Diaphoresis

	Diaphoresis;
ICD-10	R61
ICD-9	780.8

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

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:

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.
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.
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.
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

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular	Acute rheumatic fever, Acute hypertensive crisis, endocarditis, endocarditis lenta, heart attack, left heart failure, Orthostatic hypotension
Chemical/Poisoning	Carbamate insecticide poisoning, Indian tobacco (lobelia inflata), Indole alkaloids poisoning, mercury poisoning, muscarine, organophosphate insecticide poisoning, pesticide poisoning, poison hemlock (conium maculatum, tobacco plant poisoning, toxic mushrooms
Dental	No underlying causes
Dermatologic	Basal cell carcinoma, blue rubber bleb nevus syndrome, eccrine angiomatous hamartoma, eccrine nevus, granulosis rubra nasi, Jackson-lawler congenital pachyonychia, Jadassohn-Lewandowsky syndrome, Meleda disease, pachydermoperiostosis, palmoplantar punctate keratoderma type 3, pitted keratolysis, rosacea, Ross' syndrome, tufted angioma
Drug Side Effect	Acetaminophen, ambenonium, amitriptyline, amonafide, anastrozole, aspirin, aztreonam, beta blockers, beta-agonists, bethanechol, bromocriptine, bupropion, calcium channel blockers, cladribine, clozapine, cyclosporine, demecarium bromide, desipramine, desvenlafaxine, dimebon, dimercaprol, distigmine, donepezil, dothiepin, duloxetine, echothiophate iodide, exemestane, flumazenil, flutamide, fluvoxamine, gonadorelin, goserelin, histrelin, Humorsol, hydralazine, imatinib, infliximab, interferon alfa-2b, letrozole, leuprolide, methadone, morphine, nafarelin, neostigmine, niacin, nitroglycerin, nonsteroidal anti-inflammatory drugs , norepinephrine reuptake inhibitors, nortriptyline, omeprazole, opioids, phenylephrine, phospholine iodide, physostigmine, pilocarpine, protease inhibitors, pyridostigmine, raloxifene, rituximab, ropinirole, selective serotonin reuptake inhibitors, sibutramine, sildenafil, sulfonylureas, tamoxifen, theophylline, thiazolidinediones, tramadol, tricyclic antidepressants, vancomycin resistant enterococcal bacteremia, venlafaxine
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, carcinoid syndrome, diabetes insipidus, diabetes mellitus, diabetic neuropathy, gonadorelin, growth hormone secreting pituitary adenoma, growth hormone, hyperthyroidism, hypoglycaemia, hypogonadism, insulinoma, medullary carcinoma of the thyroid, menopause, multiple endocrine neoplasia type 1, multiple endocrine neoplasia type 2, multiple endocrine neoplasia type3, phaeochromocytoma, Poems syndrome, thyrotoxicosis
Environmental	Heat exhaustion
Gastroenterologic	Congenital hepatic porphyria, dumping syndrome, gastroesophageal reflux, liver abscess, rickets,
Genetic	No underlying causes
Hematologic	Polycythaemia rubra vera, Non-Hodgkin's lymphoma, Lymphoma
Iatrogenic	Castration
Infectious Disease	Abscess, acute rheumatic fever, AIDS, atypical mycobacteria, babesiosis, bacteremia, bacterial meningitis, brucellosis, Chronic hepatitis C, Chronic infections, circulatory shock, encephalitis, herpes zoster of the preauricular region, HIV infection, liver abscess, lung abscess, malaria, osteomyelitis, pitted keratolysis, pneumonia, relapsing fever, sepsis, septic shock, tetanus, tuberculosis, viral infections
Musculoskeletal/Orthopedic	Soft tissue sarcoma, Rickets, Myotonic dystrophy
Neurologic	Alternating hemiplegia of childhood, alternating hemiplegia, autonomic dysreflexia syndrome, autonomic dysreflexia, autonomic dystonia, autonomic hyperreflexia, autonomic nerve disorders, autonomic neuropathy, bacterial meningitis, diabetic neuropathy, encephalitis, Frey's syndrome, Hereditary sensorimotor neuropathy type 2, hereditary sensory and autonomic neuropathy type 3, idiopathic syringomyelia, motion sickness, myotonic dystrophy, neurogenic shock, neuroleptic malignant syndrome, pain, Parkinson's disease, POEMS syndrome, posttraumatic syringomyelia, reflex sympathetic dystrophy syndrome, reflex sympathetic osteodystrophy, sleep disorders, spinal autonomic dysreflexia, spinal muscular atrophy with respiratory distress 1, stroke, syringomyelia, temporal arteritis, traumatic brain injury
Nutritional/Metabolic	Aromatic amino acid decarboxylase deficiency, congenital hepatic porphyria, food additives, fructose intolerance, fucosidosis, hypertryptophanemia, hypoglycaemia, obesity, rickets, xanthic urolithiasis
Obstetric/Gynecologic	Menopause
Oncologic	Acute monocytic leukemia, basal cell carcinoma, Blue rubber bleb nevus syndrome, carcinoid syndrome, eccrine nevus, germ cell tumors, growth hormone secreting pituitary adenoma, hodgkin's lymphoma, insulinoma, lymphoma, malignancy, medullary carcinoma of the thyroid, multiple endocrine neoplasia type 1, multiple endocrine neoplasia type 2, multiple endocrine neoplasia type 3, non-hodgkin's lymphoma, phaeochromocytoma, polycythaemia rubra vera, prostate cancer, renal cell carcinoma, sarcomas, soft tissue sarcoma, trophoblastic cancer
Ophthalmologic	Temporal arteritis
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

3

Treatment

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