Diaphoresis
Synonyms and keywords: Cold sweat, clammy

# 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:
- 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.
- 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.
- 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.
- 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

# Causes

## Life Threatening Causes
- Anaphylactic shock
- Cardiogenic shock
- Myocardial infarction
- Pesticide poisoning
- Pulmonary embolism
- Shock

## Common Causes
- Anxiety
- Fever
- Heat exhaustion
- Hypoglycemia
- Menopause
- Thyrotoxicosis

## Causes by Organ System

## Causes in Alphabetical Order
- Abscess
- Acetaminophen
- Acrodynia
- Acromegaly
- Acute hypertensive crisis
- Acute monocytic leukemia
- Acute pulmonary oedema
- Acute rheumatic fever
- Acute stress disorder
- AIDS
- Alcohol withdrawal
- Alternating hemiplegia of childhood
- Ambenonium
- Amitriptyline
- Amonafide
- Anaphylactic shock
- Anastrozole
- Anoxemia
- Anxiety
- Anxiety disorders
- Aromatic amino acid decarboxylase deficiency
- Aspirin
- Atypical mycobacteria
- Autonomic dysreflexia
- Autonomic dystonia
- Autonomic hyperreflexia
- Autonomic neuropathy
- Aztreonam
- Babesiosis
- Bacteremia
- Bacterial meningitis
- Basal cell carcinoma
- Beta blockers
- Beta-agonists
- Bethanechol
- Bland-White-Garland syndrome
- Blue rubber bleb nevus syndrome
- Bromocriptine
- Brucellosis
- Bupropion
- Calcium channel blockers
- Carbamate insecticide poisoning
- Carcinoid syndrome
- Cardiogenic shock
- Cardiomyopathy
- Castration
- Chronic fatigue syndrome
- Chronic hepatitis C
- Chronic infections
- Circulatory shock
- Cladribine
- Clozapine
- Cocaine withdrawal
- Cold-induced sweating syndrome type 1
- Collagen vascular disease
- Common blushing
- Congenital hepatic porphyria
- Cor pulmonale
- Cyclosporine
- Demecarium bromide
- Dermatopathia pigmentosa reticularis
- Desipramine
- Desvenlafaxine
- Diabetes insipidus
- Diabetes Mellitus
- Diabetic neuropathy
- Dimebon
- Discontinuation syndrome
- Distigmine
- Donepezil
- Dothiepin
- Duloxetine
- Dumping syndrome
- Eccrine angiomatous hamartoma
- Eccrine nevus
- Echothiophate iodide
- Encephalitis
- Endocardial fibroelastosis
- Endocarditis
- Endocarditis lenta
- Exemestane
- Flumazenil
- Flutamide
- Fluvoxamine
- Food additives
- Frey's syndrome
- Fructose intolerance
- Fucosidosis
- Fungal infections
- Gamstorp-Wohlfart syndrome
- Gonadorelin
- Goserelin
- Granulosis rubra nasi
- Growth hormone secreting pituitary adenoma
- Growth hormone
- Heart attack
- Heart failure
- Heat exhaustion
- Hereditary sensorimotor neuropathy type 2
- Hereditary sensory and autonomic neuropathy
- Hereditary sensory and autonomic neuropathy type 3
- Heroin withdrawal
- Herpes zoster of the preauricular region
- Histrelin
- HIV
- Hodgkin's disease
- Hodgkin's Lymphoma
- Humorsol
- Hydralazine
- Hyperthyroidism
- Hypertryptophanemia
- Hypoglycaemia
- Hypogonadism
- Hypovolemic shock
- Idiopathic
- Idiopathic syringomyelia
- Imatinib
- Indian tobacco (lobelia inflata)
- Indole alkaloids poisoning
- Infliximab
- Insulin
- Insulinoma
- Interferon alfa-2b
- Jadassohn-Lewandowsky syndrome
- Left heart failure
- Letrozole
- Leuprolide
- Liver abscess
- Lobstein disease
- Loewenthal syndrome
- Lung abscess
- Lymphoma
- Malaria
- Malignancy
- Mastocytosis
- Medullary carcinoma of the thyroid
- Meleda disease
- Menopause
- Mercury poisoning
- Methadone
- Morphine
- Motion sickness
- Multiple endocrine neoplasia type 1
- Multiple endocrine neoplasia type 2
- Multiple endocrine neoplasia type 3
- Muscarine
- Myocardial infarction
- Myotonic dystrophy
- Nafarelin
- Neostigmine
- Neurogenic shock
- Neuroleptic malignant syndrome
- Niacin
- Nitroglycerin
- Non-Hodgkin's lymphoma
- Nonsteroidal anti-inflammatory drugs
- Serotonin-norepinephrine reuptake inhibitor
- Nortriptyline
- Obesity
- Omeprazole
- Opioids withdrawal
- Organophosphate insecticide poisoning
- Orthostatic hypotension
- Osteomyelitis
- Pachydermoperiostosis
- Pain
- Palmoplantar punctate keratoderma type 3
- Panic attack
- Parkinson's Disease
- Pesticide poisoning
- Phaeochromocytoma
- Phenylephrine
- Phospholine iodide
- Physostigmine
- Pilocarpine
- Pitted keratolysis
- Pneumonia
- POEMS syndrome
- Poison hemlock (conium maculatum)
- Polycythaemia rubra vera
- Postorchiectomy
- Posttraumatic syringomyelia
- Pourfour du petit syndrome
- Prostate cancer
- Protease inhibitors
- Pulmonary Embolism
- Pyridostigmine
- Raloxifene
- Rebound hypertension
- Reflex sympathetic dystrophy syndrome
- Reflex sympathetic osteodystrophy
- Relapsing fever
- Renal calculi
- Renal cell carcinoma
- Rheumatoid Arthritis
- Rickets
- Rituximab
- Ropinirole
- Rosacea
- Ross' syndrome
- Sarcoidosis
- Sarcomas
- Selective serotonin reuptake inhibitors
- Sepsis
- Septic shock
- Serotonin syndrome
- Shock
- Sibutramine
- Sildenafil
- Sleep apnea
- Sleep disorders
- Soft tissue sarcoma
- Spinal autonomic dysreflexia
- Spinal muscular atrophy with respiratory distress 1
- Stroke
- Sulfonylureas
- Syringomyelia
- Tamoxifen
- Temporal arteritis
- Tetanus
- Theophylline
- Thiazolidinediones
- Thyrotoxicosis
- Tobacco plant poisoning
- Toxic mushrooms
- Tramadol
- Traumatic brain injury
- Tricyclic antidepressants
- Trophoblastic cancer
- Tuberculosis
- Tufted angioma
- Urolithiasis
- Vancomycin resistant enterococcal bacteremia
- Venlafaxine
- Ventriculo-arterial discordance, isolated
- Viral infections
- Volume depletion
- Withdrawal in drug addicts
- Xanthic urolithiasis

# Treatment
When diaphoresis is pathologic, the underlying cause should be treated.  When the cause is menopause, estrogen replacement therapy may improve the symptoms.