Fever

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Author:
cheflouie
ID:
85118
Filename:
Fever
Updated:
2011-05-18 11:15:01
Tags:
fever
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Description:
Fever of Unknown Origin
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  1. Fever - body temp over:
    • rectal 38.0° C (100.4° F)
    • oral 37.8° C (100.0° F)
    • axillary 37.2° C (99.0° F)
  2. Mechanisms of Heat Loss:
    • 1. Convection - air mvmt
    • 2. Vasodilation - blood moved to skin, most effective with moderate temp elecations
    • 3. Dec. Muscle tone - washed out feeling
    • 4. Evaporation - sweat
    • 5. Inc. respiration - Inc. RR
    • 6. Voluntary mechanisms - stretch out, slow down, clothing
  3. Why do the elderly have poor temperature regulation?
    They have decreased circulation, shivering, metabolic rate, vasoconstrictor response, perception of heat/cold, and absent sweating.
  4. What is the diurnal variation in temperature for adults?
    36.8° ± 0.4° C. (98.2° ± 0.7° F.)
  5. How is fever different from hypothermia?
    • Increase in hypothalmic set point.
    • Shivering
    • Peripheral vasoconstriction
    • Increase heat production from liver
    • Responds to antipyretics
  6. How is hypothermia different from fever?
    • Unchanged hypothalamic set point
    • Increase in heat>than indv ability to decrease heat
    • No response to antipyretics
  7. Causes of hyperthermia:
    • Heat stroke - exertional and nonexertional
    • exercising in heat
    • anticholinergics/rubber suits

    • Drug induced
    • Stimulants, MAO inhibitors, PCP, TCAs,hallucinogens

    Endocrinology
  8. Central Serotonin Syndrome (Etiology)
    Iatrogenic complication from use ofdrugs/dietary supplements with CNS 5-HT(serotonin) activity

    Excess stimulationof 5-HT receptors in CNS.
  9. Central Serotonin Syndrome (Sx)
    • Confusion, agitation, anxiety
    • Hyperthermia, diaphoresis, tachycardia/tachypnea
    • Myclonus, muscle rigidity, tremor, restlessness/ataxia
  10. Central Serotonin Syndrome (Tx)
    D/C medications

    • Basic support
    • IV fluids
    • Benzodiazepines for muscular rigidity or nondepolarizingneuromuscular blockers
    • Cooling blankets
  11. Neuroleptic Malignant Syndrome (etiology/patho)
    From therapeutic doses of neuroleptic medications –mortality up to 30%

    • Rapid increase in dose orparenteral admin may increase risk of:
    • Severe muscular rigidity
    • Altered sensorium
    • Hyperthermia
    • Autonomic lability
    • Myglobinemia
  12. Neuroleptic MalignantSyndrome (treatment)
    Supportive &aggressive cooling, CV support
  13. Malignant Hyperthermia (Etiology/Patho/Prevention)
    Disorder of skeletal musclemanifested ashypermetabolic statewhen given certain anesthetics (or succinylcholine)

    Genetic Susceptability

    Prevention: Avoidance
  14. Malignant Hyperthermia (Treatment)
    Dantrolene
  15. Endocrine causes of hyperthermia
    Thyrotoxicosis

    Pheochromocytoma – catecholamine-secretingtumors of adrenal medulla
  16. Pyrogens (Il-1,IL-6, TNF, IFN) --> Fever
    _____ released by macrophages and endothelial cells in response to infections, inflammation, and immune reactions --> targets hypothalmic endothelium -->release PGE2 --> inc. cyclic AMP --> Elevated thermoregulatory set point --> Heat production --> ____
  17. Exogenous pyrogens
    • Microbial products
    • Lipopolysaccharide complex in cell wall of Gram positive bacteria, viruses
    • Microbial toxins
    • E.g. Gram negative endotoxin
    • Whole microorganisms
  18. Endogenous Pyrogens
    • Small proteins that regulate immune,inflammatory, hematopoieticprocesses
    • IL-1, IL-6
    • tumor necrosis factor (TNF)
    • Ciliary neurotrophic factor (CNTF)
    • Interferon (IFN) α
  19. Cytokine stimulation
    • ______ stimulated by:
    • Bacterial
    • fungal
    • viral infection
    • Inflammation
    • Trauma
    • Tissue necrosis
    • Antigenantibodycomplexes
  20. Cytokines produced by
    • Monocytes
    • Lymphocytes
    • Neutrophils
    • other - glial cells

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