Fever
Fever | |
An analogue medical thermometer showing the temperature of 38.7 °C |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; M.Umer Tariq [3]
Synonyms and keywords: Pyrexia; febrile response
Common Causes
Fever is a common symptom of many medical conditions:
- Infectious disease, e.g. influenza, common cold, HIV, malaria, infectious mononucleosis, or gastroenteritis.
- Various skin inflammations, e.g. boils, pimples, acne, or abscess.
- Immunological diseases, e.g. lupus erythematosus, sarcoidosis, inflammatory bowel diseases.
- Tissue destruction, which can occur in hemolysis, surgery, infarction, crush syndrome, rhabdomyolysis, cerebral hemorrhage, etc.
- Drug fever
- Directly caused by the drug, e.g. lamictal, progesterone, or chemotherapeutics causing tumor necrosis.
- As an adverse reaction to drugs, e.g. antibiotics or sulfa drugs.
- After drug discontinuation, e.g. heroin withdrawal.
- Cancers, e.g. Hodgkin disease.
- Metabolic disorders, e.g. gout or porphyria.
- Thrombo-embolic processes, e.g. pulmonary embolism or deep venous thrombosis.
Persistent fever which cannot be explained after repeated routine clinical inquiries, is called fever of unknown origin.
Complete Differential Diagnosis of the Causes of Fever
In Alphabetical Order. [1] [2]
Complete Differential Diagnosis of the Causes of Fever
(By Organ System)
Treatment
Fever should not necessarily be treated. Fever is an important signal that there's something wrong in the body, and it can be used for follow-up. Moreover, not all fevers are of infectious origin.
Even when treatment is not indicated, however, febrile patients are generally advised to keep themselves adequately hydrated, as the dehydration produced by a mild fever can be more dangerous than the fever itself. Water is generally used for this purpose, but there is always a small risk of hyponatremia if the patient drinks too much water. For this reason, some patients drink sports drinks or products designed specifically for this purpose.
Most people take medication against fever because the symptoms cause discomfort. Fever increases heart rate and metabolism, thus potentially putting an additional strain on elderly patients, patients with heart disease, etc. This may even cause delirium. Therefore, potential benefits must be weighed against risks in these patients. In any case, fever must be brought under control in instances when fever escalates to hyperpyrexia and tissue damage is imminent.
Treatment of fever should be based primarily on lowering the set-point, but facilitating heat loss may also contribute. The former is accomplished with antipyretics. Wet cloth or pads are also used for treatment, and applied to the forehead. Heat loss may be an effect of (possibly a combination of) heat conduction, convection, radiation, or evaporation (sweating, perspiration). This may be particularly important in babies, where drugs should be avoided. However, if water that is too cold is used, it induces vasoconstriction and prevents adequate heat loss.
References
Articles
Books
- Rhoades, R. and Pflanzer, R. Human physiology, third edition, chapter 27 Regulation of body temperature, p. 820 Clinical focus: pathogenesis of fever. ISBN 0-03-005159-2
- Kasper, D.L.; Braunwald, E.; Fauci, A.S.; Hauser, S.L.; Longo, D.L.; Jameson, J.L. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
External Links
- What to do if your child has a fever from Seattle Children's Hospital
- Fever and Taking Your Child's Temperature
- US National Institute of Health factsheet
- BUPA factsheet
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