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Concentration of electrolytes in the sweat of malnourished children.

The sweat test was performed by the method of Gibson and Cooke on 36 children with second and third degree malnutrition, aged from 2 months to 4 years. The results were compared with those from 32 healthy, well nourished controls in the same age range. Determinations were made of sodium and chloride concentrations, chloride/sodium ratio, and the sum of the concentrations of the two electrolytes in each sample. The malnourished children were found to have higher sodium and chloride concentrations than the well nourished ones. None of the normal or malnourished children had a sweat chloride value greater than 60 mmol/l; chloride values within a suspicious range (between 40 and 60 mmol/l) were found in two malnourished children. Two well nourished controls and six malnourished children showed suspicious sweat sodium concentrations; in one child with third degree malnutrition the sodium content was greater than 60 mmol/l. In all results in the suspicious range, or greater than 60 mmol/l, the chloride/sodium ratio was less than 1, and the sum of the two electrolytes was below 140 mmol/l. Based on these results, we conclude that malnourished children have raised sweat sodium and chloride concentrations when compared with well nourished children. The electrolyte values for most of them are not in a suspicious range or consistent with a diagnosis of cystic fibrosis. Unlike that found in cystic fibrosis, the sodium/chloride ratio in our subjects was less than 1 and the sum of both electrolytes never exceeded 140 mmol/l.

Child, Preschool↗

Inconsistencies in sweat testing in UK laboratories.

BACKGROUND: Sweat testing procedures are perceived to vary widely. AIM: To evaluate variability in sweat collection, analysis, and interpretation. METHODS: Questionnaire responses from 30 self selected centres: 15 paediatric centres, and 15 district general hospitals. RESULTS: Centres carried out 30-400 tests per year (median 100), with a diagnostic rate of 1:5-152 (median 1:30). Staff performed 5-268 tests per year. Minimum test age varied from 24 hours to four months. All stimulated sweating by pilocarpine iontophoresis using varying currents and times. Twenty six had observed urticaria or skin reddening, and nine blistering or burns. Sweat was collected for 10-60 minutes onto filter paper or into Macroduct coils. Between 2% and 25% of tests were considered insufficient. Twenty eight measured sodium, 24 chloride, and one osmolality and conductivity. Fifteen used literature and five in house reference ranges. Eleven would not test severely eczematous children. CONCLUSIONS: Local audit is required to improve performance, as well as a national guideline to standardise collection, and external quality assessment to provide analytical feedback.

Age Factors↗

Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK.

A well produced evidence based guideline has been developed in response to a national audit that demonstrated wide variations in the performance of sweat tests. Accurate and reliable sweat test results will be particularly important with the advent of neonatal screening. The guideline recommendations include the collection and analysis of sweat samples, and interpretation of results. It emphasises the importance of sweat chloride as the best discriminator.

Chlorides↗

Facial sweating after food: a new sign of diabetic autonomic neuropathy.

Facial sweating during eating (gustatory sweating) has been observed for the first time in a group of diabetics, and is considered to be a feature of the autonomic neuropathy which affected them all. The sweating, which was sometimes very severe, was produced by many foodstuffs, cheese being the most powerful stimulus. Atropine inhibited sweating stimulated by eating cheese, and oral anticholinergic drugs effectively eliminated the symptoms. These bizarre symptoms are probably due to abnormal nerve regeneration occurring as a consequence of the spontaneous autonomic neuropathy.

Adolescent↗

Absence of active cutaneous vasodilation associated with congenital absence of sweat glands in humans.

