What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature above the normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of 99 F (37.2
C) is considered to be elevated. However, these are averages, and one's normal body temperature may actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body
temperature can also vary up to 1 F (0.6 C) throughout the day.
Fever is not considered medically significant until body temperature is above 100.4 F (38 C). Anything above normal but below 100.4 F (38 C) is considered a low-grade fever. Fever
serves as one of the body's natural defenses against bacteria and viruses which cannot live at a higher temperature. For that reason, low fevers should normally go untreated, unless
accompanied by troubling symptoms.
Also, the body's defense mechanisms seem to work more efficiently at a higher temperature. Fever is just one part of an illness, many times no more important than the presence of other
symptoms such as cough, sore throat,fatigue, joint pains or aches, chills, nausea, etc.
Fevers of 104 F (40 C) or higher demand immediate home treatment and subsequent medical attention, as they can result in delirium andconvulsions, particularly in infants and children.
Fever should not be confused with hyperthermia, which is a defect in your body's response to heat (thermoregulation), which can also raise the body temperature. This is usually caused
by external sources such as being in a hot environment.
What is the treatment for a fever?
Generally, if the fever does not cause discomfort, the fever itself need not be treated. It is not necessary to awaken an adult or child to treat a fever unless instructed to do so by your
health-care practitioner.
The following fever-reducing medications may be used at home:
Acetaminophen (Tylenol and others) can be used to lower a fever. The recommended pediatric dose can be suggested by the child's health-care provider. Adults without liver
disease or other health problems can take 1,000 mg (two "extra strength" tablets) every four to six hours or as directed by your physician.
Ibuprofen (Motrin/Advil) can also be used to break a fever in patients over 6 months of age. Discuss the best dose with your doctor. For adults, 400-600 mg (two to three 200 mg
tablets) can be used every six hours.
Aspirin should not be used for fever in children or adolescents. Aspirin use in children and adolescents during a viral illness (especiallychickenpox and influenza, or flu) has been
associated with Reye syndrome. Reye syndrome is a dangerous illness which causes prolonged vomiting, confusion, and even coma and liver failure.
An individual with a fever should be kept comfortable and not overdressed. Overdressing can cause the temperature to rise further. Tepid water (85 F [30 C]) baths are a home remedy
that may help bring down a fever. Never immerse someone in ice water. This is a common misconception. Never sponge a child or an adult with alcohol; the alcohol fumes may be
inhaled, causing many problems.
When should I seek medical care for a fever?
Any child below 3 months of age who has a temperature of 100.4 F (38 C) or greater should be seen by a physician or other health-care worker. If a child or adult has a history or
diagnosis of cancer, AIDS, or other serious illness, such as heart disease,diabetes, or is taking immunosuppressant drugs, medical care should be sought for a fever.
Otherwise, observe the person with the fever. If they appear sick or have symptoms that would suggest a major illness, such as meningitis (headache, stiff neck,confusion, problems
staying awake), urinary tract infection (shaking chills,burning with urination), pneumonia (shortness of breath, cough), or any other signs of a serious illness, contact your health-care
provider.
Other symptoms that may be indicative of a severe illness include repeated vomiting, severe diarrhea, or skin rashes (could be a sign of dengue fever,Rocky Mountain spotted
fever, scarlet fever, rheumatic fever, orchickenpox).
Fever blisters (herpangina) are small blisters that turn into ulcers, usually on the lips, mouth or tongue, that are caused by a virus. When a child contracts this virus for the first time, the
symptoms and the fever blisters can be quite severe. If the child is not eating or drinking, contact your child's health-care provider.
On the other hand, if the fever accompanies a simple cold or virus, you can treat the fever as described above and be assured that the fever is only a symptom of the illness. This is not to
say that you should ignore a fever. If there are other associated symptoms that are bothersome, you should contact your health-care professional.
Some vaccines given in childhood can cause a low-grade fever within a day or two of getting the injection. This fever is usually self-limited and short-lived. If the reaction seems severe or
