Severe diaphoresis and fever during alcohol withdrawal cause hypovolemic shock: case report.

BACKGROUND: Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. CASE PRESENTATION: We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. CONCLUSIONS: The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient's water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.

Salt, sweat, and unclear? Diaphoresis and hypernatremia in end-stage kidney disease: Questions.

This quiz will discuss two patients with end-stage kidney disease (ESKD) on dialysis presenting with diaphoresis and hypernatremia.

Severe night sweating treated by oxybutynin.

Sleep hyperhidrosis is defined as profuse nocturnal sweating that disrupts sleep. Although the mechanism is unknown, some cases are secondary to hot flushes during the menopausal period, medical, mental and sleep disorders, and medication, while dysregulation of thermoregulation during sleep is suspected in primary cases. We present the case of a woman with severe primary sleep hyperhidrosis, occurring nightly for 23 years, which definitively resolved after brief treatment with oxybutynin (a muscarinic receptor-blocking anticholinergic). An ammoniacal odor in the sweat and a sensation of coldness on awakening during sweating episodes suggest that the mechanism of her night sweating was not an exacerbation of thermoregulation during the night but shares the mechanical properties of emotional/psychological sweating. This extreme case of sleep hyperhidrosis was treated with excellent efficacy and minimal side effects using oxybutynin, which could benefit other patients with nighttime discomfort. CITATION: Dias L, Martinot C, Vaillant G, Arnulf I. Severe night sweating treated by oxybutynin. J Clin Sleep Med. 2024;20(1):169-172.

Diaphoresis as the Prominent Manifestation of Pheochromocytoma.

OBJECTIVE: Pheochromocytoma is a rare neuroendocrine tumor, affecting 0.6 to 0.8 of 100,000 people per year. The "classic triad" of headache, diaphoresis, and tachycardia is well documented in the literature, although its clinical utility has come into question. Diaphoresis is part of the "classic triad" and occurs in <50% of patients with pheochromocytoma. There are few reports of diaphoresis as the sole symptom of pheochromocytoma. Our objective is to report a patient with diaphoresis as the only prominent manifestation of pheochromocytoma. CASE DESCRIPTION: A 20-year-old man presented with 5 years of worsening diaphoresis; diffuse, but predominantly in the upper half of his body. No other symptoms were present. His blood pressure was 138/82 mm Hg and had a heart rate of 60 bpm. The physical examination was unremarkable. Thyrotoxicosis, infection (including tuberculosis), and lymphoma/leukemia were ruled out. The 24-hour urine norepinephrine level was 1002 ug/24hours (0-135 ug/24 hours), plasma normetanephrine was 2873 pg/mL (0-145 pg/mL), and plasma norepinephrine was 2869 pg/mL (0-874 pg/mL). Computed tomography of the abdomen revealed a 4.0 × 3.1 × 4.3 cm left adrenal mass. After pre-operative preparation with doxazosin, the patient underwent laparoscopic left adrenalectomy. The diaphoresis resolved. Pathology confirmed a completely resected pheochromocytoma. Genetic testing for germline mutations was negative. DISCUSSION: This patient was a young adult and did not exhibit features of pheochromocytoma common to the pediatric/adolescent or adult populations. Monosymptomatic presentations are sparse in the literature. CONCLUSION: This case reflects an atypical presentation of pheochromocytoma, a disease with high cardiovascular morbidity and mortality, and helps to establish the need to better quantify individual symptoms of patients to better understand the entire spectrum of this disease.

Hypoglycemia as a Manifestation of Shapiro Syndrome.

Shapiro syndrome is an extremely rare disorder of dysautonomia characterized by paroxysmal episodic hypothermia to below 95°F. Many patients with Shapiro syndrome improve with medical management, though a minority of cases are refractory to treatment. Our patient with adult-onset Shapiro syndrome is an atypical case. Our patient has been refractory to medical treatment as well as chemical sympathectomy. Based on a review of the literature, this is also the first reported case of hypoglycemia with Shapiro syndrome episodes in the absence of other metabolic diseases. This case suggests that hypoglycemia could be a potential manifestation of Shapiro syndrome.

Portable sauna stimulated-diaphoresis for the treatment of fluid-overload in peritoneal dialysis patients: A pilot study.

Background: Fluid overload (FO) is a common problem in patients with peritoneal dialysis (PD), it is associated with adverse outcomes and may persist despite adjustements in PD therapy. Objective: To evaluate the feasibility and safety of stimulated diaphoresis to reduce FO with the use of a portable sauna bath. Methods: Open-label pilot study in patients on continuous ambulatory peritoneal dialysis (CAPD) and FO. The primary outcome was the treatment-related adverse events; secondary outcomes were changes in over-hydration (OH), body weight and blood pressure, FO symptoms, and sleep quality. Dialysis prescription and daily data were recorded. The intervention period consisted in a 30-min, 45°C sauna bath, daily for 10 days, using a portable sauna bath. Results: Fifty-one out of 54 total sauna bath sessions were well tolerated. In three (5.5%) sessions adverse effects were reported: transient dizziness in two cases, and a second-degree skin burn in a patient with advanced diabetic neuropathy. OH (6.3 ± 1.2 L vs. 5.5 ± 1.3 L, p = 0.05), body weight (67.7 ± 11.4 vs. 66.8 ± 3.8 kg, p = 0.003), diastolic blood pressure (92 ± 13.5 vs. 83 ± 13.3 mmHg, P = 0.003) and PSQI score (7.3 ± 3.7 vs. 5.1 ± 3.2, p = 0.02) improved significantly between the control and intervention period, respectively. Conclusions: Stimulated diaphoresis with a portable sauna bath could be a novel, safe, and effective alternative way to reduce FO in CAPD patients. Larger studies are needed to confirm our results. Clinical trial registration: ClinicalTrials.gov, identifier: NCT03563898.

