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Diaphoresis Definition and Causes

By , August 10th 2013. Last reviewed 27th May 2015.

Diaphoresis Definition

Diaphoresis is the medical term for excessive perspiration or profuse sweating 1,2.

Word origin: from the Greek diaphorein [dia = through; phorein = carry], which means “to pass through” or convey 2.

Pronunciation: dahy-uh-fuh-ree-sis 3

The synonym for diaphoresis is hyperhidrosis.

Types of Excessive Sweating

A. Diaphoresis, also called generalized or secondary hyperhidrosis, is excessive sweating all over the body from a known or identifiable cause.

  • Hot flushes are episodes of short-living hot feeling, redness and excessive sweating limited to face, neck and upper chest.
  • Night sweats occur predominantly during sleep.

B. Localized excessive sweating in hands, feet or other sites from a known cause

C. Primary focal hyperhidrosis, also called essential or idiopathic hyperhidrosis is excessive sweating from an uncertain cause, usually limited to the palms, soles, armpits, face or scalp 27.

A. Diaphoresis

Chart 1. Medical Emergencies With Diaphoresis

Cause

Symptoms and Signs

CLAMMY (MOIST, COOL, PALE) SKIN
Hypoglycemia 56 Progressive weakness and sleepiness, coma
Acute abdomen: appendicitis, cholecystitis, diverticulitis, pancreatitis, pyelonephritis 83 Abdominal pain and tenderness, nausea, fever
Heat exhaustion 77 Fever, headache, fatigue
Alcohol withdrawal (6-24 h after drinking) 65 Hand tremor, mood swings, vomiting, seizures, hallucinations (delirium tremens)
Opiate (morphine, codeine, heroin, methadone) withdrawal 82 Agitation, insomnia, runny nose, nausea, pin-sized pupils
Bacterial pneumonia or pulmonary edema 23 Coughing up frothy mucus, shortness of breath, high fever
Meningitis, encephalitis, Dengue 36 and typhoid fever, malaria 74 Severe headache, high fever
Heart attack 22,42,62 Severe chest pain, shortness of breath, fear of death
Cardiogenic shock (due to heart attack or arrhythmia) Chest pain, irregular heart rhythm, hypotension, impaired consciousness
Hypovolemic shock (due to severe bleeding or dehydration) Visible bleeding or abdominal or chest pain, thirst, rapid and weak pulse, hypotension, impaired consciousness, poor skin turgor
Hypoxia 57 Bluish skin, shortness of breath, confusion
Black widow or scorpion sting or snake bite 60 Skin puncture(s), local pain and redness, muscle cramps, numbness, abdominal or chest pain
Organophosphate (pesticides, war gases) and mushroom poisoning 59 “DUMBELS:” diaphoresis, diarrhea, urination, miosis, bradycardia, bronchospasm (wheezing), emesis, lacrimation, salivation
Pheochromocytoma (adrenal cancer) 58 Headache, pounding heart, high blood pressure
Drugs: amisulpride, amoxapine, chlorpromazine, clozapine, domperidone, droperidol, haloperidol, metoclopramide, olanzapine, prochlorperazine, promethazine, risperidone 7,8 Neuroleptic malignant syndrome: hyperthermia, rigidity, delirium
Drugs: amitriptyline, amphetamine, carbamezepine, cocaine, duloxetine, fentanyl, linezolid, lithium, MDMA (ecstasy), meperidine, metoclopramide, ondansetron, ritonavir, tramadol, valproic acid, venlafaxine; herbs: St. John’s wort, ginseng 7,44,45 Serotonin syndrome: agitation, confusion, sweating, dilated pupils, goose bumps
WARM SKIN
Heat stroke due to exercise 66 Fever 40 °C, muscle cramps
Hyperthyroidism (severe) 66 Goiter, high fever, very high heart rate, vomiting
Septic shock; early phase 78 Generalized swelling, high heart and breathing rate, increased or decreased body T, impaired consciousness
Malignant hyperthermia (a genetic disorder); symptoms are triggered by anesthetics (halothane) or succynylcholine 70 High fever, muscle cramps; death if not treated promptly

