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Acute fever
From WikEM
Contents
Background
Definition
- Defined as temperature ≥38°C (100.4°F).
- Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.[1]
Clinical Features
Differential Diagnosis
Fever
Infectious
- Critical
- Sepsis
- PNA with respiratory failure
- Peritonitis
- Meningitis
- Cavernous Sinus Thrombosis
- Necrotizing Fasciitis
- Emergent
- PNA
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Epiglottitis
- Endocarditis
- Pericarditis
- Appendicitis
- Cholecystitis
- Diverticulitis
- Intra-abdominal abscess
- Pyelonephritis
- Tubo-ovarian abscess
- Encephalitis
- Brain abscess
- Cellulitis
- Abscess
- Malaria
- Non-emergent
Non-infectious
- Critical
- Emergent
- CHF
- Dehydration
- Recent Seizure
- Sickle Cell Dz
- Transplant rejection
- Pancreatitis
- DVT
- Serotonin Syndrome
- Non-emergent
- Drug fever (except as in NMS, Serotonin Syndrome)
- Malignancy
- Gout
- Sarcoidosis
- Crohn's Disease
- Postmyocardiotomy sy
DDx by Heart Rate
Every 0.55°C increase in temperature should → increase HR by ~10BPM
- If patient has relative bradycardia, consider:
- Concomitant medication
- Drug fever
- Typhoid Fever
- Brucellosis
- Leptospirosis
- If patient has frank bradycardia, consider:
- Rheumatic Fever
- Lyme Disease
- Viral Myocarditis
- Endocarditis
Evaluation
See individual notes for specific workup:
- Fever and Rash
- Fever of Unknown Origin
- Neutropenic Fever
- AIDS Fever of Unknown Origin
- Heat Emergencies
- Fever in Traveler
Management
- Consider tylenol or ibuprophen for fever relief
- Treat the underlying condition
Disposition
- Depends on underlying etiology
See Also
- Pediatric fever of uncertain source
- Fever and rash
- Fever of unknown origin
- Neutropenic fever
- AIDS fever of unknown origin
- Environmental heat diagnoses
- Fever in traveler
References
- ↑ Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.
