Belgorod National Research University

Medical Institute
Faculty of General Medicine and Paediatrics
Department of Intermediate Surgery

Department of Head: Phd, MD,

associate professor Kovalenko BS
Chief Practice: Phd, MD,
associate professor Volkov DV

Project on Fever
Tanya Garg
Student of 1st year
Group number: 03011420

Body Temperature Regulation

The temperature within the deep tissues of the body (core

temperature) is normally maintained within a range of 36.0C to
37.5C.
Within this range, there are individual differences and diurnal
variations:
Internal core temperatures reach their highest point in late
afternoon and evening and their lowest point in the early morning
hours.
Body temperature reflects the difference between heat production
and heat loss.
Body heat is generated in the tissues of the body, transferred to
the skin surface by the blood, and then released into the
environment surrounding the body.

Body Temperature Regulation

The thermoregulatory center is in the hypothalamus and functions to

modify heat production and heat losses as a means of regulating
body temperature.
The thermoregulatory center in the hypothalamus regulates the
core body temperature, not the surface temperature.
This center integrates input from cold and warm thermal receptors
located throughout the body and generates output responses that
conserve body heat or increase its dissipation = thermostatic set
point.
When body temperature begins to rise above the normal range,
heat-dissipating behaviors are initiated;
When the temperature falls below the normal range, heat
production is increased;
A core temperature greater than 41C or less than 34C usually
indicates that the bodys ability to thermoregulate is impaired.

Fever

Fever, or pyrexia, describes an elevation in body temperature that

is caused by a cytokine-induced upward displacement of the set
point of the hypothalamic thermoregulatory center.
Fevers that are regulated by the hypothalamus usually do not rise
above 41C - safety mechanism.
Fever can be caused by a number of microorganisms and
substances that are collectively called pyrogens (many proteins,
breakdown products of proteins, lipopolysaccharide toxins released
from bacterial cell membranes, etc.).
Some pyrogens can act directly and immediately on the
hypothalamic thermoregulatory center to increase its set point.
Other pyrogens, sometimes called exogenous pyrogens, act
indirectly and may require several hours to produce their effect.

Causes of fever

Central type fever= neurogenic fever

Non central type fever:
Infectious disorders
Noninfectious disorders:
Myocardial infarction
Pulmonary emboli
Neoplasms (e.g. malignant cells in leukemia, Hodgkins
disease produce pyrogens)
Trauma
Surgery

Neurogenic fever

It usually is caused by damage to the hypothalamus caused by:

central nervous system trauma;
intracerebral bleeding;
an increase in intracranial pressure
drugs (e.g. anesthetics)
Neurogenic fevers are characterized by a high temperature that is
resistant to antipyretic therapy and is not associated with
sweating.

The effects of fever

It enhance immune function;

Increases motility and activity of the white blood cells;
Stimulates the interferon production and activation of T cells;
Inhibits growth of some microbial agents:
Many of the microbial agents that cause infection grow best at
normal body temperatures, and their growth is inhibited by
temperatures in the fever range (the rhinoviruses responsible for
the common cold are cultured best at 33C);
Dehydration occurs because of sweating.
May cause a febrile seizure, in children between the ages of 6
months and 5 years.

The effects of fever

Metabolic effects:
Increased need for oxygen;
Increases the heart rate
Increases the respiration rate
Increased use of body proteins as an energy source;
During fever the body switches from using glucose (an excellent
medium for bacterial growth) to metabolism based on protein and
fat breakdown;
With prolonged fever, there is increased breakdown of
endogenous fat stores;
If fat breakdown is rapid, metabolic acidosis may result.

Types of Temperature Curves

Types of Temperature Curves

1. Febris continua - permanent fever. Fluctuate between morning and evening
temperature do not exceed 1 . Such temperature curve is observed on the first
period of abdominal typhus, crupose pneumonia.
2. Febris remittens - indulgence fever. Fluctuate between morning and evening
temperature exceeds 1-2 . Such type of curve observes due to viral infections,
sepsis, in second half of abdominal typhus.
3. Febris intermittens. It is alternating fever. It is characterized that by the rising
periods of temperature (paroxysmuses) right alternate with the periods of normal
temperature (apirrhexions). Temperature of the body rises to the level of 40 and
higher, holds for a few hours, goes down to the norm and rises again. This fever type
is observed in the malaria. The paroxysmuses can arise every fourth day
(febris quartana), every third day (febris tertiana) or daily (febris quotidiana).
Periodicity of the temperature rise depends on duration of development cycle of
malarial Plasmodium. Paroxysmuses coincide
in
course
of
the
time
of erythrocytes destruction (after completion of cycle).

