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Thursday, September 26, 2013

You give me Fever.

By Dr Sylvester Ikhiesemojie

Fever is a very common symptom of illness in our environment. It is indicative of many different types of ailments. While it is nearly always present in common diseases like malaria, not every fever is caused by malaria.
Many people assume that once you have a fever then you have malaria. This is not true. Malaria is merely one of many causes of fever. The two conditions are thus not synonymous with interchangeable meanings. Fever means an increase in normal body temperature beyond the normal range of 36.5o to 37.5o Celsius and it is often referred to as pyrexia. Normally, body temperature reaches its highest point at about 6pm in the evening and its lowest point at 3am in the morning. The symptoms of a fever are hotness of the body with associated chills, which is a feeling of cold within the body as the temperature rises and becomes hot when it has stopped doing so. There is a rise in the heart rate and the breathing pattern becomes quicker. In children and in the elderly, the palms and the soles of the feet become cold paradoxically. The body temperature rise is thought to be part of the mechanism involved in the protection of the individual and so it is not necessarily a bad thing to have a fever. At a high grade, children hallucinate and could have nightmares. From infancy to the age of seven years, the potential for convulsion is high with attendant confusion among family and friends and neighbours. Calmness and the judicious use of the available tepid water help a good deal, then seek a doctor’s attention. In the elderly, there is confusion and delirium as a result of fever and oral feeding may be refused.
Fever is one of the most common signs of illness seen in clinical practice and it occurs in response to a variety of situations. It is seen in infections such as malaria, typhoid, meningitis, respiratory tract infections, ear infections and infections in the bones and joints. It is seen also in urinary tract infection, pneumonia, tonsillitis, infection in the gall-bladder and the intestines and blood-borne infections. Thus, it occurs from infection with bacteria, viruses, protozoa, parasites and drugs. While many of these infections are easily treatable, some are life-threatening and require admission in hospital for proper care. Viral infections such as hepatitis, AIDS, common cold and measles will also cause fever so that fever is so much present in many types of conditions that some of them are known to have certain characteristics. Malaria fever for example does have a different pattern of presentation than typhoid fever. These two are different from the fever seen in Dengue fever and all of these are different from the type of fever associated with tuberculosis. It is therefore harmful for individuals to sit back at home and assume that they know what is responsible for a particular fever and fail to consult a doctor early enough.
Even the attending doctor needs to properly elicit the history of a fever in association with other symptoms and signs to enable him to reach a likely diagnosis. Often, several diseases will present in similar fashion and he will need to conduct laboratory and other investigations to determine which type it is. People must not assume that they know what is responsible for a particular fever. Finally, certain cancers such as the lymphomas and leukaemias also come with fever. The wise thing for anyone who has a fever to do is visit the doctor if after a day or two of using analgesics, there is no improvement. Sometimes, the fever begins suddenly at such a high grade that even the use of home remedies is not an option. The hospital must be considered first. This situation is common at the extremes of age.
Lastly, even drugs are known to cause fever and so those people who have been on treatment with antibiotics for some time need to be informed that this is sometimes the case with some of these drugs.
There are times when it is not practical to be at the hospital at the onset of an illness such as during a journey or in the small hours of the night among homes located in gated neighbourhoods or lacking in personal means of transportation. Certain home remedies may be tried in such circumstances until help is attainable. Some of these remedies include the use of the following means.
1. Analgesics like Acetaminophen or Tylenol which is increasingly more available in Nigeria.
2. Common medications like Paracetamol administered as recommended.
3. Ibuprofen which is a potent antipyretic. This must not be given to a patient who has not eaten for several days or has a history of peptic ulcer disease because of its potential to aggravate the symptoms of that disease or even cause intestinal bleeding.
4. Asprin which is also a potent antipyretic and analgesic. This medication comes last on this list by choice because it is considered unsafe for its use in children and adolescents especially when they are suffering from fevers due to a viral infection. When the cause of a fever is chicken pox or measles and Aspirin is used, there is a serious potential for developing a complication known as Reye’s syndrome in which there is a significant potential of death occurring. It is associated with repeated vomiting, an abnormally low blood sugar level, fatty changes in the liver with some inflammation, a skin rash and swelling of the brain known as encephalopathy and coma. The precise cause of these changes is not known so it is better to avoid its use.
5. The most available means of control of fever in the home situation is the repeated bathing or sponging with tepid water which is water obtained at room temperature. This is available, safe and can be rapidly administered repeatedly. It has no dose and requires no specific expertise for its application.
What must not be done is use iced water to bathe an individual who has a high body temperature or sponge them with alcohol. In the latter case, the patient can even inhale the fumes of the alcohol and the use of iced water can rapidly cause hypothermia which is no less harmful. Temperatures reaching 42o Celsius will invariably cause brain damage but it is rare for a fever which is being treated to reach this level.
In the treatment of fevers, it is the usual practice to treat the underlying cause. It is not helpful to focus on bringing the temperature alone under control and so patients and their anxious relatives need to be informed of this need. It is important to ensure adequate hydration so that those who are well enough to take treatment at home need to be encouraged to take a lot of fluids. That is more important than food itself in contrast to the focus usually of relatives. If they are in the hospital, the state of hydration is usually assured with an intravenous line which will deliver fluids and medications directly into the vein.

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