Sweat. How many of us do not sweat it happened before a stressful situation, to have the front with shiny skin and fat, for example during an examination, not being prepared, or embarrassing during a conversation with a woman who makes us uncomfortable, if We are particularly shy. We are talking about diaphoresis, a condition that consists of profuse sweating that sometimes reaches more than 1 liter of sweat per hour. This sign represents an autonomic nervous system response to physical or psychological stress, or fever or high temperature ambientale.merocrinaLe subsidiary bodies sweat glands are distributed over the whole human skin in other species are located only in certain organs, such as in dogs in which they are located only on the paw pads. Most are in eccrine secretion / exocrine. Locally there are large apocrine glands that secrete too odorous molecules in adults (glands of Moll: armpits, circumanale, circumgenitale, nipples, auditory meatus)

He has about 3 million sweat glands spread over the skin surface: the maximum concentration is reached on the soles of the feet, palms of the hands, armpits and around the body openings of the face and genitals.
Sweat is composed of water, mineral salts and acids that are catabuleti waste substances.

Perspiration has the following functions:

excretion of substances "waste"

lowering body temperature by evaporation of water in the sweat

non-verbal communication with other mammals: body odor.
For the communicative function of the sweat glands (apocrine especially) secrete substances perceived by the sense of smell in the nose (mostly unconscious, directly connected with the limbic system) that transmit information:

on the 'equipment genetic individual (base invariable)
sex hormone status (eg age and cyclical hormonal changes)
on momentary emotions (eg anxiety, anger, ...).
It is a characteristic of our civilization "cover" these natural signals (more or less conscious) with strong smelling substances as detergents, shampoos, soaps, perfumes and other cosmetic products and / or suppress them with deodorant.

Sweating (perspiratio sensibilis)
The cholinergic neurons of the sympathetic nervous system controls the secretion of sweat from eccrine sweat glands. There is talk of thermal sweating on the regulation of body temperature (thermoregulation).

It is activated:


with increasing temperature

increases due to heat production due to physical work

for failure to heat loss due to increased environmental temperature or humidity

emotional sweating in the presence of psychological stress (sweat with fear, cold sweat, ...)
The sweat of an adult ranges from 0.5 liters per day up to a maximum of 10 liters depending on the physical labor and environmental conditions.

The nerve centers for the control of sweating are:
- Anterior hypothalamus
- In the medulla oblongata
- Columns in the mediolateral spinal cord neuronal

When the sweating is caused by stress, can be generalized or limited to the palms, soles and forehead. When caused by fever or a high ambient temperature, is usually a generalized sweating.

The diaphoresis usually starts suddenly and may be accompanied by other signs pertaining to the autonomic nervous system, such as tachycardia and increased blood pressure. However, this sign also varies with age because the immature sweat glands are functioning in children and the elderly are less active.

As a result, these age groups may not show its causes often associated with sweating. The intermittent diaphoresis may accompany diseases

characterized by chronic relapsing fever: an isolated sweating can score an episode of acute pain or fever. The night sweats can be characterized as intermittent fever the body temperature tends to return to normal between 2 and 4 in the morning, before rising again. The temperature is usually lowest at around 6 am.

When it is caused by high outside temperature, sweating is a normal body response. The acclimatization usually takes several days of exposure to high temperatures during this process, sweating helps maintain normal body temperature. The diaphoresis typically occurs during menopause, preceded by a sensation of intense heat (a hot flush). Other causes include:

· I'attivitą natural or an effort to speed up the metabolism, creating internal heat production

· Mild to moderate anxiety that helps start the attack or flight response



History and physical examination



If the patient is diaphoretic, you have to quickly exclude the possibility of a cause life-threatening: hypoglycemia, heat stroke, heart attack etc..



You have to start doing I'anamnesi describe the patient's main symptoms. So investigate signs and symptoms associated. Watch I'astenia and general weakness. The patient reported insomnia, headaches and changes in visual acuity or hearing? Frequently suffer from vertigo? He palpitations?

The presence of pleural pain, cough, sputum, dyspnea, nausea, vomiting, abdominal pain and changes in bowel or urinary habits. The patient in question is perhaps a woman in menopause? There is amenorrhea? Presents changes in her menstrual cycle. The patient presents with paresthesia, cramps, muscle stiffness and joint pain. Have you noticed any changes in urination or defecation? Have you lost weight?

The patient has altered the size of gloves or shoes lately?

