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Acute fever

The overall mean oral temperature for healthy adult individuals is 36.8 ± 0.4ºC, with a nadir at 6 AM and a peak at 4-6 PM. A morning temperature of greater than 37.2ºC and an evening temperature of greater than 37.7ºC is often considered as fever. Fever may be continuous, intermittent or remittent. However, with frequent self-medication with antipyretics, classic patterns are not generally seen. Diagnosis

It is important to work towards finding the cause of fever. A meticulous history of chronology of symptoms, any associated focal symptom(s), exposure to infectious agents and occupational history may be useful. A thorough physical examination repeated on a regular basis may provide potentially diagnostic clues such as rash, lymphadenopathy, hepatomegaly, splenomegaly, abdominal tenderness, altered sensorium, neck stiffness, lung crepts, etc. Drug fever should be considered when the cause of fever is elusive. Diagnostic tests

A large range of diagnoses may possibly be the cause of fever. If the history and physical examination suggest that it is likely to be more than a simple URI or viral fever, investigations are indicated. The extent and focus of diagnostic work-up will depend upon the extent and pace of illness, diagnostic possibilities and the immune status of the host. If there are no clinical clues, the work-up should include a complete haemogram with ESR, smear for malarial parasite, blood culture, Widal test, urine analysis including urine culture. If the febrile illness is prolonged beyond 2 weeks, an X-ray chest is indicated even in the absence of respiratory symptoms. Any abnormal fluid collection should be sampled. Ultrasonography is needed in some cases of acute fever such as in amoebic liver abscess. Treatment

Routine use of antipyretics in low-grade fever is not justified. This may mask important clinical indications. However, in acute febrile illnesses suggestive of viral or bacterial cause, fever should be symptomatically treated. Nonpharmacological

Hydrotherapy with tepid water, rest and plenty of oral fluids. Pharmacological


Tab. Paracetamol 500-1000 mg (max 4 g in 24 hours) 6-8 hourly.

(Caution: Reduce dose in frail elderly, adults weighing <50 kg and those at risk of



Tab. Ibuprofen 400-600 mg 8 hourly.

Specific. Antibiotics/antimalarials depending upon the cause suggested by clinical and laboratory evaluation. Outcome

In most cases of fever, patient may either recover spontaneously or a diagnosis is reached after repeated clinical evaluation and investigations. If no diagnosis is reached in up to 3 weeks, patient is said to be having fever of unknown origin (FUO) and should be managed accordingly. Patient education

Self-medication and over-medication should be avoided.

Avoid injectable paracetamol/NSAIDs.

Antibiotics should be taken only on advice of a physician. Avoid covering the patient having high fever with blanket, etc.

Plenty of fluids should be taken. Stay in cool environment. Washing/sponging of face and limbs should be done repeatedly.



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