In the rare syndrome, hereditary anhidrotic ectodermal dysplasia (AED), sweat glands are congenitally absent. Assuming normal vasculature and normal central mechanisms, presence or absence of active cutaneous vasodilation (AVD) in hyperthermic subjects with AED critically tests the hypothesis that AVD is a consequence of sudomotor activity. Three men with full expression of the syndrome and a woman who is mosaic were heated in water-perfused suits until oral temperature was 1.4-1.7 degrees C above control. The men showed no sweat gland imprints on iodine-treated paper nor significant elevation in forearm blood flow (FBF, determined plethysmographically). In the woman, we observed sweat gland activity, approximately 9 and 22 glands/cm2, on the right and left side, respectively, and vasodilation, slight on the right and more on the left. Cutaneous vasoconstriction in response to negative pressure applied to the lower body was observed (3 subjects) and local FBF increased in response to local heating (2 subjects). Therefore, in AED, with apparently normal cutaneous vasculature and sympathetic innervation, AVD is absent as well as sweat glands.

Adolescent↗

Sweating responses and body temperatures during nocturnal sleep in humans.

The changes in the central control of sweating were investigated in five sleeping subjects under neutral and warm conditions [operative temperature (To) = 30, 33, and 34 degrees C; dew-point temperature = 10 degrees C]. Esophageal (Tes) and mean skin (Tsk) temperatures, chest sweat rate (msw,1), and concomitant electroencephalographic data were recorded. Throughout the night, msw,1 was measured under a local thermal clamp of 38 degrees C. Results showed that the thermal environment exerted a strong influence on both the levels and the time patterns of body temperatures. Moreover, local sweating rate correlated positively with Tes, and this relationship varied according to sleep stages. For a given Tes level, there was a sleep stage-related gradation in msw,1 that was higher in slow-wave sleep (SWS) than in stage 1-2 and the lowest in rapid-eye-movement (REM) sleep. This is explained by a change in the excitability or the sensitivity of the thermoregulatory system. The msw,1 differences between stage 1-2 and SWS are accounted for by a decrease in the Tes threshold (Tset) for sweating while the slope of the msw,1-Tes relation remains unchanged. The lower msw,1 in REM sleep is explained by a lesser slope for the msw,1-Tes relation without any Tset change from stage 1-2.

Adult↗

Sweating responses during changes of hypothalamic temperature in the rhesus monkey.

A technique is presented for preparing a durable thermode implant in the hypothalamus of the rhesus monkey. In unanesthetized monkeys implanted with thermodes in the anterior hypothalamic area of the brain, a linear relation was found between local sweat rates on the general body surface and clamped hypothalamic temperature. Changes in skin temperature were found to shift the hypothalamic set-point temperature at which sweating began but did not alter the gain of the hypothalamic temperature-sweat rate relationship. This study provides direct support for the concept that central brain temperature and skin temperature interact additively in the control of sweating in higher primates. Due to the very close similarity between these responses and those seen with indirect measurements of brain temperature in men, the rhesus monkey is seen as an excellent experimental analogue for studying human thermoregulation.

Animals↗

Influence of air velocity and heat acclimation on human skin wettedness and sweating efficiency.

Before and after heat acclimation, four male resting subjects were exposed to humid heat that caused levels of skin wettedness ranging from 50 to 100%. The physical experimental conditions were chosen so that the same skin wettedness was attained with modification of only the ambient water vapor pressure, at two wind speeds (0.6 and 0.9 m . s-1). The esophageal temperature (Tes), mean skin temperature (Tsk), sweating rate (msw), and dripping sweat rate (mdr) were recorded; the amounts of local drippage in the same thermal conditions before and after acclimation were also determined. The relationship between the evaporative efficiency of sweating (eta sw) and the skin wettedness (w) is reported, as is the influence of the subject's acclimation to humid heat on adjustments of skin wettedness. The effects of the air velocity on the coefficient of evaporation and on sweating efficiency are discussed. Beneficial increases in evaporation were achievable by increasing skin wettedness only when there was a consistent drippage, which differed from one body area to another and from one subject to another. The relation of drift in body temperature to skin wettedness changed with the acclimation of the subjects.

Acclimatization↗

Effect of acclimatization to heat on the regulation of sweating during moderate and severe exercise.