Cold Sweat (Clammy Skin), No Fever

  • Anxiety, fear, panic attack (increased heart rate, fainting) 86
  • Postural hypotension (dizziness upon standing, increased heart rate)
  • Food poisoning, hangover, motion sickness, jet lag (nausea, diarrhea) 29,35
  • Alcohol intoxication 93
  • Migraine (unilateral headache, photophobia) 51
  • Vasovagal syncope (fuzzy vision, fainting, slow heart rate) 54
  • Anemia (paleness, fatigue)
  • Kidney stones, gallstones, appendicitis (sudden, severe flank or abdominal pain, nausea)
  • Angina pectoris, heart attack, pericarditis, pneumothorax, aortic dissection (sudden, severe chest pain, shortness of breath)
  • Shock due to blood loss, heart attack or arrhythmia (paleness, anxiety, rapid and weak pulse)
  • Spinal cord or brain injury (muscle weakness or paralysis), multiple sclerosis (numbness, tingling, weakness) 35, myasthenia gravis (muscle weakness), Parkinson’s disease (tremor) 68
  • Other references: 9,25,28,35,46,76

Cold Sweat, Fever

  • Infections, such as flu (headache), bacterial pneumonia (cough), infectious mononucleosis (rash), HIV/AIDS, malaria, meningitis (headache), osteomyelitis (local redness and pain) and others
  • Vasculitis, for example, temporal arteritis (unilateral headache and tenderness, fatigue) 91
  • Poisoning with acrylamide, arsenic, cadmium fumes, chlordane, dieldrin, isopropyl alcohol, phenols, strychnine (vomiting)
  •  References: 9,22,35,46

Warm Sweat, No Fever

  • High ambient temperature, physical exercise, obesity
  • Hyperthyroidism 55

Warm Sweat, Fever

  • Heat stroke due to exercise
  • Sepsis or septic shock
  • Severe hyperthyroidism

Hot Flushes

Hot flushes refer to sudden hot feeling, redness and sweating limited to the face, neck and upper chest lasting from several seconds to 10 minutes 41.

Causes:

  • Menopause (in women around age 50) 43,85; rarely in men around age 50 87
  • Emotional stress, embarrassment, anger (blushing)
  • Migraine (unilateral headache)
  • Panic attack 86
  • Epileptic attack (involuntary jerky movements of the face or limbs) 73
  • Hyperthyroidism (nervousness, increased heart rate) 24
  • Tuberculosis (cough, low-grade fever) 40
  • Tumors:
    • Benign: adrenal adenoma, pituitary adenoma (Cushing’s syndrome) 71
    • Malign: brain tumors, pancreatic carcinoma, renal cell carcinoma, medullary thyroid carcinoma 85
  • Spinal cord lesions 40
  • Male hypogonadism 43,91
  • Drug overdose:
    • Acetaminophen (paracetamol) and salicylate (aspirin) toxicity 16,35
    • Antidepressants (SSRIs: citalopram, floxetine, sertraline)
    • Steroids (in high oral doses) 32,85
    • 4-hydroxyandrostenedione, clomifene and tamoxifen (for breast cancer) 38
    • Androgen suppressants (bicalutamide, cyproterone, spironolactone)
    • Other: bromocriptine, buserelin (for prostate cancer), calcium channel blockers (nifedipine, verapamil), chlorpropamide 40, clomiphene citrate, danazol, goserelin (for endometriosis), hydralazine, leuprolide, levodopa, nitrates (nitroglycerin), raloxifene 39,40, sidenafil, tolbutamide 40
  • Estrogen withdrawal 85
  • Reference: 40

Sweating Triggered by Eating or Drinking

Gustatory sweating refers to sweating on the forehead, scalp, neck and around the mouth triggered by hot drinks (coffee), sour or spicy foods (hot peppers that contain capsaicin, habanero); it can also occur in some individuals with diabetes mellitus, cluster headaches, Parkinson’s disease or facial herpes zoster (shingles) 39, 64,85.

Auriculotemporal or Frey’s syndrome refers to facial sweating, usually only on one side, triggered by eating or even by thinking about food (or anything what triggers salivation) in individuals with damaged facial nerves, for example due to a parotid gland infection or surgical treatment of Bell’s palsy 40,63.