Deep brain stimulator-induced diaphoresis in Parkinson's disease patients.

We report an unusual finding of bilateral facial and corporeal diaphoresis and sensation of heat during deep brain stimulation in two patients. Stimulation of the hypothalamospinal tract located medial to the subthalamic nucleus is likely to be responsible for this side effect.

Nocturnal diaphoresis secondary to mild obstructive sleep apnea in a patient with a history of two malignancies.

Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom.

Efeito da atividade física moderada sobre neurônios mioentéricos nitrérgicos do íleo de ratos de meia idade / The effect of moderate physical activity on myoenteric nitrergic neurons in the ileum of middle-aged rats / Efecto de la actividad física moderada en neuronas mientéricas nitrérgicas del íleon de ratas de mediana edad

Poucos são os relatos a respeito do efeito da atividade física sobre o plexo mioentérico ao longo do envelhecimento. Portanto, analisaram-se os neurônios mioentéricos NADPH-diaforase positivos do íleo em ratos que envelheceram praticando atividade física a partir dos seis meses de vida. Dez ratos Wistar foram distribuídos em dois grupos (n = 5/grupo): S (ratos sedentários controles com 12 meses de idade) e T (ratos treinados com 12 meses de idade). Os animais do grupo T realizaram, dos seis aos 12 meses de idade, atividade física regulada conforme resultados obtidos em teste de esforço máximo. Ao final do período experimental, o íleo obtido de cada animal foi processado para a técnica de NADPH-diaforase para evidenciar neurônios mioentéricos em preparados de membrana e quantificar e mensurar a área do pericário desses neurônios. A área do pericário não diferiu (P> 0,05) entre o grupo S (218,49 µm2) e o grupo T (210,59 µm2). A média de neurônios presente em 60 campos microscópicos de preparados de membranas no grupo S (126 neurônios) foi superior (P<0,05) a média encontrada no grupo T (93 neurônios), sugerindo que a atividade física pode inibir ou diminuir a expressão dos neurônios nitrérgicos em ratos de 12 meses de idade que praticaram atividade física desde os seis meses de vida. Os resultados quantitativos sugerem que a falta de atividade física regular propicia aumento na atividade dos neurônios nitrérgicos, contribuindo para o surgimento dos distúrbios da motricidade gastrointestinal que podem ocorrer ao longo do envelhecimento.

There are only a few reports on the effect of physical activity in the myoenteric plexus throughout the aging process. For such, the positive myoenteric NADPH-diaphoresis neurons in the ileum of those rats that aged practicing physical activity from the sixth month were analyzed. Ten Wistar rats were distributed into two groups (n= 5/group): S (12 months-old control sedentary rats) and T (12 months-old trained rats). The animals from the T group practiced controlled physical activity from the age of 6 months to 12 months, according to the maximum effort test results. At the end of the experimental period, the ileum obtained from each animal was processed in the NADPH-diaphoresis technique to highlight myoenteric neurons in membrane preparations, and quantify and measure the perikaryon area from those neurons. The Perikaryon area did not differ (P>0.05) among the S group (218.49 µm2) and the T group (210.59 µm2). The average of neurons in 60 membrane preparations in the S group (126 neurons) was higher (P<0.05) than the average finding in the T group (93 neurons), indicating that the physical activity can inhibit or decrease the nitrergic expression in 12 month-old rats that have practiced physical activity from the age of 6 months. The quantitative results suggest that the lack of regular physical activity provides the elevation of nitrergic neurons, concurring to the emergence of gastrointestinal motility disorders that can occur during the aging process.

Hay pocos informes sobre el efecto de la actividad física sobre el plexo mientérico a lo largo del envejecimiento. Por lo tanto, se analizaron las neuronas mientéricas NADPH-diaforasa positivas del íleon en ratas que envejecieron practicando actividad física a partir de seis meses de vida. Diez ratas Wistar se dividieron en dos grupos (n = 5 / grupo): S (ratas sedentarias de control con 12 meses de edad) y T (ratas entrenadas con 12 meses de edad). Los animales del grupo T realizaron, de los seis a los doce meses de edad, actividad física regulada conforme resultados obtenidos en prueba de esfuerzo máximo. Al final del período experimental, el íleon obtenido de cada animal se procesó por la técnica de NADPH-diaforasa para mostrar las neuronas mientéricas en preparados de membrana, cuantificar y medir el área del pericario de esas neuronas. El área del pericario no difirió (P> 0.05) entre el grupo S (218.49 µm2) y el grupo T (210.59 µm2). El número medio de neuronas presentes en 60 campos microscópicos de preparados de membranas en el grupo S (126 neuronas) fue mayor (P <0,05), promedio encontrado en el grupo T (93 neuronas), lo que sugiere que la actividad física puede inhibir o disminuir la expresión de las neuronas nitrérgicas en ratas de 12 meses de edad que practicaron actividad física desde los seis meses de edad. Los resultados cuantitativos sugieren que la falta de actividad física regular promueve aumento en la actividad de las neuronas nitrérgicas, contribuyendo a la aparición de disturbios de la motricidad gastrointestinal que pueden ocurrir a lo largo del envejecimiento.