Wrong fever. Fever is high body temperature. Causes and treatment of fever. Diseases and illnesses, causes of fever

Fever - an increase in body temperature above 37 o C is a protective-adaptive reaction of the body.

Fever is manifested by such symptoms as: increased body temperature, fever, chills, sweating, daily temperature changes.

Fever without temperature can be observed with small changes in temperature, close to low-grade fever.

Depending on the causes occurrences are distinguished infectious and non-infectious fever. The latter is observed in cases of poisoning, allergic reactions, malignant tumors, etc.

Types of fevers depending on body temperature

The following types of fever are distinguished (according to the degree of temperature increase):

• low-grade fever (from 37 to 38 o C);
• moderate fever (from 38 to 39 o C);
• high temperature fever (from 39 to 41 o C);
• hyperpyretic fever (excessive) (over 41 o C).

Fever reactions can occur differently in different conditions and the temperature can fluctuate within different limits.

Types of fevers depending on daily temperature fluctuations

Depending on temperature fluctuations, the following types of fever are distinguished:

• Persistent fever: body temperature is usually high (often more than 39 o C), lasts for several days or weeks with daily fluctuations in the ancestors 1 O WITH; occurs in acute infectious diseases (typhus, lobar pneumonia, etc.).
• Relieving fever: significant daily fluctuations in body temperature - from 1 to 2 o C and more; occurs in purulent diseases.
• Intermittent fever: a sharp rise in body temperature to 39-40 o C and above, with a decline in a short period of time to normal or even reduced and with the repetition of such rises after 1-2-3 days; characteristic of malaria.
• Wasting fever: significant daily fluctuations in body temperature over 3 o C (can be at intervals of several hours) with a sharp drop from higher to normal and lower numbers: observed in septic conditions.
• Relapsing fever: increase in body temperature immediately to 39-40 o C and above, which remains high for several days, then decreases to normal, low, and after a few days the fever returns and is again replaced by a decrease in temperature; occurs, for example, in relapsing fever.
• Undulating fever: a gradual increase in body temperature from day to day, which reaches a maximum within a few days, then, unlike relapsing fever, it also gradually decreases and gradually increases again, which looks on the temperature curve as alternating waves with a period of several days for each wave. Observed in brucellosis.
• Incorrect fever: does not have certain patterns in daily fluctuations; occurs most often (with rheumatism, pneumonia, dysentery, influenza and many others, including cancer).
• Kinky Fever: morning temperature is higher than evening temperature: observed with tuberculosis, prolonged sepsis, viral diseases, and thermoregulation disorders.

Treatment of fever

Treatment is aimed primarily at the underlying disease. Low-grade and moderate fevers are protective and should not be reduced.

For high and excessive fever, the doctor prescribes antipyretics. It is necessary to monitor the state of consciousness, breathing, pulse rate and its rhythm: if breathing or heart rhythm is disturbed, emergency assistance should be called immediately.

A feverish patient needs to be given water frequently, changed underwear after excessive sweating, and wipe the skin successively with wet and dry towels. The room in which a feverish patient is located must be well ventilated and have a supply of fresh air.

Algorithm for measuring body temperature

A mandatory procedure for examining patients with various diseases, especially infectious ones. Many diseases are accompanied by changes in the temperature of the affected areas of the body. The cessation of blood flow, for example, when a vessel is blocked by a blood clot or an air bubble, is accompanied by decrease in temperature.

In the zone of inflammation, where, on the contrary, metabolism and blood flow are more intense, the temperature is higher. For example, malignant neoplasms in the stomach have a temperature 0.5-0.8 degrees higher than the surrounding tissues, and with liver diseases such as hepatitis or cholecystitis, its temperature rises by 0.8-2 degrees. Hemorrhages lower the temperature of the brain, and tumors, on the contrary, increase it.

How to measure body temperature correctly?

Using a mercury or electronic thermometer, body temperature is measured in the armpit (the skin is first wiped dry), less often in other areas - the inguinal fold, oral cavity, rectum (basal temperature), vagina.

Temperature is usually measured 2 times a day - at 7-8 am and at 17-19 pm; If necessary, measurements are carried out more often. The duration of temperature measurement in the armpit is approximately 10 minutes.

Normal values ​​of body temperature when measured in the armpit range from 36 o C to 37 o C. During the day it fluctuates: the maximum values ​​are observed between 17 and 21 o'clock, and the minimum, as a rule, between 3 and 6 o'clock in the morning, with In this case, the temperature difference is normally less than 1 o C (no more than 0.6 o C).