Other causes:

  • Reactive hypoglycemia 49
  • Dumping syndrome in individuals with gastric bypass surgery 68
  • Scombroid fish poisoning after eating improperly preserved fish 85
  • Ciguatera fish poisoning by big tropical fish, such as barracuda, grouper and tuna (tingling of the face and limbs, vomiting, diarrhea, headache) 61
  • Poisoning with mushrooms that contain muscarine: Inocybe fastigiata, Inocybe geophylla and Inocybe patouillardii 72
  • Disulfiram-alcohol reaction 89
  • Consuming nonedible coprine-containing mushrooms, such as Clytocibe clavites, Coprinus atramentarius (common inkcap), Coprinus comatus (shaggy mane or inkcap) along with alcohol 14,15
  • Plant poisoning: cinchona, lobelia (an Indian plant), monkshood, oleander, pilocarpus, stingray, yellow jessamine/jasmine 9,22
  • Severe allergic reaction to food (itch, swelling of the lips and face – angioedema) 84

Causes of hot flushes without sweating: Asian flush reaction to alcohol, niacin supplements, intolerance to histamine, tyramine, nitrates, nitrites (in processed meat) or sulfites (in wine, beer), and carcinoid syndrome 85,88. Monosodium glutamate (MSG) has not been proven as a cause of flushing (Chinese restaurant syndrome) 85.

Night Sweats (Nocturnal Diaphoresis)

Excessive sweating during sleep can be caused by:

  • Menopause 38
  • Night terrors 42
  • Infections, such as bacterial endocarditis, brucellosis, hepatitis C, coccidioidomycosis, histoplasmosis, HIV/AIDS, infectious mononucleosis, Lyme disease, malaria, osteomyelitis, tuberculosis 31,38
  • Crohn’s disease and ulcerative colitis (abdominal pain, diarrhea, fatige, low-grade fever) 99
  • Chronic fatigue syndrome, fibromyalgia (musculoskeletal pain) 31
  • Sarcoidosis (chest pain, cough, fatigue) 21,35,100
  • Pericarditis (chest pain, fever) 31
  • Prinzmetal angina (sudden chest pain in individuals with heart disease) 13
  • Hodgkin lymphoma, leukemia and some other cancers 37,38

In primary focal hyperhidrosis, excessive sweating in palms and soles can occur mainly at night 38.

Unilateral Diaphoresis

Sweating limited to one side of the body can be caused by:

  • Stroke (sweating can appear before or after the stroke, even months later); other symptoms: sudden unilateral weakness and numbness, headache, temporary loss of consciousness 63
  • Transient ischemic attack (TIA) or mini-stroke
  • Harlequin’s syndrome. In individuals with a damage of the sympathetic nervous system (for example, due to a lung cancer), even mild heat or exercise results in sweating on one side of the body, usually on the face 63.
  • Unilateral hyperhidrosis with accompanying contralateral anhidrosis (rare) 28

Diaphoresis in Pregnancy

  • Morning sickness (nausea, vomiting)
  • Ectopic pregnancy (lower abdominal pain)
  • Accelerated (malignant) hypertension, including pre-eclampsia and eclampsia (headache, dizziness) 46
  • Postpartum diaphoresis: Some women sweat excessively for several weeks after delivery, especially at night 20.

Diaphoresis in Children

  • Viral gastroenteritis (stomach flu) in small children (diarrhea, fever)
  • Rubella, rubeolla, scarlet fever, chicken pox (rash, fever)
  • Other infectious diseases (fever)

Diaphoresis in infants:

  • Mercury poisoning or pink disease (pink fingers) 22
  • Congenital disorders in infants, such as Chediak-Higashi syndrome, congenital autonomic dysfunction, familial dysautonomia, familial glucocorticoid deficiency, hereditary periodic fever syndromes, phenylketonuria, porphyria 11, sickle cell anemia
  • Rickets (sweating due to bone pain) 92
  • Shapiro’s syndrome – impaired brain development (alternative hyperthermia and hypothermia) 63.
  • References: 9,35,46

Constant (Chronic) Excessive Sweating

Constant or repetitive sweating can occur in:

  • Hypotension (dizziness, pallor, fatigue) 97
  • Hyperthyroidism (anxiety, increased heart rate, warm skin)
  • Cancers: lymphoma, leukemia (night sweats, fatigue)
  • Anemia (pallor, fatigue) 25
  • Severe chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema (difficulty breathing, pale or bluish skin) 67
  • Rheumatoid arthritis (joint pain and swelling, flares of flu-like symptoms) 98
  • Chronic pancreatitis 35
  • Spinal cord lesions above T6 level can result in excessive sweating triggered by mild stimuli 63.