the skin at the injection site is red, hot, and painful, contact your child's doctor.
About 3% of all children between 18 months to 3 years of age will have aseizure (convulsion) with a high fever. Of those with a history of febrile seizure, approximately one-third will have
another seizure associated with another febrile episode. Febrile seizures, while frightening to the parents, are not associated with long-term nervous-system side effects. Children used to
be prescribed phenobarbital following a febrile seizure as a preventive measure (prophylaxis). This has not been shown to be beneficial and possibly may be harmful, so it is not always
recommended.
Aches, Pain, Fever At A Glance
Although a fever could be considered any body temperature above the normal 98.6 F (37 C), medically, a person is not considered to have a significant fever until the temperature is
above 100.4 F (38.0 C).
Most fever is beneficial, causes no problems, and helps the body fight off infections. The main reason for treating a fever is to increase comfort.
Children under 3 months of age with a temperature of 100.4 F (38.0 C) or greater should be seen by a health-care provider. They may be quite ill and not show any signs or
symptoms besides a fever. Infants less than 6 weeks of age should be seen immediately by their doctor.
Acetaminophen (Tylenol and others) and ibuprofen (Advil, Motrin) can be used to treat a fever. Aspirin should not be used in children or adolescents to control fever.
A person who is taking immunosuppressant drugs or who has a history of or diagnosis of cancer, AIDS, or other serious illness, such as heart disease or diabetes, should seek
medical care if a fever develops.
NEUROPHYSIOLOGY OF THERMOREGULATION
by Dominika Dabrowski
The body keeps its core temperature constant at about 37 C by physiological adjustments controlled by the hypothalamus (Thermostat Center) where there are neurons sensitive to
changes in skin and blood temperatures. The temperature-regulating centers are found in the Preoptic Area (the anterior portion of the hypothalamus). This area receives input from
temperature receptors in the skin and mucous membranes (Peripheral Thermoreceptors) and from internal structures (Central Thermoreceptors), which include the hypothalamus itself.
The temperature sensory signals from the from the preoptic area and those form the periphery are combined in the posterior hypothalamus to control the heat producing and conserving
reactions of the body. The hypothalamic thermostat works in conjunction with other hypothalamic, autonomic and higher nervous thermoregulatory centers to keep the core temperature
constant. Some of these thermoregulatory responses are involuntary, mediated by the autonomic nervous system, some are neurohormonal and others are semi-voluntary or voluntary
behavioral responses.
RESPONSES TO COLD: Standing outside in underwear in a January snow storm drops your skin temperature quickly. This stimulates skin cold receptors (increase in their activity) and
cools the blood flowing into the skin. These signals are received by both the hypothalamic thermostat and higher cortical centers. The thermostat is also activated by the change in blood
temperature. It initiates responses that promote heat gain and inhibits centers that promote heat loss. The activation of Sympathetic Centers results in several responses including 1)
Norepinephrine release from sympathetic fibers constricts skin vessels. 2) Brown fat (found in infants and some animals) oxidation increases causing thermogenesis. 3) Piloerection,
occurs which traps air close to skin. 4) Epinephrine secretion from adrenal medulla increases thermogenesis. A Shivering Center in the hypothalamus is also activated which activates the
Brainstem Motor Centers to initiate involuntary contraction of skeletal muscles causing shivering, which generates heat. Cold also activates some compensatory behavioral responses
including huddling, voluntary physical activity (hand rubbing, pacing), sheltering next to a heat source and wearing warm clothing. Voluntary or semivoluntary behaviors in response to
cold are activated by the higher brain centers, mainly the cortex and limbic system. When the environmental temperature decreases gradually (ex. summer to fall), the hypothalamus
releases Thyrotropin Releasing Hormone which activates the anterior pituitary gland to release Thyroid Stimulating Hormone (TSH). TSH induces the thyroid gland to liberate large
amounts of thyroid hormone (T3 and T4) into the blood. Thyroid hormone increases metabolic rate, which increases the amount of body heat production. As the body gets warmer, the
hypothalamic sensors detect the warmth and diminish the heat producing and heat loss prevention responses.