P increased body temperature not necessarily associated with any disease. After great physical or emotional stress, in a hot room, body temperature may rise. In children, body temperature is 0.3-0.4 o C higher than in adults; in old age it may be slightly lower.

Increased body temperature that is not caused by changes in the hypothalamus is usually called hyperthermia. Many patients use the term “fever” very loosely, often implying a feeling of being warm, cold, or sweating without actually taking their temperature.

Symptoms are primarily due to the condition causing the fever, although the fever itself may cause discomfort.

Pathogenesis of fever

The goal of the body's thermoregulation system is normally to ensure that the actual internal body temperature remains at a set level of about 37 °C (with daily fluctuations). In contrast to passive hyperthermia, during fever the mechanisms of thermoregulation are preserved and when exposed to the pyrogenic factor, the set point of temperature homeostasis increases. In this regard, thermoregulation mechanisms begin to maintain an increased temperature (green line). Clinically, this becomes noticeable during an increase in body temperature. Since the actual body temperature does not correspond to the increased set point, the body reduces heat loss due to decreased cutaneous blood flow, resulting in cooling of the skin (cold sensation). In addition, heat production is also increased due to shaking (tremor). This continues until the actual temperature level (red line) approaches the new set point (plateau). When the set point for temperature homeostasis decreases, body temperature drops because the actual level is now too high. Accordingly, the skin bleeds, the person feels hot and sweats profusely.

Fever is especially characteristic of infections as a manifestation of the acute phase reaction, in which pyrogens are the cause of the change in the set point. Exogenous pyrogens are structural elements of the pathogen, and the most active of them are lipopolysaccharide complexes (endotoxins) of gram-negative bacteria. These pathogens, or pyrogens, are opsonized and phagocytosed by macrophages, such as Kupffer cells in the liver. Macrophages secrete many cytokines, including endogenous pyrogenic interleukin, interferon, tumor necrosis factors TNF-α (cachectin) and TNF-β (lymphotoxin), macrophage inflammatory protein MIP-1 and many others. These cytokines (with a molecular weight of approximately 15-30 kDa) are thought to reach the circumventricular regions of the brain, which do not have a blood-brain barrier. Cytokines can therefore induce a temperature response in these organs or in the nearby preoptic zone and vascular organ of the lamina terminalis via prostaglandin PGE2. In this case, antipyretic drugs (antipyretics) are effective.

For example, acetylsalicylic acid inhibits the enzymes that convert arachidonic acid to PGE2.

Considering that after intravenous injection of lipopolysaccharides, the above-mentioned cytokines are released only 30 minutes after the onset of fever, and with subdiaphragmatic vagotomy their release is delayed, one should think that exogenous pyrogens activate the preoptic region and the vascular organ of the terminal lamina also through afferent fibers from the abdominal cavity. It is possible that the signaling substances secreted by the Kupffer cells of the liver activate the afferent fibers of the vagus nerve closest to them, which transmit the pyrogenic signal through the solitary nucleus to groups of noradrenergic neurons of types A1 and A2. They, in turn, transmit a signal from the ventricular noradrenergic pathway to the thermoregulatory neurons of the preoptic area and the vascular organ of the lamina terminalis. Norepinephrine released there causes the formation of PGE2, and through it, fever. This usually causes the release of ADH (V 1 -receptor effect), α-melanocyte-stimulating hormone (α-MSH) and corticotropin-releasing hormone (CRH; corticoliberin), which prevent the development of fever through negative feedback due to the release of endogenous antipyretics.

Due to an increase in body temperature, heart rate increases (by 8-12 beats per minute per degree) and energy metabolism increases, resulting in fatigue, aching joints and headaches, and the phase of slow wave sleep (which performs a restorative function for the brain) is prolonged. , and also, under certain circumstances, disturbances of consciousness, sensory disturbances (delirium febrile) and convulsions occur. The role of fever is to counteract infection. Elevated temperature inhibits the replication of some pathogens and kills others. In addition, the plasma concentration of metals necessary for bacterial reproduction, such as iron, zinc and copper, decreases. In addition, cells affected by viruses are destroyed, which slows down the replication of viruses. Therefore, exogenous antipyretics should only be used if the fever is accompanied by seizures (usually in infants and young children) or is so high (> 39°C) that seizures are feared.

During a 24-hour period, body temperature varies from the lowest levels in the early morning to the highest in the late afternoon. The maximum change is approximately 0.6 °C.

