The body performs best if its temperature is around 37º Celsius (98.6º Fahrenheit). The body’s internal temperature is closely monitored by the hypothalamus. Once the temperature reaches a point where homeostasis is compromised, the hypothalamus will try to lower it by the triggering the sweat mechanism.
Sweating is the body’s inherent method of regulating temperature that is why people would sweat more if the temperature outside is high, when doing exercises or when responding to circumstances that would make them afraid, embarrassed or angry.
The amount of sweat produced would depend on the number of sweat glands a person has. Normally, a person has around 2 – 4 million sudoriferous glands at birth and all of these become fully functioning during the puberty stage. Women possess more of these glands than men but the men’s sweat glands tend to be more active.
Excessive sweating that is sometimes over one liter per hour and is frequently linked with medical emergencies especially shock is termed diaphoresis. It is differentiated from hyperhidrosis by the presence of “cold sweat” or “clammy” skin. Diaphoresis defines the autonomic nervous system’s response to psychogenic or physical stress, fever or elevated environmental temperature. If the condition is brought about by stress, then the excessive perspirations are limited to the soles, palms and/or forehead. However, it is more generalized with fever and increased environmental temperature. Diaphoresis usually begins suddenly and may possibly be come with other ANS signals such as elevated blood pressure and tachycardia.
The causes of diaphoresis may be due to the following common diseases or conditions:
- Sudden febrile illness caused by infection
- Heart failure
- Parkinson’s disease
- Circulatory shock
- Autonomic hyperreflexia
- Any type of shock : cardiogenic, anaphylactic, hypovolemic, septic or neurogenic
- Opioid and alcohol withdrawal
- Pheochromocytoma (resulting from ectopic catecholamine)
- Various drugs as well as caffeine, some antipsychotics
- Infantile acrodynia (mercury poisoning during childhood)
Causes of diaphoresis may range from a number of medical conditions and diseases. If the condition is come with unexplained loss of weight, fever, tachycardia, shortness of breath or any chest discomforts then consultation with a physician is recommended.
Diaphoresis, by itself, is a symptom or a sign of other underlying pathological disease or abnormal responses of the body to specific stimuli. The major indication of diaphoresis is profuse production of cold sweats accompanied by a cold or clammy skin. Or the excessive sweating of over one liter per hour not related to fever or environmental factors such as high temperature.
Diaphoresis Differential Diagnosis
Differential diagnosis is a process wherein all probable causes of a group of symptoms are examined in order to determine a specific diagnosis.
A differential diagnosis should be done for:
- Myocardial Infarction with ST elevation
- Any vagal episodes
- Acute respiratory distress
- Central Neurologic injury
Diaphoresis can’t really be treated as it is a symptom not a disease. Therefore, the main causes of the profuse sweating should be treated. When the underlying cause for excessive sweating is pathologic in nature, it should be treated first in order to totally eliminate diaphoresis. If the case is due to menopause, then symptoms would improve with the intake of estrogen replacement therapy. If the cause is anxiety or any psychological stress, then relaxation techniques such as yoga or meditation, a healthy diet and regular exercise would help.
Some individuals can manage their condition with the use of a strong antiperspirant or one that contains aluminum hydroxide. Anti-cholinergic medications would help stop the excessive sweating temporarily but regrettably the dosages necessary to reduce sweating also cause side effects such as bowel and bladder dysfunction, xerostomia, cycloplegia and mydriasis.
The prognosis of diaphoresis would depend on the underlying cause. Early management of the cause and its successful treatment would determine if diaphoresis would be totally eliminated.
There are really no serious health risks for excessive sweating. However prolonged diaphoresis, if not managed right away, could cause electrolyte imbalances and could worsen the underlying disease or condition.