat.
3. Secondary Hyperhidrosis: Secondary hyperhidrosis is a condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature that is secondary to an underlying pathologic process such as infections, disorders of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. This is not a cold sweat.
4. Night sweats: Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. The sufferer may or may not also suffer from excessive perspiration while awake.

Physiological (normal) causes of Sweating

Normal physical causes of diaphoresis include exercise, menopause, fever, spicy foods, high environmental temperature, and vigorous sports. Strong emotions (anger, fear) and remembrance of past trauma can also trigger profuse sweating.

The vast majority of sweat glands in the body are innervated by sympathetic cholinergic neurons. Sympathetic cholinergic neurons are sympathetic postganglionic neurons that happen to release acetylcholine instead of norepinephrine.

Pathological causes

Diaphoresis may be associated with some abnormal conditions, such as hyperthyroidism and shock. If it is accompanied by unexplained weight loss or fever or by palpitations, shortness of breath, or chest discomfort, a physician should be consulted. Diabetics relying on insulin shots or oral medications may have low blood sugar, which can also cause diaphoresis.

Various drugs (including caffeine, morphine, alcohol, and certain antipsychotics) may be causes, as well as withdrawal from alcohol or narcotic painkiller dependencies. Sympathetic nervous system stimulants such as cocaine and amphetamines have also been associated with diaphoresis. Diaphoresis due to ectopic catecholamine is a classic symptom of a pheochromocytoma, a rare tumor of the adrenal gland.

Diaphoresis is also seen in an acute myocardial infarction, from the increased firing of the sympathetic nervous system.

Differential Diagnosis of Diaphoresis

Common Causes

• Shock
• Lymphoma
• Fever
• Hypoglycemia
• ST Elevation Myocardial Infarction
• Vagal episode

Causes by Organ System

Cardiovascular	Orthostatic hypotension, Left heart failure, Heart attack, Endocarditis lenta, Endocarditis, Acute rheumatic fever, Acute hypertensive crisis
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Eccrine nevus, Eccrine angiomatous hamartoma, Blue rubber bleb nevus syndrome, Basal cell carcinoma
Drug Side Effect	Tricyclic antidepressants, Tramadol, Thiazolidinediones, Theophylline, Tamoxifen, Sulfonylureas, Sildenafil, Selective serotonin reuptake inhibitors (SSRIs) , Ropinirole, Rituximab, Raloxifene, Protease inhibitors, Phenylephrine, Opioids, Omeprazole, Nortriptyline, Norepinephrine reuptake inhibitors (SSNRIs) , Nonsteroidal anti-inflammatory drugs (NSAIDs) , Nitroglycerin,Niacin, Neostigmine, Nafarelin, Morphine, Methadone, Leuprolide, Letrozole, Interferon alfa-2b, Infliximab,Imatinib, Hydralazine, Histrelin, Goserelin, Gonadorelin, Fluvoxamine, Flutamide, Dothiepin, Donepezil,Desvenlafaxine, Desipramine, Cyclosporine, Clozapine, Calcium channel blockers, Bupropion, Bromocriptine, Bethanechol, Beta-agonists, Beta blockers, Aspirin, Anastrazole , Ambenonium, Acetaminophen, Flumazenil, Physostigmine
Ear Nose Throat	No underlying causes
Endocrine	Phaeochromocytoma, Multiple endocrine neoplasia type 3, Multiple endocrine neoplasia type 2, Multiple endocrine neoplasia type 1, Insulinoma, Hypogonadism, Hypoglycaemia, Hyperthyroidism, Growth hormone secreting pituitary adenoma, Growth hormone, Diabetic neuropathy, Diabetes Mellitus, Carcinoid syndrome, Acromegaly, Diabetic neuropathy
Environmental	No underlying causes
Gastroenterologic	Dumping syndrome
Genetic	No underlying causes
Hematologic	Polycythaemia rubra vera, Non-Hodgkin's lymphoma, Lymphoma
Iatrogenic	Castration
Infectious Disease	Viral infections, Tuberculosis, Pneumonia, Malaria, HIV, Herpes zoster of the preauricular region, Encephalitis, Chronic infections, Brucellosis, Bacterial meningitis, Bacteremia, Babesiosis
Musculoskeletal/Orthopedic	Soft tissue sarcoma, Rickets, Myotonic dystrophy
Neurologic	Syringomyelia, Spinal autonomic dysreflexia, Reflex sympathetic dystrophy syndrome, Parkinson's Disease, Misdirection of autonomic nerve fibers following parotid surgery (Frey's syndrome), Hereditary sensory and autonomic neuropathy type 3, Hereditary sensory and autonomic neuropathy type 2, Hereditary sensorimotor neuropathy type 2, Autonomic neuropathy, Autonomic dystonia, Autonomic dysreflexia, Alternating Hemiplegia
Nutritional/Metabolic	Obesity, Hypertryptophanemia , Fructose intolerance, Congenital hepatic porphyria
Obstetric/Gynecologic	Menopause
Oncologic	Malignancy, Leukemia Monocytic, Acute, Hodgkin's Lymphoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	Withdrawal in drug addicts, Toxic mushrooms -- Cholinergic, Tobacco Plant poisoning, Organophosphate insecticide poisoning, Mercury poisoning, Indole alkaloids poisoning, Heroin withdrawal, Alcohol
Psychiatric	Panic attack, Anxiety, Acute stress disorder
Pulmonary	Pulmonary Embolism
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Rheumatoid Arthritis, Collagen vascular disease
Sexual	No underlying causes
Trauma	Traumatic brain injury, Post-traumatic syringomyelia
Urologic	No underlying causes
Miscellaneous	Shock, Serotonin syndrome, Ross syndrome, Primary hyperhidrosis, POEMS syndrome, Neuroleptic malignant syndrome, Meleda disease, Mastocytosis, Loewenthal syndrome, Lobstein disease, Jadassohn-Lewandowsky syndrome, Idiopathic, Gamstorp-Wohlfart syndrome, Fucosidosis type II, Fucosidosis type 1, Frey syndrome, Exemestane, Bland-Garland-White syndrome, Aromatic amino acid decarboxylase deficiency, Acrodynia

