Approach to Fever (Pyrexia)
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Fever is abnormal elevation of body temperature that occurs as part of a specific biologic response that is mediated and controlled by central nervous system and is usually a symptom of an infection. It is characterized by an elevation of body temperature above the normal range of 36.5–37.5 0C
Clinical presentation
- Depression
- Lethargy
- Anorexia
- Sleepiness
- Hyperalgesia
- Inability to concentrate
- Feeling cold
- Increased muscle tone
- Shivering
- Irritability
Note: Fever alone is not a diagnosis
Investigations
Will be specific basing on the clinical presentation. These may include:
- Rapid Malaria test
- Blood slide for malaria parasites
- POC Urine dipstick
- POC ECG
- Radiological investigations - X-ray, CT scan
- Complete blood count
- Bedside USS - Gall bladder, Liver, spleen, Abdominal aorta, kidneys, etc
- Serum Electrolytes
- Serum Creatinine and Urea
- Lactate
Non-Pharmacological Treatment
- Perform both primary and secondary assessment. Intervene whenever necessary.
- Advise patient for bed rest
- Ask patient to take plenty of fluids (If able to take orally)
Note
- In children, temperature >400C need urgent lowering. However, lukewarm sponging and evaporative cooling are not recommended.
- Fevers caused by virus are usually self-limiting but all other fevers need treatments.
Pharmacological Treatment
Give antipyretic medicines:
A: paracetamol (PO): Adult1g 6hourly when required, Paediatrics 15mg/kg 6hourly when required OR suppository 125mg–250mg, 6hourly
OR
A: ibuprofen (PO): Adult 400mg 8hourly when required; Paediatrics 5-10mg/kg 8hourly when required
For patient who are unable to take oral medications, give:
D: paracetamol 1gm (IV)
Referral
Refer the patient to the next facility with adequate expertise and facilities.
- If no diagnosis is established
- If no improvement of fever after the use of antibiotics
- Fever that recurs