2. BODY TEMPERATURE
 Controlled by the hypothalamus
 normal range of 36.5–37.5 °C (98–100 °F)
 Varieties of normal body temperature:
 Temperature in the anus (rectum/rectal) is at or over 37.5–
38.3 °C (100–101 °F)
 Temperature in the mouth (oral) is at or over 37.7 °C
(99.9 °F)
 Temperature under the arm (axillary) or in the ear (otic) is
at or over 37.2 °C (99.0 °F)

3. Normal body temperatures vary
depending on many factors:
 Age
 Sex
 Ambient temperature
 Activity level
 Time of day
 Low levels occur at 6 am: 37.2˚C (98.9˚F)
 Higher levels at 4-6 pm: 37.7˚C (99.9˚F)

4. Definition:
 An elevation of body temperature above normal range
due to an increase in the body temperature regulatory
set-point. The increase in set-point is triggers increased
muscle tone and shivering.
 A fever is one of the body's immune responses that
attempts to neutralize a bacterial or viral infection.
 Can be caused by many different conditions ranging from
benign to potentially serious.

5. Types:
 Continuous fever: Temperature remains above normal
throughout the day and does not fluctuate more than 1 °C in
24 hours.
 Lobar pneumonia, typhoid, urinary tract infection, brucellosis,
or typhus. Typhoid fever may show a specific fever pattern, with
a slow stepwise increase and a high plateau. (Drops due to fever-
reducing drugs are excluded.)
 Intermittent fever: Elevated temperature is present only for
some hours of the day and becomes normal for remaining
hours.
 Malaria, pyaemia, or septicemia. In malaria, there may be a fever
with a periodicity of 24 hours (quotidian), 48 hours (tertian
fever), or 72 hours (quartan fever, indicating Plasmodium
malariae). These patterns may be less clear in travelers.

6.  Remittant fever: Temperature remains above normal
throughout the day and fluctuates more than 1 °C in 24
hours.
 Infective endocarditis.
 Pel-Ebstein fever: A specific kind of fever associated
with Hodgkin's lymphoma, being high for one week and
low for the next week and so on. However, there is some
debate as to whether this pattern truly exists.

7. Hyperpyrexia
 Fever with an extreme elevation of body
temperature greater than or equal to 41.5 °C (106.7 °F).
 Such a high temperature is considered a medical
emergency as it may indicate a serious underlying
condition or lead to significant side effects.
 Intracranial hemorrhage (most common cause)
 Sepsis, Kawasaki syndrome, neuroleptic malignant
syndrome, drug effects, serotonin syndrome, and thyroid
storm.

8. Hyperthermia
 High temperature that is not a fever.
 Occurs from a number of causes:
 Heatstroke
 neuroleptic malignant syndrome
 malignant hyperthermia
 stimulants:
 amphetamines
 cocaine
 idiosyncratic drug reactions
 serotonin syndrome.

9. Signs and symptoms
 Fever is usually accompanied by sickness behavior.
 Lethargy
 Depression
 Anorexia
 Sleepiness
 Hyperalgesia
 Inability to concentrate.

10. Exogenous pyrogens
(infectious agents,
toxins,
tumors)
+
Monocytes,
macrophages,
endothelial
cells, other immune
cells
+ Heat production Heat conservation
Antipyretics
(involuntary muscle (vasoconstriction,
contractions) behavior changes)
PGE 2 (-)
NSAIDs
(+) Anterior Elevated Thermoregulatory set-point
Hypothalamus

11. Management:
 Use of a fan or air conditioning may somewhat reduce the
temperature and increase comfort.
 Sponging or bathing feverish children with tepid water.
 Adequately hydration
 ice pops
 juice
 non-alcoholic drinks.

12. Medications:
 Antipyretic ibuprofen is effective in reducing fevers in
children.
 Acetaminophen (paracetamol)