Fever is one of the most common symptoms. Defined as the increase in body temperature at values greater than 37 ° C. The rise in temperature to 37,6 ° C is called low-grade fever or “tenths”.Fever Temperature above 41,5 ° C called hyperpyrexia, while less than named 36 ° C hypothermia. The fever usually accompanied by the appearance of coldness (chills) or muscle tremor called shiver.
Other clinical manifestations associated with the occurrence of the disease is the initial coldness of limbs during the invasion, and the redness of the face and ear flaps, the tachypnea, the tachycardia, myalgias and arthralgias, and infants may develop seizures and very elderly drowsiness, confusion or change their level of consciousness. The fall of fever usually accompanied by sweating.
According to the Greek Cancer Society, the human body temperature displays diurnal variation with an average of 36,8 ° C and range + 0,4 ° C. It is lowest in the morning (6:00 a.m.) and highest in the afternoon (4.00pm). H warming> 37 ° C is called hyperthermia and does not always reflect disease. Women of childbearing age in the days of ovulation ( fertile days ), showing an increase of the temperature of approximately 0,6 ° C, which is due to hormonal preparation of the reproductive system. Similar hormonal reasons justify the increased temperature during pregnancy. Abnormal increase in temperature, which is not considered fever, occurs during strenuous exercise or work, emotion and stress. Pathological hyperthermia, but not fever, observed in heatstroke (exhaustion of Heating regulators mechanism), the use of drugs, especially neuroleptics paralyzing the autonomic nervous system or “thermostat” by removing completely the possibility thermoregulation, alcoholism, hyperthyroidism etc.
Similar hormonal reasons justify the increased temperature during pregnancy. Abnormal increase in temperature, which is not considered fever, occurs during strenuous exercise or work, emotion and stress. Pathological hyperthermia, but not fever, observed in heatstroke (exhaustion of Heating regulators mechanism), the use of drugs, especially neuroleptics paralyzing the autonomic nervous system or “thermostat” by removing completely the possibility thermoregulation, alcoholism, hyperthyroidism etc.
Fever accompany common viral infections and childhood diseases, bacterial infections (eg tuberculosis), severe surgical diseases, malignant tumors, hematological or autoimmune diseases, allergies Fever stroke and traumatic brain injury, dehydration, and even myocardial infarction. Due to the influence of pyrogens in the area of the brain that controls the thermoregulation (a type of biological thermostat) and is called hypothalamus. The hypothalamus gets messages about the body temperature of neural receptors in the periphery and the temperature of the blood that reaches him. In fever, the “thermostat” is set at a higher temperature than normal and the body adapts to this mobilizing neural, vascular, muscular and hormonal mechanisms of heat preservation and production increase. Preserving heat is achieved by peripheral vasoconstriction (decrease in blood supply to the skin and inhibit sweating) and behavior modification ( the coiled body that exhibits the smallest surface area, search more clothing and hot environment). Heat production is to increase muscle tone and muscle contraction ( shivering ) or by increasing metabolism wit the acceleration of combustion (mainly the liver).
In fever, the “thermostat” is set at a higher temperature than normal and the body adapts to this mobilizing neural, vascular, muscular and hormonal mechanisms of heat preservation and production increase. Preserving heat is achieved by peripheral vasoconstriction (decrease in blood supply to the skin and inhibit sweating) and behavior modification ( the coiled body that exhibits the smallest surface area, search more clothing and hot environment). Heat production is to increase muscle tone and muscle contraction ( shivering ) or by increasing metabolism wit the acceleration of combustion (mainly the liver).
Just reduce the effect of pyrogenic or act antipyretic drugs, the hypothalamus is set again at normal temperature and mobilizes the heat dissipation mechanisms, causing vasodilation and sweating (heat elimination by the irradiation and evaporation) and reduced metabolism.
The pyrogen distinguished exogenous pyrogens produced by microbes and endogenous pyrogens or pyrogenic cytokines are interleukins (IL-1, IL-6, IL-8), the tumor necrosis factor (TNF), interferon (IFN ) and the protein of inflammation macrophage 1 (MIP-1) produced by the activation of immune cells and tissue inflammation. Pyrogens act by increasing the production of prostaglandin E2 (PGE2) in both the hypothalamus, where they cause modification of thermoregulation and in the region, which caused the related phenomena such as myalgias and arthralgias. The same drugs and various intermediate mechanisms causing quite often the so-called drug fever.
The temperature varies depending on the area of the body which is measured and is approximately the same in the mouth, armpit, and the ear, but in the rectum (central temperature) is higher by 0,4-1 ° C. In septic patients may be a big difference between the outside temperature and the center, with apparent pyrexia or hypothermia armpit and hyperpyrexia measuring rectal. The elderly, people with kidney or liver failure, or people taking steroids or anti-inflammatory drugs, can not do more fever and severe infections.
The temperature measurement is made with the patient at rest, from exercise or stress , without sweaty or wet, the same always point, armpit (less reliable) or orally, by use of clinical mercury thermometer with lowered column of mercury below a reference to 36 ° C. It must be done at least twice a day, morning and afternoon, because the disease is usually followed diurnal variation (lower or apyrexia the morning and higher in the afternoon) and 10 to 15 minutes after shivering event. In some cases hospitalized requested a three thermometry. The most common temperature measurement is meaningless.