Complete I'anamnesi asking if he has made travel in tropical countries. Evaluate a recent exposure to high ambient temperature or pesticides. The patient

has recently been stung by an insect on a Obtain a partial gastrectomy and abuse of drugs or alcohol. Finally. obtain an accurate drug history.

This is followed by physical examination. But first you must determine I'entitą sweating watching the trunk and extremities, and so like the palm, plants and forehead. Also check the patient's clothing and if the bed is wet. Consider if the sweating occurs during the day or night. Exclude redness (erythema), skin changes or tissue damage and an increase in coarse body hair. Note the lack of turgor

dry skin and mucous membranes. Controģlare

the presence of sub bleeding nail and nail Plummer (separation of nail from the end Ietto nail).

Then assess the mental state of the patient and monitor vital signs. Search the driven pulley presence of fasciculations and flaccid paralysis. Pay attention to the possibility of seizures. Note I'espressione patient's face and eyes to examine if there is valulare mydriasis or miosis or excessive tearing. Make a visual field examination and hearing, and check for dental or gum disease. Run the percussion of the chest in search of dullness and auscultate the lungs to detect crackles, diminished or bronchial breath sounds and increased vocal tremor touch. Search for a reduction

chest expansion. Perform palpation looking for lymphadenopathy and hepatosplenomegaly.
Medical causes of sweating



In order of severity and frequency we have:



- Myocardial infarction. If the patient is diaphoretic complaining chest pain and shortness of breath, you suspect a heart attack or heart failure. The sweating accompanies acute retrosternal chest pain with radiation trend in this potentially fatal disease for the patient. Signs and symptoms include anxiety associated with dyspnea, nausea, vomiting, tachycardia, irregular pulse, change in pressure, fine crackles, pale and mottled skin. Connect the patient to a cardiac monitor, secure the airway and administer supplemental oxygen. Place an intravenously administered, and analgesics. Be prepared to undertake emergency resuscitation if cardiac arrest occurs or resplratorio and cyanosis.



-Heat exhaustion. Although this condition is characterized by insufficient heat dissipation, initially may cause profuse diaphoresis, fatigue, weakness and anxiety. These symptoms may progress to circulatory collapse and shock (confusion, filiform pulse, hypotension, tachycardia and skin

cold and mottled). Other features include a waxy appearance, dilated pupils and a temperature to the standards or a little less.



-Lpoglicemia. Hypoglycemia can cause a rapid onset of sweating accompanied by irritability, tremors, hypotension, blurred vision, tachycardia, feeling of hunger and loss of consciousness.



-Stress and anxiety. The patient, usually shy and depressed, sweating under stress and may make the skin shiny, greasy, sweaty forehead and a rash rash known as "acne rosacea" in the face.



-Heart failure (see also liver). Generally, the following I'astenia diaphoresis, dyspnea, and tachycardia in heart failure I'ortopnea left, the distension of neck veins and dry cough in right heart failure. Other aspects include tachypnea, cyanosis, edema, crackles, ventricular gallop, and anxiety.



-Thyrotoxicosis. This condition usually accompanied by sweating causes heat intolerance, despite increased appetite, tachycardia, palpitations, enlarged thyroid, dyspnea, irritability, diarrhea, tremors, Plummer's nails and sometimes exophthalmos. There may also gallop.



-Empyema, lung abscess and pneumonia. The accumulation of pus in the pleural cavity or an abscess of the lung are due to significant quantities of night sweats and fever. The patient also complains about chest pain, cough with purulent sputum and weight loss. L 'examination showed reduced chest expansion on the affected side.



-Hodgkin's disease. Especially in the elderly, the first signs of Hodgkin's disease may include night sweats, fever, weakness. itching and weight loss. Often, however. This disease initially causes a painless swelling of a cervical lymph node. Sometimes, there is a pattern of Pel-Ebstein fever, several days or weeks of fever and chills that alternate with periods of apyrexia without chills. Systemic symptoms such as weight loss, fever and night sweats indicate a poor prognosis. Lymphadenopathy ingrevescente the end, because the effects are very important as hepatomegaly and dyspnea.



-Withdrawal syndrome by drugs and alcohol, abstinence from alcohol and narcotic analgesics may cause generalized sweating, dilated pupils, tachycardia, tremors, and mental status changes (confusion, delusions, hallucinations, agitation). Signs and symptoms associated may include severe muscle cramps, generalized paresthesias, tachypnea. increased or decreased pressure, and sometimes, seizures. Nausea and vomiting are common.