RESPONSES TO HEAT: When the body is exposed to heat (sun, fire, too much clothing), body temperature rises. Skin warmth receptors and blood convey these changes to the
hypothalamic thermostat. The thermostat inhibits the adrenergic activity of the sympathetic nervous system, which control vasoconstriction and metabolic rate, thus causing cutaneous
vasodilation and reducing BMR. This causes an increase in heat loss via the skin and a decrease in heat production in the core. If the heat is sufficiently intense, the cholinergic
sympathetic fibers, which innervate sweat glands release ACh, stimulating sweat. Sweating is the most effective involuntary heat fighting response in man. Behavioral responses to heat,
such as lethargy, resting or lying down with limbs spread out, decreases heat production and increases heat loss. Wearing loose and light clothing, fanning and drinking cold drinks also
helps with heat loss.


Antipyretics
An antipyretic is a type of medication that will prevent or reduce fever by lowering body temperature from a raised state. They will not affect normal body temperature if the patient
does not have a fever. Generally, most non-steroidal anti-inflammatory drugs (NSAIDs) work by inhibiting prostaglandin synthetase within the hypothalamus.

Fever, or pyrexia, occurs when the body reaches a temperature above what is considered "average". Bear in mind, however, that this "average" temperature can vary from person
to person within certain parameters. It is generally accepted fever exists at a temperature above 37 degrees Celsius (98.6 degrees Fahrenheit) when the thermometer is placed
under the armpit, or over 37.5 degrees Celsius (99.5 degrees Fahrenheit) when measured orally or rectally.

Fever usually results from microbes such as bacteria or viruses triggering the body's defence mechanisms. This activates certain types of cells, some of which release the
substance interleukin. Prostaglandin is another chemical released by the body that plays a part in this process. Prostaglandin is induced by bacterial pyrogens and is produced in
the Central Nervous System (CNS). Interleukin affects the hypothalamus, which is the part of the brain that regulates body temperature, signalling it to raise the temperature by a
few degrees. The hypothalamus works like a thermostat while the interleukin that is released serves to raise its preset temperature.

The body has a number of techniques that it uses to achieve this change in temperature. Shivering involves physical movement that produces heat. Vasoconstriction, which
entails the constriction of blood flow beneath the skin, reduces the amount of heat lost from the body. It also causes one to feel cold in their extremities, such as the hands and
feet, prompting them to be covered up.

How is this increase in temperature part of the body's defence mechanism? The body raises the temperature in an effort to create an inhospitable environment for the microbes
that cause the infection. Fever is a symptom of illness is part of the body's attempts to rid itself of the infection and inhibit its spread. Once the infection has been dealt with, the
fever is said to have "broken" and the patient feels overheated, breaking out in a sweat as the body tries to cool down to its normal temperature. Vasodilatation of peripheral blood
vessels also occurs at this stage, increasing the blood flow once again.

Antipyretics work by getting the "thermostat" in the hypothalamus to override the interleukin-induced increase in temperature. The body will then work to lower the temperature to
the new, lower temperature and the result is a reduction in the fever. Antipyretics will also reduce prostaglandin synthesis in the hypothalamus by inhibiting the effect of
endogenous or microbial pyrogens on the heat regulating sensors of the hypothalamus. By blocking prostaglandin synthetase, antipyretics prevent a rise in prostaglandin levels in
the brain.
Analgesics
Analgesics are medications used to relieve pain without reducing the consciousness of the patient. They work by reducing the amount of pain felt and this is generally achieved by
interfering with the way the pain message is transmitted by the nerves. Analgesics will not treat the cause of the pain but they will provide temporary relief from pain symptoms.

There are three main categories of analgesics. The first is the opioid analgesics which are prescription only medicines that are very potent, being chemically related to morphine. The
second is the non-opioid analgesics. Non-opioid analgesics work by affecting the prostaglandin system, which is the system within the body responsible for producing pain. This
category includes non-steroidal anti-inflammatory drugs, or NSAIDs, such as Aspirin, ketoprofen and ibuprofen. The last category is adjuvant analgesics, which are medicines typically
used for purposes other than pain relief. This includes some antidepressants that may also help to relieve pain in specific circumstances.

It is the second of these three categories of analgesic that is the focus of this website. They are over-the-counter drugs that are can be safely used provided that the recommended
dosage restrictions are observed. They are non-habit forming and have an effective ceiling, at which point the patient will derive no further benefit from increasing the dosage.

Non-opioid analgesics act peripherally and not centrally like opioids that depress the central nervous system (CNS) and inhibit the brain's ability to feel pain. Non-opioid analgesics
target the chemical substances released by the brain in response to injury that facilitate the transmission of the pain stimuli to the brain. The most prevalent of these chemical
mediators is prostaglandin. Non-opioid NSAIDs are effective because they serve to block the release of prostaglandin at the peripheral nerve sites.

