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Chapter 2 Index
A. Evaluation by system: |
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Definition and Treatment of Fever
General Information
Definition of Fever: The general consensus is that temps of
> 100.6 degrees rectally; >99.4 degrees axillary, and > 98.6 degrees orally
(though diurnal variation make some say >99.0 degrees orally) constitute
fever. Fever Phobia: A condition of parents, grandparents, nurses, and
doctors! It should be avoided at all costs.
Pathogenesis of Fever: response of the CNS to endogenous
pyrogenic cytokines (e.g. interleukin1) which also induce slow-wave sleep -
? reason for somnolence with fever.
How Should a Temperature Be Measured?: A Number of Choices.
- Rectal temperature: considered the gold standard in child between
birth and three years of age. However, some infrared tympanic
temperatures more reliable in older children.
- Ear temperatures are the quickest and technology has improved with
these methods. Some question of effect of cerumen interfering with
this method. Not sure of reliability in children under 3 years of age. (J
Peds: 98;133:471-473)
- Strips on forehead: not a reliable way to check temperatures.
- Pacifier thermometer: takes too long to be considered for routine
office use - 3.5 minutes. Must add 0.5 degrees F to be comparable to
rectal temperature. Useful at home.
- Axillary temperature: First Years Comfortemp takes 20 readings/second,
which are averaged to get final result in 3 seconds. Infrared: accurate
within 0.1 degree when compared to rectal. This new in 1997: Phone number:
800-533-6700
- Parental touch: reliable in 79% of cases; 2nd study - accurate in 84%
of cases.
Treatment of Fever:
Why treat fever? Primary reason: comfort of child.
Theoretical reason to not treat under 102 degrees (helps fight infection);
definitely poorer outcome if don’t treat fever over 104.
A. Medications: Parents will have preferences. Recommend: do not
give both meds!
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Acetaminophen is the standard, and still the first
line med for the treatment of fever: dosage: 10-15 mg/kg every 4 hours:
15/kg is more effective in reducing fever
-
Ibuprofen dosage: 10 mg/kg every 6-8 hours: max: 40
mg/kg/24hrs Comparison of the two types of medication: No difference (AJDC
1992;146:626-32): Another article (European J of
ClinPharm1994;46:197-201): Ibuprofen works better in the first four hours
of treatment but not after that time. Combination of the two: Review
article: (Clinical Pharmacy: 1992:11:1005-21) - 244 references
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no evidence that combining Ibuprofen and
Acetaminophen works better.
-
increased toxicity risk because of increased dosing
errors: the two meds are given at different intervals, and parents forget
which meds they gave last;
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increased likelihood of adverse reactions; Ibuprofen:
gastritis, GI bleed, and dyspepsia
-
Acetaminophen alone is still the preferred treatment
for fever.
B. General advice to give parents in treating fever:
- dress the child lightly: do not bundle child up; keep room cool - not
hot;
- give plenty of liquids to drink; put child in a lukewarm bath for at
least 30 minutes if child is uncomfortable.
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