Fever

[Max]

FEVER

I. Key words
- Delirium: A state in which the thoughts, expressions, and actions are wild, irregular.
- Convulsion: An unnatural, violent, and unvoluntary contraction of the muscular parts of an animal body.
- Infection: Any disease caused by the entrance, growth, and multiplication of microorganisms in the body
- VTE: venous thromboembolism, blood clots in the veins.
- Neutropenic patient: a patient with abnormally low number of neutrophils.
- Asplenic patient: a patient with the absence of normal spleen function and is associated with some serious infection risks.
- Hyperpyrexia: an elevation of temperature in a disease, in excess of the limit usually observed in that disease.

II. Summary
1. Etiology
Fever can cause increased tissue catabolism and oxygen consumption, dehydration, exacerbation of heart failure, delirium, and convulsions.
2. Diagnosis
a) Differential diagnosis
- Main cause: infection.
- Diagnoses of exclusion: drug reaction, malignancy, VTE, vasculitis, tissue infarction.
- Depending on the clinical stability and immune status.
b) History
Including chronology and symptoms, medications, potential exposures, a social and travel history.
c) Physical examination
- Measuring oral and rectal temperature.
- Paying attention to rash, murmur, abnormal fluid accumulation, intravascular lines, and indwelling devices (gastric tubes or Foley catheters).
- Examining the skin, oral cavity and perineal area in the neutropenic patient for breaches of mucosal integrity.
3. Testing
- CBC, serum chemistries/ liver function test, urinalysis.
- Blood, urine, abnormal fluid, sputum, cerebrospinal fluid and stool cultures.
- Chest radiography.
4. Treatment
- Antipyretic drugs (aspirin and acetaminophen). Don't use aspirin in adolescents with viral infections.
- Tepid water bath (treating hyperpyrexia)
- Empiric antibiotics (using in infection and neutropenic and asplenic patients)
- Heat stroke and malignant hyperthermia.