Prostaglandins serve a variety of regulatory functions within the body. One of these functions is to assist the transmission of pain signals to the brain so that you are readily alerted that
damage or dysfunction has occurred within the body. Other prostaglandin actions include the regulating body temperature, inflammation, the elasticity of blood vessels and the
contraction of smooth muscle tissue.

When damage occurs to the body, prostaglandins are formed from the unsaturated fatty acids released by damaged cells. Prostaglandins contain an enzyme called cyclo-oxygenase
(COX). Prostaglandin synthetase amplifies the amount of pain experienced by serving as a pain activator. They increase the sensitivity of the nerves to pain impulses. By reducing the
synthesis of prostaglandin the amount of pain stimuli sent to the brain is correspondingly reduced.

Analgesics like paracetamol and codeine mostly affect the central nervous system (CNS) while NSAIDs like ibuprofen and aspirin are more effective near the actually site of the pain,
exerting their analgesic effect in the periphery. Codeine works on the CNS as a weak opiate agonist that inhibits pain signals so that less pain is felt. Codeine achieves this by binding
with receptors at various sites in the CNS to alter the chemical process that stimulates pain signals. Paracetamol is a weak prostaglandin inhibitor that blocks prostaglandin
biosynthesis in the CNS.

NSAIDs like Aspirin, ibuprofen, diclofenac, and ketoprofen block the pain impulse at the source of the pain. They work by hindering the body's ability to biosynthesise prostaglandin by
adhering to the cyclo-oxygenase (COX) that controls the amount of prostaglandin produced by the immune system. The special nerve endings that transmit the pain message are
sensitised to prostaglandin so, by restricting its presence, the pain message is reduced. This weakens the physiological chemical process that results in the sensation of pain.

Aspirin overdose
An overdose of aspirin means you have too much aspirin in your body.
This can happen in two ways:
If a person accidentally or intentionally takes a very large dose of aspirin at one time,
it's called an acute overdose.
If a normal daily dose of aspirin builds up in the body over time and causes symptoms,
it's called a chronic overdose. This may happen if your kidneys do not work correctly or
when you are dehydrated. Chronic overdoses are usually seen in older patients during
hot weather.
Poisonous Ingredient
Acetylsalicylic acid
Where Found
Acetylsalicylic acid (aspirin) can be found in many prescription and over-the-counter
pain relievers, including:
Alka Seltzer

