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Diaphoresis

Diaphoresis Definition

Diaphoresis means excessive perspiration 1. Doctors sometimes use diaphoresis to describe profound sweating 2. Diaphoresis can be associated with strong emotions or physiological conditions such as menopause, or by medical emergencies, such as acute hyperthyroidism or shock.

Word Origin

The word diaphoresis originates from Greek diaphorein; [dia = through; phorein = carry] and it literally means “to pass through” or convey 2.

Pronunciation

Diaphoresis is pronounced as [dahy-uh-fuh-ree-sis] 3.

Synonyms

Other terms for diaphoresis or generalized excessive sweating with a known cause:

  • Drenching sweats
  • Profuse sweating
  • Secondary hyperhidrosis

Associated Terms

  • Localized excessive sweating without known cause, which usually affects only the palms, soles, armpits or face is called primary or essential or idiopathic hyperhidrosis 27.
  • Localized excessive sweating with known cause can occur in acromegaly, blue rubber-bleb nevus, glomus tumor, peripheral neuropathy, pretibial myxedema (in lower legs) 28, cellulitis 33, burning feet syndrome 34.
  • Hot flashes are short (2-30 minutes) bursts of hot feeling, redness and sweats, usually confined to chest, neck and face 41.

What does ‘diaphoretic’ mean?

Diaphoretic as an adjective means:

  • The effect of a substance or medication having a power to produce diaphoresis, for example, a diaphoretic drug 4
  • An activity or condition producing diaphoresis; for example exercise has a diaphoretic effect.

A synonym for diaphoretic is sudorific (Latin sudor = sweat; facere = to make). Diaphoretic as a noun usually refers to a medication or other substance that causes diaphoresis.

  • Diaphoretics stimulate only insensible perspiration 4.
  • Sudorifics stimulate sensible perspiration (visible sweating) 4.

Symptoms

  • Excessive sweating
  • The skin can be pale or flushed, warm or cold, intact or cracked and scaly.
  • In hot, humid weather or during intense physical activity, some people get heat rash also called miliaria or prickly heat with translucent, non-itchy, or red, itchy bumps 49
  • Fever may be present or not, depending on the underlying cause.
  • Body odor due to bacteria and fungi on the skin, which break down the sweat, and also due to certain underlying disorders (kidney failure, diabetic ketoacidosis) and medications to treat these disorders.
  • Symptoms of the underlying disorder.

Causes and Differential Diagnosis

Legend:

  • Blue: conditions with cool or cold and clammy skin
  • Red: excessively warm or hot and sweaty skin

Most causes of diaphoresis in this article are listed in references 6,9,11,17.

Physiological Causes

  • Gustatory sweating: spicy foods: hot peppers, habanero, capsaicin 39
  • Hot environment
  • Physical exertion
  • Menopause (hot flashes)
  • Obesity
  • Pregnancy

Psychological Causes

  • Strong emotions: anxiety, fear, panic attack 25,32

Common Health Disorders

  • Acute illnesses with fever:
    • Warm, moist skin: systemic infections, such as Q fever
    • Cool, clammy skin: influenza (flu), bacterial 23 or viral 31 pneumonia, gastroenteritis (stomach flu) due to food poisoning 29, severe dengue fever 36
  • Alcoholism or alcohol withdrawal (delirium tremens) (sweating of palms and soles — palmar or plantar or palmoplantar hyperhidrosis) 47,48
  • Anemia 25
  • Diabetes mellitus
  • Fainting (vasovagal syncope)
  • Gout (the affected toe is warm)
  • Heart failure
  • Holiday heart syndrome
  • Hyperthyroidism
  • Hypothermia 22
  • Hypoxemia (low blood oxygen levels) due to high altitude, pneumonia 32
  • Jet lag 35
  • Lymphoma
  • Motion sickness
  • Severe pain
  • Panic attack
  • Postural hypotension
  • Primary hyperhidrosis 26
  • Rheumatoid arthritis (affected joints are warm)
  • Vomiting

Infections

Acute:

  • Abscess (lung, brain, liver)
  • Bacterial meningitis
  • Candidiasis
  • Childhood infections: measles, chickenpox, rubella, scarlet fever
  • Dengue fever
  • Diverticulitis
  • Empyema (pus in the pleural cavity)
  • Erysipelas 35
  • Infectious mononucleosis caused by Epstein-Barr Virus (EBV)
  • Encephalitis
  • Osteomyelitis 35
  • Plague, bubonic
  • Q fever
  • Rabies 35
  • Sepsis, septic shock 11
  • Tetanus

Chronic:

  • Babesiosis
  • Brucellosis 35
  • Coccidioidomycosis
  • Histoplasmosis 35
  • HIV/AIDS
  • Malaria 11
  • Psittacosis
  • Schistosomiasis
  • Tuberculosis
  • Tularemia 11

Circulatory Disorders

  • Accelerated (malignant) hypertension, including pre-eclampsia and eclampsia 46
  • Congestive heart failure (CHF) 22
  • Heart attack (acute myocardial infarction) 22,32,42
  • Bacterial endocarditis 35
  • Aortic aneurysm 35
  • Shock 32:
    • Early phase of cardiogenic (arrhythmia), obstructive (cardiac tamponade, pulmonary embolism), hypovolemic/hemorrhagic shock 22
    • Late phase of any type of shock, those mentioned above, and septic, anaphylactic and toxic shock.

