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ULY CLINIC

6 Julai 2025, 10:00:44

Diaphoresis

Diaphoresis is defined as excessive or profuse sweating that can exceed 1 liter per hour. It typically represents an autonomic nervous system response to physical or psychological stress, elevated environmental temperature, fever, or metabolic disorders. It can be localized (e.g., palms, soles, forehead) or generalized, and may appear abruptly. Associated symptoms often include tachycardia, elevated blood pressure, and signs of sympathetic overactivity. In some cases, diaphoresis may manifest as night sweats or be intermittent, particularly in chronic infections or malignancies. It varies with age due to the underdevelopment or decline in sweat gland function in infants and the elderly.

Pathophysiology and Mechanisms

Diaphoresis occurs due to overstimulation of eccrine sweat glands via sympathetic cholinergic fibers. Triggers include:

Thermoregulatory stimuli: Heat, fever, menopause (hot flashes)
Stress response: Physical exertion, anxiety, pain
Metabolic causes: Hypoglycemia, hyperthyroidism
Infection and inflammation: TB, malaria, endocarditis
Toxin or drug effects: Alcohol or opioid withdrawal, pesticide poisoning
Autonomic dysfunction: Spinal cord injury above T6

Emergency diagnostic and therapeutic considerations

1. Initial rapid assessment

Vital signs: Note hypotension, tachycardia, bradycardia, or fever
Blood glucose: Check for hypoglycemia in symptomatic patients
Airway and cardiac monitoring: Especially if chest pain or altered mental status is present
Temperature regulation: Suspect heatstroke if patient was exposed to high ambient temperatures
Spinal injury context: In cases with recent trauma or known SCI, suspect autonomic hyperreflexia

2. Focused interventions

Emergency Condition	Key Features	Immediate Actions
Hypoglycemia	Diaphoresis, hunger, blurred vision, irritability, tremors, tachycardia	Check glucose, give IV dextrose, monitor vitals and airway
Heatstroke	Weakness, profuse sweating, gray skin, dilated pupils, normal/subnormal temp	Move to cool area, initiate cooling, IV fluids, monitor for shock
Autonomic Hyperreflexia	Sweating above T6 level, hypertension, bradycardia, headache, restlessness	Remove noxious stimuli (e.g., full bladder), lower BP, monitor CNS signs
MI/Heart Failure	Chest pain, arrhythmias, dyspnea, ECG changes	Oxygen, IV line, analgesia, cardiac monitoring, emergency resuscitation as needed

Medical causes of Diaphoresis

Condition	Sweating Pattern	Associated Features	Special Considerations
AIDS	Night sweats	Fatigue, lymphadenopathy, weight loss, fever	Consider opportunistic infections
Acromegaly	Generalized	Thickened skin, enlarged jaw/hands, visual field defects	Diaphoresis tracks disease activity
Anxiety Disorders	Palms, soles, forehead	Palpitations, tremors, GI upset	May be acute (panic) or chronic
Autonomic Hyperreflexia	Above injury (T6)	Flushing, high BP, bradycardia, blurred vision	Common after spinal shock resolution
Alcohol/Opioid Withdrawal	Generalized	Tachycardia, tremors, confusion, hallucinations	Risk of seizures, psychosis
Empyema	Night sweats	Fever, cough, chest pain, decreased breath sounds	Suspect if chronic symptoms persist
Heart Failure	Generalized	Fatigue, orthopnea, JVD, edema, gallop rhythm	Left-sided: dyspnea; Right-sided: systemic signs
Heat Exhaustion	Generalized	Weakness, tachycardia, hypotension, cold clammy skin	Can progress to heatstroke
Hodgkin’s Disease	Night sweats	Painless lymphadenopathy, Pel-Ebstein fever, pruritus	Systemic symptoms = poor prognosis
Hypoglycemia	Generalized	Irritability, blurred vision, tremors, altered consciousness	Common in diabetics or fasting individuals
Infective Endocarditis	Night sweats	Fever, murmur, petechiae, splinter hemorrhages	Suspect in IV drug users, prosthetic valves
Lung Abscess	Night sweats	Foul sputum, fever, pleuritic pain, clubbing	Look for anaerobic bacterial infection
Malaria	Stage 3 diaphoresis	Chills → high fever → sweating, splenomegaly	Consider travel history
MI	Sudden onset	Substernal pain, nausea, tachycardia, cold sweat	Emergency cardiac care
Pheochromocytoma	Paroxysmal	Hypertension, headache, palpitations	Rule out with plasma metanephrines
Pneumonia	Intermittent	Fever, cough, dyspnea, pleuritic pain	Chest auscultation important
Tetanus	Generalized	Lockjaw, stiffness, spasms	High mortality if untreated
Thyrotoxicosis	Generalized	Weight loss, heat intolerance, tachycardia, tremor	Palpable thyroid and eye signs may help diagnosis
Tuberculosis	Night sweats	Chronic cough, hemoptysis, weight loss	Reactivation TB = upper lobe cavitation

Other causes

Drugs and Toxins: Antipsychotics, antipyretics, sympathomimetics, thyroid hormones, alcohol poisoning, pesticide exposure
Dumping Syndrome: Post-gastrectomy; causes sweating after meals with palpitations, diarrhea
Environmental Heat: Common in children or overdressed patients
Postprocedural: Post-anesthesia, drug infusion reactions

Special populations and situational considerations

Pediatrics

Commonly caused by overdressing, drug withdrawal, cardiac defects, or infections.
Risk of rapid fluid loss → monitor hydration, weigh daily, and track I&O carefully.

Geriatrics

Diaphoresis may be absent even in life-threatening illness due to decreased sweat gland activity.
TB may present atypically without night sweats or fever — look for weight loss or functional decline.
Increased susceptibility to heatstroke due to impaired thermoregulation.

Clinical management strategies

Immediate interventions

Airway, breathing, circulation: Support as needed
IV fluids: Replace losses with isotonic solutions
Electrolyte monitoring: Correct imbalances
Cooling/warming measures: Based on suspected etiology (e.g., cold packs for hyperthermia)
Antipyretics: If fever-related
Antibiotics: If infection suspected

Monitoring

Vital signs: Especially temperature, BP, and HR
Neurologic status: Track changes indicating stroke, MI, or CNS infection
Labs: Glucose, CBC, CRP/ESR, cultures, thyroid function, cardiac enzymes
Imaging: Chest X-ray, echocardiogram, CT if indicated

Patient education and Prognosis

Teach about triggers, fluid intake, and skin care
Educate on when to seek emergency care (chest pain, confusion, high fever)
Prognosis depends on underlying cause: benign in anxiety/heat but critical in MI, infection, or endocrine crisis

References

Harrison’s Principles of Internal Medicine, 21st ed.
Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Manual of Medicine. 19th ed. McGraw Hill; 2016.
McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment 2023. McGraw Hill Education; 2022.
Ropper AH, Samuels MA. Adams and Victor’s Principles of Neurology. 11th ed. McGraw Hill; 2019.
Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020.
Iserson KV. Improvised Medicine: Providing Care in Extreme Environments. 2nd ed. McGraw-Hill Education; 2015.