Diaphoresis

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Diaphoresis
ICD-10 R61
ICD-9 780.8

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

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

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
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 No underlying causes

Causes in Alphabetical Order

[1] [2]


Treatment

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

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

See also


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