Types of Temperature Curves

4. Febris hectica. It is exhausting fever. Daily fluctuation of it is equal 3-4 and more. Sometimes
temperature goes down below the norm. Such fever is typical for sepsis, tuberculosis, malignant tumors.
5. Febris inverse. It is inverted fever. Maximum of the temperature is observed in the morning, temperature
decreases in the evening, sometimes to normal range. It is typical for sepsis and serious types of tuberculosis.
6. Febris recurrens. It is recurrent fever. There are periods of rising temperature (5-8 days) and normal level
of temperature (nonfever periods). Example is recurrent typhus, malaria.
7. Febris undulans. It is undulating fever. There is slow increasing of bodys temperature during some term
after that there its decreasing with period of normal temperature. It is typical for brucellosis.
8. Febris irregularis. It is irregular fever (atypical). It is characterize by nonright and different daily fluctuations
of the temperature. It is typical for chronic bronchitis, chronic cholycystites, rheumatism and leucosis.

Types of fever

Intermittent
Temperature returns to normal at least once every 24 hours;
It is commonly associated with conditions such as gram - negative /
positive sepsis, abscesses, and acute bacterial endocarditis;
Remittent
Temperature does not return to normal and varies a few degrees in
either direction;
It is associated with viral upper respiratory tract, legionella, and
mycoplasma infections;
Sustained or continuous
Temperature remains above normal with minimal variations;
It is seen in persons with drug fever;
Relapsing
There is one or more episodes of fever, each as long as several
days, with one or more days of normal temperature between
episodes;
It may be caused by a variety of infectious diseases, including
tuberculosis, fungal infections, Lyme disease, and malaria.

Manifestations of fever

There are 4 successive stages - not all persons proceed through the
four stages of fever development:
1. Prodrome
nonspecific complaints, such as mild headache and fatigue,
general malaise, and fleeting aches and pains;
2. Temperature rises
generalized shaking with chills and feeling of being cold;
vasoconstriction and piloerection usually precede the onset of
shivering;
skin is pale;
when the shivering has caused the body temperature to reach
the new set point of the temperature control center, the
shivering ceases, and a sensation of warmth develops.
3. Flush
cutaneous vasodilation occurs and the skin becomes warm
and flushed;
4. Defervescence
the initiation of sweating.

Fever of unknown origin

It is defined as a temperature elevation of 38.3C or higher that is

present for 3 weeks or longer.
Among the causes are:
malignancies (lymphomas, metastases to the liver and central
nervous system);
infections
such as human immunodeficiency virus or
tuberculosis, or abscessed infections;
drug fever;
cirrhosis of the liver.

Principles of treatment

Because fever is a disease symptom, its manifestation suggests the

need for treatment of the primary cause.
Actions:
modifications of the external environment intended to increase
heat transfer from the internal to the external environment;
support of the hypermetabolic state that accompanies fever;
protection of vulnerable body organs and systems;
treatment of the infection or condition causing the fever.

Antipyretic drugs

Antipyretic drugs, such as aspirin and acetaminophen, often are

used to alleviate the discomforts of fever and protect vulnerable
organs, such as the brain, from extreme elevations in body
temperature.
These drugs act by resetting the hypothalamic temperature control
center to a lower level, presumably by blocking the activity of
cyclooxygenase, an enzyme that is required for the conversion of
arachidonic acid to prostaglandin E2.

Nursing care for patients with

fever

Monitoring body temperature: Frequent monitoring and assessment of

body temperature gives information about pattern, duration and course
of fever. The aim of measuring body temperature in clinical practice is
to estimate the deep body temperature, the core temperature.
A cool environment, exposure of the patients skin and sponge baths
were medical recommendations.
Antipyretic drugs were introduced during the late 1800s and have
since been commonly used.
ice water or cold water immersion should be avoided.
Surface cooling should always be combined with antipyretic drugs to
prevent shivering
Covering the extremities with cloth before lowering the temperature by
cooling, also prevents shivering