Body temperature is determined by the balance between heat production by tissues, especially the liver and muscles, and heat loss in the periphery. Typically, the thermoregulatory center of the hypothalamus maintains core temperature between 37° and 38°C. Fever results from the hypothalamic control point being elevated, causing vasoconstriction and shunting blood away from the periphery to reduce heat loss; Sometimes shivering occurs, which increases heat production. These processes continue until the temperature of the blood washing the hypothalamus reaches a new point. Rebooting the hypothalamus point downward (for example, with antipyretic drugs) provokes heat loss through sweating and vasodilation. The ability to generate fever is reduced in certain patients (eg, alcoholics, very old people, very young people).

Pyrogens are those substances that cause fever. External pyrogens are ordinary microbes or their products. The best studied are lipopolysaccharides from gram-negative bacteria (commonly called endotoxins) and the Staphylococcus aureus toxin that causes toxic shock. External pyrogens usually cause fever by producing the release of endogenous pyrogens, which raise the hypothalamic point. Prostaglandin E 2 synthesis plays a critical role.

Consequences of fever. Although many patients worry that the fever itself can be harmful, the mild increases in temperature caused by most acute illnesses are well tolerated by healthy adults. However, excessive temperature rise (usually >41°C) can be dangerous. This increase is more typical of severe environmental hyperthermia, but sometimes results from exposure to illicit drugs (eg, cocaine, phencyclidine), anesthetics, or antipsychotics. At this temperature, protein denaturation occurs and inflammatory cytokines are released, which activate the inflammatory cascade. The result is cellular dysfunction, leading to malfunction and ultimately failure of most organs; the coagulation cascade is also activated, leading to disseminated intravascular coagulation.

Because fever can increase, with the basal metabolic rate at temperatures above 37°C increasing by approximately 10-12% for every 1°C, fever can produce physiological stress in adults with pre-existing cardiac or pulmonary insufficiency. Fever may also worsen mental status in patients with dementia.

Fever in healthy children can cause febrile seizures.

Causes of fever

Many disorders can cause fever. Broadly speaking, they are classified as:

• infectious (most common);
• neoplastic;
• inflammatory (including rheumatic, non-rheumatic and drug-related).

The cause is acute (i.e., with a duration<4 дней) лихорадки у взрослых чаще всего инфекционная. Когда у пациентов появляется лихорадка из-за неинфекционной причины, лихорадка является почти всегда хронической или рецидивирующей. Кроме того, изолированная острая лихорадка у пациентов с установленными воспалительным или неопластическим процессами с большой вероятностью является инфекционной. У здоровых людей острая лихорадка вряд ли будет первоначальным проявлением хронического заболевания.

Infectious causes. Virtually all infectious diseases can cause fever. But in general, the most likely reasons are:

• upper and lower respiratory tract infections;
• gastrointestinal infections;
• urinary tract infections;
• skin infections.

Most acute respiratory and gastrointestinal infections are viral.

Certain patient and environmental factors also determine which causes are most likely.

Patient factors include health status, age, occupation, and risk factors (eg, hospitalization, recent invasive procedures, presence of intravenous or urinary catheters, use of mechanical ventilation).

External factors are those that place patients at high risk of contracting certain diseases - for example, through infectious contacts, local outbreaks, disease vectors (eg, mosquitoes, ticks), shared objects, food, water, or geographic location (eg, living in endemic area or recent travel there).

Some reasons based on these factors are predominant.

Two main questions are important in the initial assessment of acute fever:

• Identify any local symptoms (eg headache, cough). These signs help narrow down the range of possible causes. The localizing sign may be part of the patient's chief complaint or be identified only by specific issues.
• Determining whether the patient is seriously or chronically ill (especially if such an illness has not been identified). Many causes of fever in healthy people are self-limiting, and many (for viral infections) are difficult to diagnose accurately. Limiting tests to the severely or chronically ill may help avoid many expensive, unnecessary and often fruitless searches.

Story. The history of present illness should include the level and duration of fever and the method used to measure the temperature. Severe, shaking, teeth-chattering chills (not just a feeling of cold) suggest fever due to infection. Pain is an important clue to the possible cause of the disease; The patient should be asked about pain in the ears, head, neck, teeth, throat, chest, abdomen, side, rectum, muscles and joints.

Other local symptoms include nasal congestion and/or discharge, cough, diarrhea, and urinary symptoms (urinary frequency, incontinence, dysuria). The presence of the rash (including its nature, location, and timing of the rash's onset in relation to other features) and enlarged lymph nodes may aid in diagnosis. The patient's contacts must be identified.

