Acute fever

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.
- Rectal or oral
- Rectal temperatures should not be performed in neutropenic patients[1]

Clinical Features

Fever directly causes an increase in:[2]
- Heart rate: 10 beats per minute per degree centigrade
- Respiratory rate

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
- Viral syndrome
- Otitis Media
- Sinusitis
- Pharyngitis
- Influenza
- TB
- UTI
- Epididymitis
- Prostatitis

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:

Management

Consider tylenol or ibuprophen for fever relief
Treat the underlying condition

Disposition

Depends on underlying etiology

See Also

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.
Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009 Sep;26(9):641-3. doi: 10.1136/emj.2008.061598.

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