Management of hyperpyrexia

1. Management of
Hyperpyrexia
Lt Dhirendra

2. Hyperpyrexia
• Also called Fever
• represents an elevation in the body's set
thermoregulatory point
• Core temperature is regulated by the anterior
hypothalamus
• Fever is caused by increased prostaglandin E2
(PGE2) synthesis in the hypothalamus

3. • Autonomic discharge from hypothalamus
raises core temperature through shivering and
dermal vasoconstriction
• Normal circadian variation in core
temperature occurs with nadir in early
morning and peak in late afternoon
• Normal Body Temperature
– Upto 98.9 at 6 am
– Upto 99.9 at 4 pm

4. Etiology
• infectious process
• Drugs
– Antiarrhythmics (procainamide, quinidine)
– Antibiotics (penicillins, sulfonamides, erythromycin, isoniazid,
nitrofurantoin)
– Anticonvulsants (barbiturates, carbamazepine, phenytoin)
– Antidepressants (TCAs, monoamine oxidase inhibitors)
– Antihistamines (H1 and H2 antagonists)
– Antihypertensives (nifedipine, hydralazine, methyldopa, captopril,
hydrochlorothiazide)
– Drugs of abuse (cocaine, amphetamines)
– NSAIDs
– Others (allopurinol, heparin, meperidine)

5. • Systemic inflammatory
– Collagen vascular diseases
– Rheumatic fever
– Rheumatoid arthritis
– Systemic lupus erythematosus
– Vasculitis
– Polymyalgia rheumatica
– Temporal arteritis
– Granulomatous diseases
– Sarcoidosis
– Inflammatory bowel disease
– Sickle cell disease
– Hemolytic anemia

6. • Neoplastic disease
– Lymphomas and leukemias
– Hepatoma
– Metastatic carcinomas
– Atrial myxomas
• Endocrine
– Lymphomas and leukemias
– Hepatoma
– Metastatic carcinomas
– Atrial myxomas
• Pulmonary embolus
• Familial Mediterranean fever
• CNS lesions

7. Signs and Symptoms
• Chills, shivering, and rigors
– Mechanisms to raise body core temperature
• Fatigue
• Malaise
• Myalgias
• Night sweats
• Anorexia

8. • Specific fever patterns
– Relapsing fevers: febrile episode with alternating
afebrile intervals
– Seen in malaria, Borrelia infections, rat-bite fever, and
lymphoma (Pel Ebstein fevers)
– Remittent fever: temperature falls daily but does not
return to normal
– Seen in TB and viral diseases
– Intermittent fevers: exaggerated circadian rhythm
– Seen in systemic infections, malignancy, and drug
fever
– Reversal of normal circadian patterns
– Sometimes seen in typhoid fever and disseminated TB

9. • Differential Diagnosis
– Core temperatures >41°C more common in these
states
– Neuroleptic malignant syndrome
– Malignant hyperthermia
– Serotonin syndrome
– Heat stroke

10. Treatment
• Monitoring and IV access should be obtained in
the field for unstable patients or patients with
altered mental status
• Immediate treatment rarely required
• Airway control, breathing and circulatory support
for unstable patients
• Initiate broad-spectrum antibiotic treatment
immediately for immunocompromised patients
and patients with unstable vital signs or profound
mental status changes

11. • Antipyretics
– Acetaminophen, NSAIDs, or salicylates
• Glucocorticoids
– Most febrile patients do not require antipyretic medication
other than for comfort.
– Selected patients require more aggressive antipyretic
interventions
• Pregnant women
• Patients with history of seizure disorders
• Patients with significant cardiac disease
• Hemodynamically unstable patients
• Patients with altered mental status
• Empiric antibiotics for unstable or
immunocompromised patients
• External cooling mechanism rarely indicated