Review of systems should exclude symptoms of chronic illness, including recurrent fevers, night sweats, and weight loss.

Previous medical history should include the following:

• recent surgeries;
• known medical conditions that predispose to infection (eg, HIV infection, diabetes, cancer, organ transplantation, sickle cell anemia, heart valve disease - especially if there is a prosthetic valve);
• other known disorders that predispose to fever (eg, rheumatologic disorders, systemic lupus erythematosus, gout, sarcoidosis, hyperthyroidism, cancer).

Questions to ask about recent travel include inquiring about travel location, time since return, specific location (e.g., off-the-beaten-path, urban only), pre-travel vaccinations, and use of malaria preventive medications (if required) .

All patients should be asked about the possibility of exposure (eg, through suspicious food or water, insect bites, contact with animals, or unprotected sex).

Vaccination history, especially against hepatitis A and B and against organisms that cause meningitis, influenza, or pneumococcal disease, should also be reviewed.

The drug use history should include specific questions about the following:

• drugs known to cause fever;
• drugs that predispose to an increased risk of infection (eg, corticosteroids, anti-TNF drugs, chemotherapy and anti-rejection (eg, transplant) drugs, other immunosuppressants);
• illegal use of injectable drugs (predisposing to endocarditis, hepatitis, septic pulmonary embolism and skin and soft tissue infections).

Physical examination. The physical examination begins with confirmation of fever. Fever is most accurately diagnosed by measuring rectal temperature.

Oral temperature is usually about 0.6°C lower and can be even lower for many reasons, such as recent ingestion of a cold drink, mouth breathing, hyperventilation, and inappropriate measurement time (mercury thermometers require up to several minutes) . Measuring tympanic membrane temperature with an infrared sensor is less accurate than rectal temperature. Monitoring skin temperature using temperature-sensitive crystals fused into plastic strips placed on the forehead is not productive for detecting increases in core temperature.

Other vital signs are assessed if tachypnea, tachycardia, or hypotension is present.

For patients with local symptoms, examination continues as described in this Guide. For patients with fever without local symptoms, a complete examination is necessary because clues to diagnosis may lie in any organ system.

The patient's general appearance should be taken into account, including any weakness, lethargy, confusion, cachexia, and depression.

The entire skin should be inspected for rash, especially petechial or hemorrhagic rash and any lesions or areas of erythema or blisters that suggest skin or soft tissue infection. The axillae and areas of the internal epicondyle of the humerus and groin should be examined for adenopathy. In hospitalized patients, the presence of any intravenous, internal (NGT), urinary catheters, and any other tubes inserted into the body should be noted. If the patient has recently had surgery, the surgical sites should be carefully examined.

When examining the head and neck, you need to pay attention to the following:

• eardrums: inspection for infection;
• sinuses (frontal and maxillary): percussion;
• temporal arteries: palpation for tenderness;
• nose: examination for congestion and discharge (clean or with pus);
• eyes: examination for conjunctivitis or jaundice;
• fundus: examination for Roth spots (suggesting infective endocarditis);
• Oropharynx and gums: inspect for inflammation or ulceration (including any candidiasis that suggests decreased immunity);
• neck: tilt to detect discomfort, stiffness, or both, indicating meningism, and palpate for adenopathy.

The lungs are examined for abnormal sounds or signs of consolidation, and the heart is listened for murmurs (suggesting possible endocarditis).

The abdomen is palpated for hepatosplenomegaly and tenderness (suggesting infection).

Percussion is performed along the lateral surfaces to identify pain in the kidney area (which suggests pyelonephritis). A pelvic examination is performed in women to check for cervical pathology or adnexal tenderness; A genital examination is performed on men to check for urination and local tenderness.

The rectum is inspected for tenderness and swelling, suggesting a perirectal abscess (which may be occult in immunocompromised patients).

All major joints are examined for swelling, erythema, and tenderness (suggesting joint infection or rheumatologic disorder). The hands and feet are examined for signs of endocarditis, including hemorrhages from splinters under the nails, painful erythematous subcutaneous nodules on the tips of the fingers (Osler's nodes), and nontender hemorrhagic spots on the soles of the feet (Janeway lesions).