-Immunoblastic lymphadenopathy. Similar to Hodgkin's disease but more rare, this disease causes episodic sweats, with fever, weight loss, weakness, generalized lymphadenopathy, rash and hepatosplenomegaly.



-Infective endocarditis (subacute). Nottuma generalized sweating occurs early in the disease. Accompanying signs and symptoms include intermittent fever, weakness, fatigue, weight loss, and arthralgias I'anoressia. The sudden change in the characteristics of a heart sound or the finding of a new sound is a classic sign. They also shared the subungual petechiae and bleeding.



-Liver abscess. Signs and symptoms vary depending on the extent of the abscess, but commonly include sweating, pain in the right upper quadrant, weight loss, fever, chills, nausea, vomiting and signs of anemia.



-Acquired Immune Deficiency Syndrome. It is characterized by nottume sweats, the patient has serotina fever, fatigue, lymphadenopathy as an early feature, and a manifestation of the disease itself or secondary to opportunistic infection. The patient also has anorexia, decreased

dramatic, unexplained weight gain, diarrhea and a persistent cough.



-Acromegaly. In this condition slowly worsening sweating is a sensitive measure of disease activity, including hypersecretion of growth hormone and an increase in basal metabolism. The patient has an imposing appearance and clumsy with expansion of the supraorbital ridge and enlargement of the ears and nose. Other signs and symptoms include warm skin, oily. thickened, hands, feet and jaw wider, joint pain, increase of I, redness on the forehead and is accompanied by redness. Other findings may include agitation, nausea, nasal congestion and bradycardia.



- Poisoning. Depending on the type of toxin, the neurotoxic effects may include sweating, chills (with or without fever), fatigue, dizziness, blurred vision, drooling, nausea and vomiting as well as paresthesias and muscle fasciculations.



- Malaria. Profuse diaphoresis marks the third stage of malaria paroxysmal first two stages consist of chills (first stage) and a high temperature (second stage). They may also experience headache, arthralgia, and hepatosplenomegaly. In the benign form of malaria in these paroxysms are alternsano periods of prosperity. The severe form may progress to delirium, convulsions and coma.



-Meniere's disease. This alteration is characterized by severe vertigo, tinnitus and hearing loss may also cause sweating, nausea, vomiting and nystagmus. DelI'udito loss can be progressive and tinnitus may persist between attacks.



-Pheochromocytoma. The disease usually causes diaphoresis, but its cardinal sign is persistent paroxysmal hypertension. Other manifestations of feocromociloma include headache, palpitations, tachycardia, anxiety, tremors, pallor, arrossamentl, paresthesia, abdominal pain, tachypnea, nausea, vomiting and orthostatic hypotension.



Autonomic-Hypereflexia. If you look at sweating in a patient with spinal cord injury above T6 or T7, ask if charges throbbing headache, agitation, blurred vision and nasal congestion. Check the parameters of the patient, requiring attention to bradycardia and a very high blood pressure. If you suspect autonomic hyperreflexia, we must exclude the most common complications quickly. Search for the presence of ocular pain associated with any intraocular hemorrhage and facial paralysis, speech or clumsy limb weakness that may reveal intracerebral hemorrhage. Quickly reposition the patient to avoid any pressure stimulation. Also, check if the bladder is distended or if there are signs of intestinal obstruction.



-Tuberculosis. Although often asymptomatic in both 'primary infection, this disease can cause night sweats, fever, fatigue, weakness, anorexia and weight loss. During Nattiv, this can be a productive cough with mucopurulent sputum, occasional hemoptysis and chest pain.



Other causes

-Farrnaci. Sympathomimetic drugs, some antipsychotics, antipyretics I'ormone thyroid and can cause sweating. Even I'avvelenamento

by aspirin and acetaminophen can cause this sign.

Dumping-syndrome. Result of rapid emptying of gastric contents into the small intestine after partial gastrectomy, due to sweating, palpitations, profound weakness, epigastric discomfort, nausea and diarrhea important. This syndrome occurs after ingestion of food.

-Poisoning by pesticides. Among the toxic effects of pesticides include sweating, nausea, vomiting, diarrhea, I'annebbiamento vision, miosis and lacrimation and salivation eccessiv.
.
......

e- mail E-MAIL here

>>>see first page

>>>see also RICERCA