Sweat regulation in two male subjects, one an athlete in training, was examined over a range of exercise intensities and environmental temperatures. The results after artificial heat acclimatization in the nonathlete showed that sweating rate over 1 h of maximal exercise increased to the same level as the athlete, but his evaporative sweat loss remained significantly (15%) lower. Rectal temperature (Tre) was reduced for a given oxygen intake (VO2) and relative work load (%VO2 max), but the difference in Tre/%VO2 max between the subjects was not significant. At different mean skin temperatures (Tsk), relative sweat rate (%msw, max), for a given Tre was unaffected and the relationship of %mSW, max with Tre was the same in both subjects. Lowering the relative work load (and thus Tre) displaced the Tre/%msw, max relationship to the right, and regression lines for different %VO2 max were parallel. The multiple regression equation %msw, max = -1,531 +/- 36.67 Tre (degrees C) + 6.08 Tsk (degrees C) (r = +0.92), related the parameters and was independent of the subject's fitness and state of acclimatization providing %msw, max was expressed in terms of the appropriate msw, max at the time of measurement.

Acclimatization↗

Central and peripheral inputs in sweating regulation during thermal transients.

Eight nude resting men were exposed to consecutive heating-cooling cycles of air and wall temperatures varying from 28 to 45 degrees C in a sawtooth pattern using one of the following slopes: +/- 3.40, +/- 2.27, +/- 1.70, +/- 1.42, or +/- 1.13 degrees C . min-1. Ambient vapor pressure and air velocity were kept constant at 20.0 mbar and 0.9 m . s-1, respectively. Continuous measurements were made of rectal, esophageal, and mean skin temperatures. Local upper limb sweating response was measured from an arm chamber under a local thermal clamp. The results point out the insufficiency of an explantation based on a simple additive function of core and skin temperatures for describing the sweating regulation. During transient thermal loads, a multiplicative interaction of mean skin and core temperatures must also be taken into account for describing the central drive for local sweating response. The interindividual differences observed in the sweating regulation mechanism seem to be linked to a nonlinearity in the response of the thermoregulatory system.

Adult↗

15 degrees head-down tilt attenuates the postexercise reduction in cutaneous vascular conductance and sweating and decreases esophageal temperature recovery time.

The following study examined the effect of 15 degrees head-down tilt (HDT) on postexercise heat loss and hemodynamic responses. We tested the hypothesis that recovery from dynamic exercise in the HDT position would attenuate the reduction in the heat loss responses of cutaneous vascular conductance (CVC) and sweating relative to upright seated (URS) recovery in association with an augmented hemodynamic response and an increased rate of core temperature decay. Seven male subjects performed the following three experimental protocols: 1) 60 min in the URS posture followed by 60 min in the 15 degrees HDT position; 2) 15 min of cycle ergometry at 75% of their predetermined V(O2 peak) followed by 60 min of recovery in the URS posture; or 3) 15 min of cycle ergometry at 75% of their predetermined V(O2 peak) followed by 60 min of recovery in the 15 degrees HDT position. Mean skin temperature, esophageal temperature (T(es)), skin blood flow, sweat rate, cardiac output (CO), stroke volume (SV), heart rate (HR), total peripheral resistance, and mean arterial pressure (MAP) were recorded at baseline, end exercise, 2, 5, 8, 12, 15, and 20 min, and every 5 min until end of recovery (60 min). Without preceding exercise, HDT decreased HR and increased SV (P < or = 0.05). During recovery after exercise, a significantly greater MAP, SV, CVC, and sweat rate and a significantly lower HR were found with HDT compared with URS posture (P < or = 0.05). Subsequently, a significantly lower T(es) was observed with HDT after 15 min of recovery onward (P < or = 0.05). At the end of 60 min of recovery, T(es) remained significantly elevated above baseline with URS (P < or = 0.05); however, T(es) returned to baseline with HDT. In conclusion, extended recovery from dynamic exercise in the 15 degrees HDT position attenuates the reduction in CVC and sweating, thereby significantly increasing the rate of T(es) decay compared with recovery in the URS posture.

Adaptation, Physiological↗

Upright LBPP application attenuates elevated postexercise resting thresholds for cutaneous vasodilation and sweating.