Danger signals. The following phenomena should be given special attention:

• change in mental state,
• headache, neck stiffness, or both,
• petechial rash,
• hypotension,
• dyspnea,
• significant tachycardia or tachypnea,
• temperature >40 °C or<35 °С,
• recent travel to an area where malaria is endemic,
• recent use of immunosuppressants.

Interpretation of results. The degree of fever is usually not related to the cause of the infection. The fever pattern, once thought to be significant, is not.

The likelihood of severe illness is considered. If severe illness is suspected, immediate and rapid testing and often hospitalization are necessary.

Danger signals strongly suggest severe impairment. Headache, neck stiffness, and a petechial, or purpuric, rash suggest meningitis. Tachycardia (below the normal increase usually seen with fever) and tachypnea, with or without hypotension or changes in mental status, suggest sepsis. Malaria should be suspected in patients who have recently been to an endemic area.

Decreased immunity, whether due to a known cause, the use of immunosuppressive drugs, or suspected by physical examination (eg, weight loss, oral candidiasis), is also a concern, as are other known chronic diseases, intravenous drug use, and heart murmurs.

The elderly, especially those living in nursing homes, are at particular risk.

Local findings identified by history or physical examination are assessed and interpreted. Other suggestive symptoms are generalized adenopathy and rash.

Generalized adenopathy may occur in older children and young adults with acute mononucleosis; usually accompanied by significant pharyngitis, malaise, and hepatosplenomegaly. Primary HIV infection or secondary syphilis should be suspected in patients with generalized adenopathy, sometimes accompanied by arthralgias, rash, or both. HIV infection develops 2–6 weeks after infection (although patients may not always report unprotected sex or other risk factors). Secondary syphilis is usually preceded by chancroid with systemic symptoms developing 4-10 weeks later.

Fever and rash have many reasons to be related to infection or drug use. Petechial, or purpuric, rashes should be given special attention; it suggests possible meningococcemia, Rocky Mountain spotted fever (especially if the palms or soles of the feet are affected), and, less commonly, certain viral infections (eg, dengue fever, hemorrhagic fevers). Other suggestive skin lesions include the classic erythema migrans of Lyme disease, lesions of Stevens-Johnson syndrome, and painful erythema of cellulitis and other bacterial soft tissue infections. The possibility of delayed hypersensitivity to the drug (even after long periods of use) should be taken into account.

If there are no localized findings, healthy individuals with an acute fever and only nonspecific symptoms (eg, malaise, generalized pain) are likely to have a self-limited viral illness unless there is a history of exposure (including new, unprotected sexual contact) to a vector. illness or exposure to an endemic area (including recent travel).

Drug-related fever (with or without rash) is a diagnosis of exclusion and often requires a decision to discontinue the drug. The difficulty is that if antibiotics are the cause, then the disease being treated may also cause the fever. Sometimes the clue is that fever and rash begin after clinical improvement in the infection and without worsening or reappearance of underlying symptoms (eg, a patient being treated for pneumonia reappears with fever without cough, shortness of breath, or hypoxia).

Carrying out analyzes. The analysis depends on whether there are local phenomena.

If there are local phenomena, tests are carried out in accordance with clinical hypotheses and symptoms. This applies to the following situations:

• mononucleosis or HIV infection - serological analysis;
• Rocky Mountain spotted fever - biopsy of skin lesions to confirm the diagnosis (serological analysis in the acute period is useless);
• bacterial or fungal infection - blood cultures to diagnose possible bloodstream infections;
• meningitis - immediate lumbar puncture and IV dexamethasone and antibiotics (CT scan of the head should be done before lumbar puncture if patients are at risk for cerebral herniation syndrome; IV dexamethasone and antibiotics should be given immediately after blood cultures are taken for culture and before CT head tomography);
• specific tests are based on evidence of possible exposure (eg contacts, vectors or exposure to endemic areas): testing for these diseases, especially peripheral blood smear for malaria.

If there are no local findings in otherwise healthy patients and severe disease is not suspected, patients can usually be observed at home without testing. For most, symptoms disappear quickly; and the few who develop bothersome or localized symptoms should be re-examined and tested based on new findings.

If a patient is suspected of having a severe illness, but there are no local phenomena, tests are necessary. Patients with danger signs suggestive of sepsis require culture (urine and blood), chest x-ray, and evaluation of metabolic abnormalities with measurement of serum electrolytes, glucose, BUN, creatinine, lactate, and liver enzymes. Typically, a complete blood count is done, but the sensitivity and specificity for diagnosing a severe bacterial infection is low. However, the white blood cell count is prognostically important in immunocompromised patients (a low count may be associated with a poor prognosis).