Abdominal Disorders

  • Crohn’s disease and ulcerative colitis
  • Diverticulitis (infection of intestinal diverticula)
  • Pyelonephritis (kidney infection)
  • Chronic pancreatitis 35

Neurological Disorders

  • Auriculotemporal syndrome
  • Autonomic hyperreflexia 35
  • Epidermolysis bullosa
  • Familial dysautonomia
  • Gopalan’s syndrome
  • Guillain-Barre syndrome 12
  • Nail-patella syndrome
  • Palmoplantar keratoderma
  • Parkinson’s disease
  • Pachyonychia congenita
  • Pressure and postural hyperhidrosis
  • Reflex sympathetic dystrophy
  • Spinal cord injury
  • Stroke or transient ischemic attack (TIA)
  • Syringomyelia
  • Tabes dorsalis (in syphilis)
  • Increased vagal tone

Allergies

  • Anaphylactic reaction (severe allergic reaction): Chinese restaurant syndrome (reaction to monosodium glutamate or MSG) 30,35

Hormonal disorders

  • Hyperpituitarism
  • Hyperthyroidism
  • Hypoglycemia: in diabetics treated with insulin or hypoglycemic drugs; hypoglycemia after meals (postprandial hypoglycemia or dumping syndrome)
  • Testicles removal (after testicular cancer) 43

Metabolic Disorders

  • Rickets

Tumors, Cancer

  • Carcinoid syndrome 54
  • Hypothalamic mass
  • Leukemia 35
  • Lung cancer, kidney, pancreatic and thyroid cancer, pheochromocytoma 35
  • Lymphoma 35
  • Pituitary adenoma 35
  • POEMS syndrome
  • Polycythemia vera

Poisoning, Intoxication

  • Acrylamide exposure
  • Alcohol intoxication and withdrawal (delirium tremens)
  • Cassava 22
  • Disulfiram-like reactions 22, which occur only when a certain substance is ingested along with alcohol:
    • Disulfiram
    • Nonedible coprine-containing mushrooms, such as Clytocibe clavites, Coprinus atramentarius (common inkcap), Coprinus comatus (shaggy mane or inkcap) Coprinus insignis,Coprinus quadrifidus and variegatus (scaly inkcap) 14,15.
  • Cadmium fumes 22
  • Caffeine intoxication
  • Ciguatera poisoning 35
  • Cinchona (herb)
  • Chlordane
  • Chronic arsenic intoxication
  • Dieldrin
  • Insecticides or warfare gases (sarin, soman, tabun) that are cholinesterase inhibitors (organophosphates)
  • Isopropyl alcohol poisoning
  • Lobelia (Indian plant)
  • Mercury 22: childhood mercury poisoning or pink disease causing acrodynia (pink fingers, no fever)
  • Monkshood 22
  • Oleander 22
  • Phenols/carbolic acid ingestion
  • Pilocarpus (herb)
  • Stingray 22
  • Strychnine
  • Yellow jessamine/jasmine

Bites/stings

  • Bee sting
  • Black widow or brown recluse spider sting 22
  • Scorpion sting 35
  • Snake bite 22

Other

  • Acrocyanosis 46
  • Angina pectoris
  • Aortic dissection
  • Arteritis 53
  • Burns
  • Cardiomyopathy
  • Dumping syndrome (postprandial hypoglycemia)
  • Ectopic pregnancy 35
  • Erythrocyanosis
  • Fibromyalgia, chronic fatigue syndrome (CFS)
  • Frey’s syndrome (hot flashes after thinking about food) 40
  • Gastric retention, acute
  • Granulosis rubra nasi
  • Heat exhaustion 10
  • Hemolytic anemia
  • Hypogonadism
  • Kidney stones 18
  • Mania
  • Menieres disease
  • Migraine 39
  • Mitral valve stenosis
  • Myasthenia gravis
  • Periodic hypokalemic paralysis
  • Pneumothorax 35
  • Pulmonary edema
  • Pyelonephritis 19
  • Raynaud’s phenomenon or disease
  • Rheumatic fever
  • Sarcoidosis 35, (Erythema nodosum, rash on the shins, may be warm to touch)
  • Symmetric lividity of the palms and soles
  • Impairment of thermoregulation
  • Vasomotor instability
  • Vitamin B12 deficiency
  • Vitiligo
  • Wegener’s granulomatosis

