DEMAM

Ivana
406172126
 Definition
• Fever is an elevation of body temperature that exceeds the normal daily
variations
• In normal temperature environment  human metabolic rate produces more heat
than is necessary to maintain core body temperature in the range of 36.5 – 37.5o C
• Hypothalamic thermoregulatory center balances excess heat production (derived from
metabolic activity in muscle and liver) with heat dissipation (from skin and lungs)
• Oral temperature (36.8 ±0.4), rectal temperature 0.4 higher, axillary temperature 0.5
lower
• > 41,5 ºC  hyperpyrexia (severe infections , CNS hemorrhages)
• Hyperthermia  characterized by an uncontrolled ↑ in body temperature that exceeds
the body ability to lose heat
• Normal daily variation is typically 0.5ºC
• Elderly  ↓ ability to develop fever, with modest fever event in severe infections
• Set point ↑  neurons in vasomotor activated  vasoconctriction
commences (shunting blood away from periphers to the internal organs), (↓
heat loss from skin)
• Shivering  ↑ heat production from muscles (not required if heat
mechanisms ↑ blood temperature sufficiently
• Behavioural adjustments  putting more clothing (↓ heat loss)
 History
• Duration, pattern
• Chronology events preceding fever, including exposure to other infected
individuals / to vectors of disease
• Associated symptoms
• Travel within past year
• Recent hospitalizations
• Chemotherapy
• Same site should be used
consistently to monitor a febrile
disease
• *{newborns, elderly patients,
patient taking glucocorticoids,
treated with anticytokine  may
have infection in the absence of
fever due to a blunted febrile
response}
 Diagnostic studies
• Laboratory test : CBC, CRP, ESR
• Imaging
• The objectives in treating fever are first to reduce the elevated hypothalamic set
point and second to facilitate heat loss
• Reducing fever with antypyretics also reduces systemic symptoms of headache,
myalgias, and arthralgias
• Oral aspirin and NSAID effectively reduce fever but can adversely affect plateles
and gastrointestinal tract, therefore acetaminophen is preferred
• Treatment of fever in some patients is highly recommended
• Fever increases the demand for oxygen ( 13% O2 consumption, for every 1ºC over
37ºC) and can aggravate the condition of patients with preexisting impairment of
cardiac, pulmonary, or CNS function.
• ↑ 1ºC  ↑ HR 10 bpm, ↑ RR 2-4 bpm
Non infectious causes include :

• Pulmonary embolism
• Intracranial hemorrhage
• Cerebrovascular accident
• Neuroleptic malignant
syndrome
• Malignant hyperthermia
• Thyroid storm
• Transfusion reaction
• Malignancy
• Autoimmune disorders
• Drug fever