Examples of fever in children
To imagine the diversity and inconsistency of the problem associated with fever, it is necessary to discuss some clinical situations. They reflect the difficulty of making a decision even in cases where this decision is considered simple, automatically proved.
A 2.5-year-old boy with a history of febrile seizures entered the emergency room with a temperature of 40.3 ° C; diagnosis – otitis media. He did not receive anticonvulsants. What will you prescribe in addition to the treatment for otitis media: acetylsalicylic acid, paracetamol, wet wiping, or perhaps a combination of the first two or all three remedies? Is the effect of these agents additive, or synergistic, or neither?
A high fever has developed in a patient with meningitis in a state of septic shock. Do I need to reduce the temperature? If yes, how and to what level? Will the chances of survival increase or decrease after the body temperature is reduced to a normal level? How will this affect the recovery of brain functions?
In a one-year-old child with severe acetylsalicylic acid poisoning, the body temperature rose to 40.6 ° C. Is it possible to treat a child with paracetamol? Cold rubdowns? One and the other? Not that and not another?
A child with a rectal temperature of 42.2 ° C, which developed after being in the car in the open sun, was brought to the intensive care unit. The child is inhibited, the skin is hot and dry. What treatment is most indicated in this situation: rubbing with cool water or a bath with ice water? Can acetylsalicylic acid or paracetamol be prescribed? What else needs to be done? At your reception are 3 children aged 1 to 2 years. The first child with a temperature of 41.1 ° C, the second – 40 ° C, the third – 38.3 ° C.
Which of the first two children has a high statistical probability of developing bacteremia, the presence of a hidden severe bacterial infection? Who is more seriously ill or has bacteremia – a child with a temperature of 40 ° C or 38.3 ° C?
An athletic teenager came from the North to a southern city with a hot and humid climate. After he ran more than 8 km, his body temperature rose to 38.9 ° C. Is this a pathology? Will acetylsalicylic acid, taken before the run, help to maintain normal body temperature and well-being?
Although not all the situations described above are hazardous to health, in all these cases, the wrong decision will adversely affect the outcome. Empirical knowledge is not enough to answer these questions. They require an understanding of the mechanisms of thermoregulation, the pathophysiology of hyperthermia, and fever. They require knowledge of the causes of fever and other types of fever, the importance of fever, an understanding of the biological effect of fever and hyperpyrexia.
Although much remains to be learned in order to understand when the fever is favorable and when it is dangerous, but the data that are already in science are enough to allow the doctor to choose the right course of conduct in all the cases described above.
Fever has a significant physiological effect, which has a positive or negative effect on the course of the disease. Symptomatic treatment of fever is quite reliable, and most of the means used for this can be applied without a doctor’s prescription. However, it is necessary to know that each of these drugs, each measure of physical exposure often causes significant side effects.
Examining a child with an elevated body temperature and prescribing symptomatic treatment, the doctor must find out the specific cause of this fever. At the same time it is necessary to answer the following questions:
– What is the temperature increase mechanism? What is it, a fever or one of the heat diseases?
– What is its specific etiology?
– Should there be symptomatic treatment? In other words, should antipyretic therapy be carried out in addition to treating the underlying disease?
– If it is decided to carry out symptomatic treatment of fever, then how best to do it? What pharmacological and physical treatments will help restore normal body temperature? What are the side effects of pharmacological drugs and physical treatments and how to prevent them?