Drugs and Supplements

  • Alcohol
  • Ambenonium
  • Anesthetics, such as halothane and muscle relaxants, such as succinylcholine, can cause malignant hyperthermia in sensitive individuals 7
  • Antipsychotics (for treatment of schizophrenia) and other dopamine antagonists causing a life-threatening neuroleptic malignant syndrome with hyperthermia, muscle rigidity, delirium impaired consciousness; muscle cell breakdown (rhabdomyolysis) 7
    • Atypical antipsychotics: amisulpride, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone 8
    • Neuroleptics (chlorpromazine,  haloperidol)
    • Antiemetics: domperidone, droperidol, metoclopramide, prochlorperazine, promethazine 7
    • Tricyclic antidepressants: amoxapine, clomipramine
  • Beta-blockers (atenolol) 52
  • Disulfiram/alcohol reaction
  • Illegal drugs abuse; amphetamine 45, heroine, MDMA (ecstasy), LSD, methamphetamine (speed), cocaine 35,45, narcotics (opiates) 22, synthetic cannabinoids
  • Rapid withdrawal of drugs to treat Parkinson’s disease: dopamine agonists, such as amantadine, bromocriptine and levodopa 7
  • Lethal catatonia
  • Drug withdrawal (nicotine 35, alcohol, amphetamines, benzodiazepines, narcotic painkillers)
  • Parasympathomimetics (cholinergics) overdose: neostigmine, physostigmine; cholinergic crisis toxidrome
  • Drugs and supplements that can cause hot flashes: acetaminophen (paracetamol) and aspirin (salicylate) toxicity 16,35, chlorpropamide 40, cyproterone (anti-androgens), danazol, goserelin, hydralazine, niacin, nitroglycerine, raloxifene (selective estrogen receptor modulators or SERMS) 39,40, steroids, tamoxifen (to treat breast cancer) 38,tolbutamide 40
  • Drugs that can cause serotonin syndrome (agitation, confusion, sweating, warm skin) 7,44,45:
    • Analgesics: fentanyl, meperidine, tramadol
    • Antiretrovirals (for HIV/AIDS): ritonavir
    • Antibiotics: linezolid
    • Anti-migraine medications: carbamazepine, valproic acid
    • Anti-nausea medications: metoclopramide, ondansetron
    • Dextromethorphan
    • Ginseng
    • Lithium
    • SNRIs: trazodone, venlafaxine
    • SSRIs: citalopram, fluoxetine, paroxetine, sertraline
    • St. John’s wort
    • Other antidepressants: amitriptyline, bupropion, isocarboxazid, phenelzine
  • A list of other drugs that can cause diaphoresis

Night Sweats (Nocturnal Diaphoresis)

Excessive sweating at night can be caused by:

  • Night terrors 42
  • Menopause (hot flashes) 38
  • Primary hyperhidrosis 38
  • Infections: bacterial endocarditis, HIV/AIDS, osteomyelitis, tuberculosis 38 and many other infections (Lyme disease, infectious mononucleosis, trichinosis, brucellosis, histoplasmosis, babesiosis, coccidioidomycosis, nocardiosis, malaria, amebic abscess) 55
  • Prinzmetal angina (sudden chest pain in individuals with heart disease) 13
  • Pericarditis 55
  • Hodgkin lymphoma, leukemia and some other cancers 37,38
  • Chronic fatigue syndrome, fibromyalgia 55
  • Sweating after delivery

Postpartum Diaphoresis

Some women sweat excessively for several weeks after delivery, especially at night 20.

Diaphoresis in Children

Congenital Disorders

  • Chediak-Higashi syndrome
  • Congenital autonomic dysfunction with universal pain loss
  • Congenital ichthyosiform erythroderma
  • Debility
  • Familial dysautonomia
  • Familial glucocorticoid deficiency
  • Hereditary periodic fever syndromes
  • Hines-Bannick syndrome
  • Klippel-Trenaunay syndrome
  • Maffucci’s syndrome
  • Phenylketonuria
  • Porphyria 56

Treatment

Treatment of diaphoresis can include treating of underlying cause, discontinuing certain drugs, avoiding environmental heat or toxins or psychological counseling. Deodorants can be used to reduce body odor. Antiperspirant sprays are usually used only in hyperhidrosis.

ICD 9 and 10 Codes

The ICD 9 code for excessive general sweating, including night sweats with a known cause (diaphoresis, secondary hyperhidrosis) is 780.8 21. The ICD 10 code is R61 58.

The ICD 9 code for focal primary hyperhidrosis (unknown cause) is 705.21 59. The ICD 10 codes 59:

  • Axilla: L74.510
  • Face: L74.511
  • Palms: L74.512
  • Soles: L74.513
  • Unspecified: L74.519

Published on August 10th 2013 by  under Symptoms.
Article was last reviewed on 21st November 2014.

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