Causes in Alphabetical Order

Acetaminophen Acrodynia Acromegaly Acute hypertensive crisis Acute rheumatic fever Acute stress disorder Alcohol Alternating Hemiplegia Ambenonium Anastrazole Anxiety Aromatic amino acid decarboxylase deficiency Aspirin Autonomic dysreflexia Autonomic dystonia Autonomic neuropathy Babesiosis Bacteremia Bacterial meningitis Basal cell carcinomas Beta blockers Beta-agonists Bethanechol Bland-Garland-White syndrome Blue rubber bleb nevus syndrome Bromocriptine Brucellosis Bupropion Calcium channel blockers Carcinoid syndrome Castration Chronic infections Clozapine Collagen vascular disease Congenital hepatic porphyria Cyclosporine Desipramine Desvenlafaxine Diabetes Mellitus Diabetic neuropathy Donepezil Dothiepin Dumping syndrome Eccrine angiomatous hamartoma Eccrine nevus Encephalitis Endocarditis Endocarditis lenta Exemestane Flumazenil Flutamide Fluvoxamine Frey syndrome Fructose intolerance Fucosidosis type 1 Fucosidosis type II

Gamstorp-Wohlfart syndrome Gonadorelin Goserelin Growth hormone secreting pituitary adenoma Growth hormone Heart attack Hereditary sensorimotor neuropathy type 2 Hereditary sensory and autonomic neuropathy type 2 Hereditary sensory and autonomic neuropathy type 3 Heroin withdrawal Herpes zoster of the preauricular region Histrelin HIV Hodgkin's Lymphoma Hydralazine Hyperthyroidism Hypertryptophanemia Hypoglycaemia Hypogonadism Idiopathic Imatinib Indole alkaloids poisoning Infliximab Insulin Insulinoma Interferon alfa-2b Jadassohn-Lewandowsky syndrome Left heart failure Letrozole Leukemia, Monocytic, Acute Leuprolide Lobstein disease Loewenthal syndrome Lymphoma Malaria Malignancy Mastocytosis Meleda disease Menopause Mercury poisoning Methadone Misdirection of autonomic nerve fibers following parotid surgery (Frey's syndrome) Morphine Multiple endocrine neoplasia type 1 Multiple endocrine neoplasia type 2 Multiple endocrine neoplasia type 3 Myotonic dystrophy Nafarelin Neostigmine Neuroleptic malignant syndrome Niacin Nitroglycerin

Non-Hodgkin's lymphoma Nonsteroidal anti-inflammatory drugs (NSAIDs) Norepinephrine reuptake inhibitors (SSNRIs) Nortriptyline Obesity Omeprazole Opioids Organophosphate insecticide poisoning Orthostatic hypotension Panic attack Parkinson's Disease Phaeochromocytoma Phenylephrine Physostigmine Pneumonia POEMS syndrome Polycythaemia rubra vera Post-traumatic syringomyelia Primary hyperhidrosis Protease inhibitors Pulmonary Embolism Raloxifene Reflex sympathetic dystrophy syndrome Rheumatoid Arthritis Rickets Rituximab Ropinirole Ross syndrome Sarcomas Selective serotonin reuptake inhibitors (SSRIs) Serotonin syndrome Shock Sildenafil Soft tissue sarcoma Spinal autonomic dysreflexia Sulfonylureas Syringomyelia Tamoxifen Theophylline Thiazolidinediones Tobacco Plant poisoning Toxic mushrooms -- Cholinergic Tramadol Traumatic brain injury Tricyclic antidepressants Tuberculosis Viral infections Withdrawal in drug addicts

Treatment

When diaphoresis is pathologic, the underlying cause should be treated. When the cause is menopause, estrogen replacement therapy may improve the symptoms.

References

See also

• Hyperhidrosis

Template:WikiDoc Sources