We evaluated postexercise venous pooling as a factor leading to previously reported increases in the postexercise esophageal temperature threshold for cutaneous vasodilation (ThVD) and sweating (ThSW). Six subjects were randomly exposed to lower body positive pressure (LBPP) and to no LBPP after an exercise and no-exercise treatment protocol. The exercise treatment consisted of 15 min of upright cycling at 65% of peak oxygen consumption, and the no-exercise treatment consisted of 15 min upright seated rest. Immediately after either treatment, subjects donned a liquid-conditioned suit used to regulate mean skin temperature and then were positioned within an upright LBPP chamber. The suit was first perfused with 20 degrees C water to control and stabilize skin and core temperature before whole body heating. Subsequently the skin was heated ( approximately 4.0 degrees C/h) until cutaneous vasodilation and sweating occurred. Forearm skin blood flow and arterial blood pressure were measured noninvasively and were used to calculate cutaneous vascular conductance during whole body heating. Sweat rate response was estimated from a 5.0-cm2 ventilated capsule placed on the upper back. Postexercise ThVD and ThSW were both significantly elevated (0.27 +/- 0.04 degrees C and 0.25 +/- 0.04 degrees C, respectively) compared with the no-exercise trial without LBPP (P < 0.05). However, the postexercise increases in both ThVD and ThSW were reversed with the application of LBPP. Our results support the hypothesis that the postexercise warm thermal responses of cutaneous vasodilation and sweating are attenuated by baroreceptor modulation via lower body venous pooling.

Adult↗

Muscle mechanoreceptor modulation of sweat rate during recovery from moderate exercise.

The objective of this study was to identify whether muscle mechanoreceptor stimulation is capable of modulating sweat rate. Seven healthy subjects performed two 20-min bouts of supine exercise on a tandem cycle ergometer (60 rpm at 65% of maximal heart rate). After one bout, the subject stopped exercising (i.e., no pedaling), whereas, after the other bout, the subject's legs were passively cycled (at 60 rpm) via a second person cycling the tandem ergometer. This allows for mechanical stimulation of muscle with minimal activation of central command. Esophageal temperature (T(es)), mean skin temperature (T(sk)), heart rate, mean arterial blood pressure, oxygen consumption, cutaneous vascular conductance (CVC), and sweat rate were not different during the two exercise bouts. Regardless of the mode of exercise recovery, there were no differences in T(es), T(sk), or CVC. In contrast, early in the recovery period, chest and forearm sweat rate were significantly greater in the passive cycling recovery mode relative to the no-pedaling condition (chest: 0.57 +/- 0.13 vs. 0.39 +/- 0.14, forearm: 0.30 +/- 0.05 vs. 0.12 +/- 0.02 mg.cm(-2).min(-1); both P < 0.05). These results suggested that muscle mechanoreceptor stimulation to the previously activated muscle is capable of modulating sweat rate.

Adult↗

Treatment of gustatory sweating with botulinum toxin: special aspects.

Botulinum toxin treatment is an efficient, well-tolerated technique for patients suffering from gustatory sweating, first described by our group. With the experience gained in recent years we were able to improve on some of our skills in the diagnosis and treatment of gustatory sweating and here we wish to focus on some interesting aspects: (1) the necessity for an exact anamnesis before treatment with botulinum toxin to ensure correct treatment; (2) the advantages of Minor's test in special situations, for example, when sweating occurs in regions of hairy skin, retroauricular, at the back of the auricle and in areas distant from the site of salivary gland surgery; (3) the reduction of pain during treatment using an anesthetic ointment containing lidocaine and prilocaine as active substances; (4) intracutaneous injections in areas anterior to the fascia-protected skin of the lateral face-covering mimetic muscles, and (5) the occasional necessity for short-time reinjection in small areas of persistent sweating.

Adult↗

Distribution of hairs and sweat glands on the bodies of Korean adults: a morphometric study.