Anacin
Bayer
Bufferin
Ecotrin
Excedrin
Fiorinal
Percodan
St. Joseph's
Note: This list may not be all inclusive.
Symptoms
Symptoms of acute overdose may include:
Upset stomach and stomach pain
Nausea
Vomiting -- may cause an ulcer or irritation of the stomach known as
gastritis
Symptoms of chronic overdose may include:
Fatigue
Slight fever
Confusion
Collapse
Rapid heart beat
Uncontrollable rapid breathing
Large overdoses may also cause:
Ringing in the ears
Tempoary deafness
Hyperactivity
Dizziness
Drowsiness
Hyperactivity
Seizures
Coma
Before Calling Emergency
Determine the following information:
Patient's age, weight, and condition
Name of the product (ingredients and strengths, if known)
Time it was swallowed
Amount swallowed
What to Expect at the Emergency Room
The health care provider will check your temperature, pulse, breathing rate, and blood
pressure. An intravenous (IV) line will be placed into a vein. Lab tests, including
an arterial blood gas test, will be done.
Treatment depends on the amount of aspirin, the time you swallowed it, and your
overall condition when you reach the emergency room. You may receive:
Fluids
Activated charcoal to soak up aspirin in the stomach
Laxative to cause bowel movements that help remove aspirin and
charcoal from the body
Other medicines may be given through a vein, including potassium salt and sodium
bicarbonate, which helps the body remove aspirin that has already been digested.
If these treatments do not work or the overdose is extremely severe, hemodialysis may
be needed to remove aspirin from your blood.
Very rarely, a breathing machine may be needed. But many poisoning experts think
this causes more harm than good, so it is only used as a very last resort.
Outlook (Prognosis)
Taking more than 150mg/kg of aspirin can have serious and even deadly results if
untreated. For a small adult, that's roughly equal to taking 20 tablets containing 325mg
aspirin. Much lower levels can affect children.
If treatment is delayed or the overdose is large enough, symptoms will continue to get
worse. Breathing becomes extremely fast or may stop. Seizures, high fevers, or death
may occur.
How well you do depends greatly on how much aspirin your body has absorbed -- and
how much is flowing through your blood. If you take a large amount of aspirin but
come quickly to the emergency room, treatments may help keep your blood levels of
aspirin very low. If you do not get to the emergency room fast enough, the level of
aspirin in your blood can become dangerously high.
Alternative Names
Acetylsalicylic acid overdose
Acetaminophen overdose
Acetaminophen overdose is one of the most common poisonings worldwide. People
often think that acetaminophen, a pain-relieving medicine, is extremely safe. However,
it may be deadly if taken in large doses.
Where Found
Acetaminophen is found in a variety of over-the-counter and prescription pain
relievers.
Tylenol is a brand name for acetominophen. Other medicines that contain
acetominophen include:
Anacin-3
Liquiprin
Panadol
Percocet
Tempra
Various cold and flu medicines
Note: This list is not all inclusive.
Common dosage forms and strengths:
Suppository: 120 mg*, 125 mg, 325 mg, 650 mg
Chewable tablets: 80 mg
Junior tablets: 160 mg
Regular strength: 325 mg
Extra strength: 500 mg
Liquid: 160 mg/teaspoon
Drops: 100 mg/mL, 120 mg/2.5 mL
*mg = milligrams
You should not take more than 4000 mg of acetaminophen a day. Taking more,
especially 7000 mg or more, can lead to a severe overdose if not treated.
Symptoms
Abdominal pain
Appetite loss
Coma
Convulsions
Diarrhea
Irritability
Jaundice
Nausea
Sweating
Upset stomach
Vomiting
Note: Symptoms may not occur until 12 or more hours after the acetaminophen was
swallowed.
Home Care
There is no home treatment. Seek immediate medical help.
Before Calling Emergency
Determine the following information:
Patient's age, weight, and condition
Name of the product (ingredients and strengths, if known)
Time it was swallowed
Amount swallowed
What to Expect at the Emergency Room
The health care provider will measure and monitor the patient's vital signs, including
temperature, pulse, breathing rate, and blood pressure. Blood tests will be done to
check how much acetaminophen is in the blood. The patient may receive:
Medicines to treat symptoms
Activated charcoal
Laxative
Medicine (antidote) to reverse the effect of the poison
Outlook (Prognosis)
If treatment is received within 8 hours of the overdose, there is a very good chance of
recovery.
However, without rapid treatment, a very large overdose of acetaminophen can lead to
liver failure and death in a few days.
Alternative Names
Tylenol overdose; Paracetamol overdose
Ibuprofen overdose
Ibuprofen is a type of nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen
overdose occurs when someone accidentally or intentionally takes more than the
normal or recommended amount of this medication. See also:Pain medicine
Poisonous Ingredient
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) that is sold over-the-counter
and by prescription.
Where Found
Advil
Medipren
Midol
Motrin
Nuprin
Pamprin IB
PediaProfen
Rufen
Note: This list may not be all-inclusive.
Symptoms
Eyes, ears, nose, throat, and mouth
Ringing in the ears
Blurred vision
Gastrointestinal
Diarrhea
Heartburn
Nausea
Stomach pain (possible bleeding in stomach and intestines)
Vomiting
Kidneys
Little to no urine production
Lungs
Breathing - difficult
Breathing - slow
Wheezing
Nervous system
Headache
Agitation
Incoherence (not understandable)
Confusion
Coma
Drowsiness
Seizures
Dizziness
Unsteadiness
Skin
Rash
Sweating
Before Calling Emergency
Determine the following information:
Patient's age, weight, and condition
Name of the product (ingredients and strengths, if known)
Time it was swallowed
Amount swallowed
If the medication was prescribed for the patient
What to Expect at the Emergency Room
The health care provider will measure and monitor the patient's vital signs, including
temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as
appropriate. The patient may receive:
The patient may receive:
Activated charcoal
Laxative
Outlook (Prognosis)
Recovery is very likely with prompt medical treatment.
Alternative Names
Advil overdose; Nuprin overdose; PediaProfen overdose; Rufen overdose; Motrin
overdose