Patients with significant abnormalities may need testing even if they do not have any local findings and do not appear severely ill. Because of the risk and devastating effects of endocarditis, intravenous drug users typically are admitted to the hospital for serial blood cultures and often echocardiography when febrile. Patients taking immunosuppressants require a complete blood count; if neutropenia is present, begin testing and obtain a chest x-ray, as well as cultures of blood, sputum, urine, stool, and any suspicious discharge from skin lesions.

Elderly patients with fever often require testing.

Treatment of fever

In certain cases, anti-infective therapy is prescribed; Empiric anti-infective therapy is required if severe infection is suspected.

Whether fever due to infection should be treated with antipyretics is controversial. Experimental evidence, but not clinical studies, suggests that fever increases host defenses.

Fever may need to be treated in certain patients at particular risk, including adults with heart or lung failure or dementia. Drugs that inhibit brain oxygenase are effective in reducing fever:

• acetaminophen 650-1000 mg orally every 6 hours;
• ibuprofen 400-600 mg orally every 6 hours

The daily dose of acetaminophen should not exceed 4 g to avoid toxicity; Patients should be asked not to concomitantly take non-prescription cold and flu products that contain acetaminophen. Other nonsteroidal anti-inflammatory drugs (eg, aspirin, naproxen) are also effective antipyretics. Salicylates should not be used to treat fever in children with viral illnesses because such use has been associated with Reye's syndrome.

If temperature >41°C, other body cooling measures (eg, cool water evaporative cooling, cooling blankets) should also be used.

Basics of Geriatrics

In frail older adults, the infection is less likely to cause a fever, and even if the infection raises the temperature, it may be lower than a normal fever. Likewise, other signs of inflammation, such as focal pain, may be less obvious. Often, a change in mental status or a decrease in daily functioning may be the only initial manifestations of pneumonia or a urinary tract infection.

Despite less severe illness, older people with fever are significantly more likely to develop severe bacterial illness compared with younger people. In younger adults, the cause is usually a respiratory or urinary tract infection, while in older adults, skin and soft tissue infections are among the main causes.

Focal phenomena are assessed as in younger patients. But unlike younger patients, older patients will likely require urinalysis, urine culture, and x-rays. Blood cultures should be done to rule out sepsis; if septicemia is suspected or vital signs are abnormal, patients should be hospitalized.

Reasons for rising temperature

Symptoms of fever

Sometimes an increase in body temperature may be accompanied by other symptoms associated with exacerbation of chronic diseases.

You should call a doctor if children under 3 months of age have a fever above 37.5°C or if the temperature has been elevated for more than 24 hours.

In children aged 6 months to 6 years, high fevers are sometimes observed. If your child has these seizures, make sure he doesn't get hurt, remove any dangerous objects from his area, and make sure he's breathing freely.

If in children an elevated temperature is accompanied by convulsions, stiff neck, rash, if they are noted at an elevated temperature, then you should immediately seek medical help.

If the temperature is accompanied by swelling and pain in the joints; as well as a rash, especially dark red or in the form of large blisters, you should immediately consult a doctor. If you experience any of the following symptoms: cough with yellowish or greenish mucus, severe headache, ear pain, confusion, severe irritability, dry mouth, abdominal pain, rash, extreme thirst, severe, painful urination and vomiting, you should also call a doctor . If a pregnant woman has a fever, she should also consult a doctor.

What can you do

Try to rest, it is best to stay in bed, do not wrap yourself up or dress too warmly, drink more fluids. Be sure to eat, but it is better to eat light and easily digestible food. Take your temperature every 4-6 hours. Take a fever-reducing medicine if you have a headache or a temperature above 38°C.

If a child has a temperature above 38°C, use paracetamol (special children's forms). Follow the instructions and calculate the required dose depending on the weight and age of the child. Do not give children (aspirin) because... It has been found that it can lead to Reye's syndrome (hepatocerebral syndrome), a serious condition that can lead to coma and even death.

What can a doctor do?

The doctor must determine the cause of the elevated body temperature and prescribe appropriate therapy. If necessary, order an additional examination, and if a serious illness is suspected, refer for hospitalization.

Most healthy people usually have a body temperature of around 37°C, and to be more precise, the ideal body temperature is considered to be 36.6°C, and it remains at the same level day after day until microbes disturb this stable pattern. . Microorganisms, be careful! The body's defense system begins to increase body temperature in an attempt to restore order and destroy pathogens.