It must be done at least twice a day, morning and afternoon because the disease is usually followed diurnal variation (lower or apyrexia the morning and higher in the afternoon) and 10 to 15 minutes after shivering event. In some cases hospitalized requested a three thermometry. The most common temperature measurement is meaningless.
The duration of the temperature measurement should be, depending on specifications of the thermometer, from 1 to 3 minutes. When ear thermometers used or luminescent thermometers (movies) the instructions must be followed.
The presence of the disease in the clinical picture of a patient is so important, as long there is a separation of a febrile illness or not. The disease characters such as daily, weekly or monthly variation of particular clinical relevance, as the context of other symptoms and findings of a febrile illness.
The evaluation of fever identified and correlated to the age, the history of the patient, the epidemiology of the time and place where it occurs, the clinical picture, and pre-existing health problems.
Points reassuring for the presence of fever are the recent history of viral assistance in the patient’s environment, good general condition and appetite when the patient is afebrile.
Points for immediate medical evaluation
Is the high fever in extreme ages (newborns, infants and the elderly), the appearance of the rash , strong headache and photophobia or convulsions , changes in the level of consciousness , the presence of abdominal pain and severe malaise that persists after solution of fever, the jaundice , the vomiting or uncontrollable or bloody diarrhea , the shortness of breath and cough with expectoration in color of rust , the alteration of the voice , the appearance of lymph node swellings , the painful swelling large joint or member , the dysuria symptoms and deterioration of vital signs (hypotension, severe tachycardia, pallor and sweating, shortness of breath ) etc.
It also needs the medical evaluation,
The incidence of complications in a viral assistance, extension beyond the weekend and any fever in burdened and immunocompromised individuals (diabetes, cancer, hematologic patients, patients treated with cortisone, renal, cardiac, respiratory and liver failure or treated with psychotropic drugs).
There is no evidence so far some benefit
from fever for the immune response of the body and there is no point address it. Instead, there is an urgent need for intensive antipyretic treatment in a history of seizures, central nervous system, heart disease, cardiac and respiratory failure. Diagnostic reasons may rarely require temporary interruption of antipyretic treatment.
The treatment of disease by using antipyretic
drugs such as acetaminophen, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). The antipyretic activity of directly detected in the hypothalamus to inhibit the enzyme cyclooxygenase (COX), which is responsible for the production of prostaglandin E2 (PGE2), and the similar effect in the region offer relief of associated symptoms related thereto. In normal thermoregulation, these drugs do not act like there act and heat stroke, heat exhaustion, neuroleptic syndrome and generally in situations where the system Heating regulators either exhausted or deregulate. Generally avoid the use of aspirin and NSAIDs because of their side effects especially gastrointestinal, while in children the use of aspirin completely prohibited because of the risk of Reye syndrome lethal challenge (acute liver failure). Preferred systemic administration of paracetamol orally in three or four doses in 24 hours of up to 500mg 1gr each time rather than where administration to the anode of fever. If this is not possible the substance in the form of suppositories or intramuscular injections administered.
The antibiotics are not antipyretic and their administration without medical directive can become dangerous and may alter the clinical picture through misleading side effects or be masking the cause of the fever
The ineffective control by exhaustion of the maximum dosage (4,5g / 24 hours for granting short-term and 2,5gr / 24 hours for sustained administration in adults), combination use with other NSAIDs in alternating administration with paracetamol and always taking measures gastroprotection with drugs that control gastric acidity.
Corticosteroids are rarely used as an antipyretic,
although particularly effective because they simultaneously cause immunosuppression. They act by inhibiting the production of pyrogen.
The use of natural resources such as cold, wet compresses, ice bags to large vessels crossing points, such as armpits and groins, cold baths (up to 22 ° C or as tolerated by the patient) or cold wet blankets or towels achieves rapid decline of fever, particularly hyperpyrexia and relieves, but is not sufficient without antipyretics to control it. It should not be neglected patient hydration with plenty of fluids, and fever by perspiration and tachypnea causes large water losses.
Points for immediate medical evaluation
– High fever in extreme ages (newborns, infants and the elderly)
– Show rash
– A strong headache, photophobia
– Change in level of consciousness
– Abdominal pain
– Intense discomfort that persists after fever solution
– Jaundice (yellowing of skin and eyes)
– Vomiting or uncontrollable or bloody diarrhea
– Shortness of breath
– A cough with expectoration in rust color
– Alteration of voice
– Lymphatic swellings
– Painful swelling or large hinge member
– Dysuria symptoms and back pain
– Deterioration of vital signs (hypotension, severe tachycardia, pallor and sweating, shortness of breath, etc.)
– Complications in viral subscription or extension beyond the weekend
What to do in the fever
– Correct thermomometrisi least morning and afternoon
– Regular administration of antipyretics (paracetamol every four hours, can interfere with some NSAIDs)
– An environment with a constant temperature (21-22 ° C) and humidity
– Comfortable clothes, bedding (what the patient needs)
– Light diet with plenty of fluids
– Cold compresses and baths (no exaggeration, the patient feels pleasant)
– Grant gastroprotection when used NSAIDs
– Search medical advice when there is a busy background
What not to do in the fever
– No aspirin for children
– No aspirin and NSAIDs in adults without gastroprotection and people taking anticoagulants
– The use of antibiotics is prohibited without medical advice
– The use of alcohol is forbidden
– Not too much bedding or clothing
– No rubbing or pads with alcohol or oil (do not offer therapeutic, dermatological serious risk of complications)