A morphometric study was made of the number of sweat glands and hairs per square centimeter of skin on different body regions of Korean adults. For this purpose, samples of skin from 30 body regions were obtained by punch biopsy from 74 cadavers of Korean adults. Serial transverse sections that extended through the papillary layer of the dermis were prepared in each case and subjected to routine histological staining. Sections of skin were examined under low magnification and the sweat ducts and hair follicles in each section were counted and recorded in terms of the number per square centimeter of skin. Arithmetic means and standard deviations for each region were also obtained for comparison of the densities of distribution. The soles (male) and the palms (female) were the regions of most densely distributed sweat glands while the mammary area in both sexes was the region of lowest density. Hairs were distributed most densely in the buccal region in males and on the mental (chin) region in females. The region of lowest density of hairs was the dorsum of the middle phalanx of the fingers in both sexes. Seven regions of the body exhibited significant sexual dimorphism in terms of the density of sweat glands while only four regions showed significant sexual dimorphism in terms of the density of hairs. Hairs appeared to be more densely distributed in the buccal regions of females than of males. However, the density of hairs in the dermis was not always proportional to the density of visible hairs.

Adult↗

Subclinical dilatation of dermal sweat ducts.

1,323 biopsied skin specimens were retrospectively investigated. Dilatation of dermal sweat ducts was observed in 18 specimens (1.36%). They included 7 specimens of malignant and benign neoplasms or nevi, 5 of fibrosis and 6 of various inflammations. The face was the favored site, but it was also seen in other areas. Ten out of 18 specimens were taken in the summer. It was speculated that the massive secretion of sweat and the compression of sweat ducts by several tissue components in the dermis played an important role for the dilatation of the sweat ducts.

Biopsy↗

Mutations of the cystic fibrosis gene and intermediate sweat chloride levels in children.

The incidence of mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in children with intermediate sweat chloride levels is unknown. The results of 2,349 sweat tests performed at two Belgian university hospitals were reviewed. Intermediate chloride concentrations were observed in 98 subjects (4.2%), 68 being younger than 18 years of age. Forty-three children could be traced and their parents agreed to take part in the study. Exhaustive analysis of the CFTR gene disclosed a total of 24 putative mutations (27.9%). Three subjects were found to carry only one CFTR mutation, whereas 10 harbored one mutation on both CFTR genes. These 10 children were investigated in detail. At the time of writing, the mean age (+/-SD) of this group is 8.9 years (+/-4.2 years). Nine children are pancreatic sufficient. Three have been asymptomatic for more than two years, whereas the others display, to different degrees, clinical features suggestive of CF. The sweat chloride concentration is slightly higher in this group (39.4 +/- 5.4 mM) than in subjects without CFTR mutation (35.2 +/- 4.4 mM, p < 0.05). The nasal potential difference was abnormal in five of the nine subjects tested. In this study, 23% of children displaying intermediate sweat chloride levels were found to carry a putative mutation on both CFTR genes.

Adolescent↗

Normal sweat chloride values do not exclude the diagnosis of cystic fibrosis.

Since its introduction in 1959, the sweat test has remained the "gold standard" diagnostic test for cystic fibrosis (CF). It is apparent that CF encompasses a wide spectrum of disease, from meconium ileus and severe respiratory compromise in infants to the presentation of mild pulmonary symptoms and no evidence of gastrointestinal disease in adults. In patients with lung disease that might otherwise be consistent with CF, normal sweat chloride (Cl-) values have tended to exclude the diagnosis. In this report we describe two patients from two families with the compound heterozygotic CF mutations delta F508/3849 + 10 kb C-->T. These patients had mild manifestations of disease, including clinical pancreatic sufficiency (normal growth without pancreatic enzyme supplementation) and absence of azoospermia. Sweat Cl- values were in the normal range. However, both patients developed bronchiectasis, progressive obstructive lung disease, and colonization with Pseudomonas. The diagnosis of CF was made using nasal transepithelial voltage measurements and genotyping. These cases emphasize the need to maintain a high index of suspicion of CF in atypical cases, and to pursue alternative diagnostic tests to confirm a diagnosis of CF suspected on clinical grounds, despite normal sweat test results.

Adult↗