Drugs and Supplements and Sweating

  • Drug overdose: Ambenonium (for myasthenia gravis) 94, beta blockers (atenolol, propranolol) 52, caffeine 81, digitalis, lisinopril 69, cholinergics (neostigmine, physostigmine, pilocarpine), steroids 81, tolbutamide 81, tricyclic antidepressants (amitriptyline, doxepin, imipramine, paroxetine) 95 and serotonin reuptake inhibitors (fluoxetine, sertraline) 96
  • Illegal drugs abuse: LSD 80, methamphetamine (speed) 79, cocaine 35,45, heroin 22
  • Rapid drug withdrawal: alcohol, amantadine, amphetamines, benzodiazepines (diazepam), bromocriptine, estrogen, levodopa, narcotics (morphine, heroin), nicotine 7,35,85
  • A list of other drugs that can cause diaphoresis

Diaphoretics and Sudorifics

Diaphoretics are drugs that stimulate only insensible (invisible) perspiration 4.

Sudorifics [Latin sudor = sweat] are drugs that stimulate sensible (visible) perspiration 4.

Diaphoresis Pathophysiology

Sweat glands are innervated by sympathetic nerves. Excessive sweating occurs because of stimulation of the sympathetic nervous system.

Increased body temperature due to ambient heat, exercise, bacterial toxins or poisons, pain, stress and other factors stimulate the hypothalamus (a part of the central nervous system below the brain) to activate sympathetic nerves, which stimulate the sweat glands to produce sweat. The neurotransmitter involved in the stimulation of most sweat glands is acetylcholine and not norepinephrine as in most other parts of sympathetic system.

Treatment of Diaphoresis

Treatment of diaphoresis can include:

  • Fluids by mouth or intravenous infusion to prevent dehydration
  • In prolonged, severe diaphoresis, electrolytes, mainly sodium
  • Treating the underlying cause
  • Discontinuing certain drugs, if necessary

B. Localized Excessive Sweating

Hands and/or feet:

  • Peripheral neuropathy (for example, in diabetes mellitus or chronic alcoholism)
  • Acromegaly (due to a pituitary tumor with excessive growth hormone secretion)
  • Acrocyanosis 46
  • Erythrocyanosis
  • Raynaud’s phenomenon or disease
  • Symmetric lividity of the palms and soles
  • Palmoplantar keratoderma
  • Pachyonychia congenita

Feet only:

  • Burning feet syndrome 34

Lower legs:

  • Hypothyroidism (pretibial myxedema) 28

Face:

  • Granulosis rubra nasi
  • Temporal arteritis (unilateral throbbing headache) 91

Random sites:

  • Blue rubber-bleb nevus
  • Burns
  • Glomus tumor
  • Dyshidrotic eczema
  • Cellulitis (bacterial underskin infection) 33
  • Vitiligo
  • Pressure and postural hyperhidrosis
  • (Erythema nodosum, rash on the shins, may be warm to touch)
  • Reflex sympathetic dystrophy

C. Primary Focal Hyperhidrosis

Primary focal hyperhidrosis, also called essential or idiopathic hyperhidrosis, is excessive sweating from an uncertain cause, usually limited to the palms, soles, armpits, face and scalp 27.

Possible causes include psychosomatic disorders and chronic alcoholism 28.

Individuals with primary hyperhidrosis, even if otherwise healthy, can experience constant or episodic excessive sweating at rest at moderate ambient temperatures that usually do not cause sweating in other people.

Hyperhidrosis Pathophysiology

Emotional stress triggers the hypothalamus to stimulate the sympathetic nerves that stimulate the sweat glands in the palms and soles. The neurotransmitter involved in stimulation of sweat glands in the palms and soles is norepinephrine (noradrenaline). This type of excessive sweating is commonly referred to as hyperhidrosis.

Treatment of Hyperhidrosis

  • Antiperspirant sprays

Deodorants can be used to reduce body odor. Antiperspirant sprays are usually used only in primary hyperhidrosis.

Frequently Asked Questions?

1. Do high blood pressure and diabetes cause excessive sweating?

Uncomplicated high blood pressure (hypertension) and diabetes mellitus by themselves usually do not cause excessive sweating.

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