Diaphoresis

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 (A Cold Sweat)

 * Shock
 * ST Elevation Myocardial Infarction
 * Vagal episode

Differential Diagnosis of Secondary Hyperhidrosis (Excess Sweating):
In alphabetical order.


 * Acromegaly
 * Acute hypertensive crisis
 * Acute rheumatic fever
 * Autonomic dystonia
 * Brucellosis
 * Carcinoid syndrome
 * Castration
 * Chronic infections
 * Collagen vascular disease
 * Diabetes Mellitus
 * Diabetic neuropathy
 * Drugs
 * Dumping syndrome
 * Encephalitis
 * Endocarditis lenta
 * Fever
 * Fructose intolerance
 * Glycogenoses I, III, VI
 * Heart attack
 * HIV infection
 * Hodgkin's Lymphoma
 * Hypernephroma
 * Hyperthyroidism
 * Hypoglycemia
 * Hypoglycemic shock
 * Hypogonadism
 * Insulinoma
 * Left heart failure
 * Malaria
 * Mastocytosis
 * Menopause
 * Mercury poisoning
 * Non-Hodgkin's lymphoma
 * Obesity
 * Parkinson's Disease
 * Phenylketonuria
 * Pheochromocytoma
 * Pneumonia
 * Polyneuropathy
 * Primary liver cell carcinoma
 * Pulmonary Embolism
 * Rheumatoid Arthritis
 * Rickets
 * Sarcomas
 * Serotonin syndrome
 * Shock
 * Syringomyelia
 * Tabes Dorsalis
 * Traumatic brain injury
 * Tuberculosis
 * Vagal episode
 * 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.