Temperature rise is important

In the center of the brain is the hypothalamus, which acts like a thermostat on the body. Therefore, when the hypothalamus receives a message that germs have illegally entered the territory it controls, it begins to set the body's core temperature higher than normal. Heat helps fight bacteria, making the body less suitable for their existence. With a cold, some viruses do not multiply at elevated body temperatures, so even a slight increase in temperature can really help get rid of the virus faster.

A fever indicates that the body has entered fight mode to rid itself of a virus or infection. Almost any infection can cause a fever - chickenpox, sore throat, flu and even the common cold - all of them often cause an increase in body temperature.

Sometimes fever appears along with other symptoms such as chills, loss of appetite, a general feeling of fatigue or weakness, headache, since a simple increase in body temperature is not enough to quickly cope with germs.

Is it worth fighting a fever?

There are several ways to measure body temperature, including holding a thermometer under your armpit, in your mouth, in your ear, and in your rectum. The rectal method is the most accurate, but it is too messy, although children get the most benefit from this method. Measuring the temperature in the mouth is another fairly accurate way to measure temperature,

and measurements under the armpit and in the ear provide the least accurate readings. One more thing - leave those mercury thermometers for the medical museums and make your life a little easier.

We take glasses and check the numbers on the screen: with a fever, the temperature is usually two to three, and sometimes four degrees higher than normal body temperature. In general, fevers below 38.9°C cannot be treated, even with over-the-counter medications. Medicines such as ibuprofen and acetaminophen can help relieve symptoms that accompany a fever, but do not treat the underlying condition. And since the drug blocks the signals sent by the hypothalamus, the microbes survive and the disease will last longer.

If the fever is higher than 38.9°C or lasts longer than three days, medical attention may be required. Children, pregnant women and people with weakened immune systems are most at risk from fever, so it is important for them to take action early on.

For everyone else, it's worth knowing that when your body gets hot, it's easy to become dehydrated, so you should drink more fluids to prevent this. Here's the good news: Once the cause of the fever goes away, the hypothalamus restores order, returning your body temperature to normal.

An increase in body temperature above normal values ​​is called fever. Normal body temperature in the armpit ranges from 36,0-36,9 degrees, and in the morning it can be a third or half a degree lower than in the evening. In the rectum and oral cavity, the temperature is usually half a degree or a degree higher than in the armpit, but no more 37,5 degrees.

Fever may occur for different reasons. The most common causes of its appearance are infectious diseases. Microorganisms, their waste products and toxins affect the thermoregulatory center located in the brain, resulting in an increase in body temperature.

There are several types of fever. So, According to the degree of temperature increase, fever is:
subfebrile – not exceeding 37,5 degrees,
febrile.

When diagnosing daily temperature fluctuations are taken into account. But today the situation is such that the picture of diseases is often erased due to the use of antipyretic drugs, and in some cases, the independent use of antibiotics. Therefore, the doctor has to use other diagnostic criteria.

Manifestations of fever are known to everyone: headache, muscle aches, weakness, pain in the eyes, chills. Chills are nothing more than a physiological way to increase body temperature. During muscle contractions, heat production increases, resulting in an increase in body temperature.

For infectious diseases It is not by chance that body temperature rises. The physiological significance of fever is very great. Firstly, most bacteria at high temperatures lose their ability to reproduce or die altogether. In addition, with an increase in temperature in the body, the activity of defense mechanisms designed to fight infection increases. Therefore, if the fever is benign and there are no other symptoms, treatment with medication is not necessary. Drinking plenty of fluids and rest is sufficient.

However, fever can also have negative consequences. In addition to causing discomfort to a person, it also causes increased fluid loss and excessive energy expenditure. This can be dangerous for patients with heart and vascular diseases, as well as other chronic diseases. Fever is extremely dangerous for children who have an increased tendency to seizures.

When to lower the temperature?

In what cases is it necessary to reduce the temperature:
body temperature exceeds 38,5 degrees,
sleep is disturbed
severe discomfort appears.

How to reduce temperature?

Recommendations for reducing temperature:
You are allowed to take a warm (not cold!) bath
the room must be regularly ventilated, it should not be hot,
you need to drink as much warm liquid as possible,
in order to avoid increased chills, it is forbidden to rub the patient with alcohol,
medications to reduce fever: ibuprofen, paracetamol,
if chills appear, the patient should not be wrapped up,
always consider the dosage of the drug - be sure to read the instructions on the packaging,
aspirin Only permitted for use by adults; give to children without special doctor's recommendation aspirin prohibited
special attention should be paid to drinking alcohol: if the body temperature rises, drinking alcohol is allowed, however, provided that the patient is in bed,
After drinking alcohol, any hypothermia is very dangerous, since with a subjective feeling of warming, heat transfer increases significantly.

Helping a child with a fever

As a rule, in the first day or two of an acute viral infection, the temperature rises approximately three to four times a day, on the third or fourth day - twice a day. The duration of the general febrile period in most cases is two to three days, but with some types of viral infections, such as entero- and adenoviral fevers, influenza, the “norm” can reach up to a week. In any case a child with a fever requires medical attention.

When fighting a fever, medication and physical methods are used to combat fever.

If the child’s fever is severe (the body and limbs are dry, hot), the following physical methods of fighting the fever are used:
wiping with vinegar solution ( 9 percent (strictly!) vinegar is diluted with water in a ratio of 1:1). When rubbing, do not touch the nipples, face, pimples, genitals, diaper rash, or wounds. Rubbing can be done repeatedly until the temperature drops to 37-37,5 degrees;
vinegar wraps. If the child’s skin is not damaged or inflamed, during the procedure the nipples and genitals should be covered with napkins and a dry diaper. The diaper must be soaked in a vinegar solution (mixed with water, as when wiping) and wrap the child in it (cover his stomach, chest, legs with one edge of the diaper, raise his arms up; then press the child’s arms to the body and wrap the other edge of the diaper ). To limit the inhalation of vinegar fumes, Place a roll made from a dry diaper on the baby’s neck. If necessary, having previously measured the temperature, the wrap can be repeated later. 20-30 minutes;
apply cold to the area of ​​large vessels (armpits, groin, subclavian region), back of the head, forehead (a heating pad filled with cold water or ice, wrapped in a diaper, or wet compresses);
drink at room temperature.

If there are chills, cold feet and hands, It is forbidden to use rubdowns and cold: the child, on the contrary, needs to be additionally covered; it is allowed to use a heating pad filled with hot water and wrapped in a diaper (the water temperature is not higher than 60 degrees), apply it to the child’s feet, give a warm drink.

If the temperature rises to 38 degrees and the child feels normal, the use of antipyretics is not recommended. The child is given plenty of fluids: warm water, sour compotes, fruit drinks, strong emotions and physical activity should be limited.

The exception is cases when there is severe malaise, weakness, chills in the child, the temperature rises rapidly, especially closer to night (it needs to be measured every half hour), the presence of aches in the joints and muscles, as well as a convulsive syndrome suffered in the past. In such a situation, you can give the child antipyretic drugs from the paracetamol group ( cefekon, efferalgan, calpol, panadol and so on.). A single dose should be no more 10 mg per 1 kg of child's weight.

If the temperature rises from 38 before 38,5-38,8 degrees it is necessary to give the child antipyretics: ibuprofen (nurofen) based on 5 mg per kilogram of weight or paracetamol(or analogues) based on 10 mg/kg. Simultaneous use of a combination of single doses is allowed paracetamol And ibuprofen or a ready-made product “ibuklin for children” (if separate use is ineffective or there is a pronounced inflammatory process).

When the temperature rises to 39 degrees, the dose of antipyretic drugs should be as follows: paracetamol - 15 mg/kg, ibuprofen – 10 mg/kg (permissible single dosage 15 mg/kg). Allowed to enter analgin: 0.1 percent solution based on 0,15 ml/kg plus papaverine (or [i]no-spa) 2 percent - 0.1 ml/kg plus tavegil (suprastin) 1 percent - 0.1 ml/kg as an injection or as an enema (with the addition of a small amount of warm water).

In addition, you can give your child Nise for Children ( nimesulide) based on 5 mg/kg per day, divided into two or three doses - the antipyretic and anti-inflammatory effects of this drug are higher than those of ibuprofen or paracetamol, however, it is also more toxic.

To reduce and remove toxic products from the body, which are formed during high and prolonged fever, the child is additionally given "enterodesis" (1 bag for 100 ml of water two to three times a day).

When is an ambulance needed?

In which cases should you consult a doctor immediately:
if the fever lasts longer 48-72 hours for a teenager or adult (longer for a child under two years of age) 24-48 hours),
if the temperature is higher 40 degrees,
if there are disturbances of consciousness: hallucinations, delusions, agitation,
if there are convulsive seizures, severe headache, breathing problems.