RIME - Fever Ademola Michael Obajuluwa, MSIII November 2, 2010

History Intake

· Elevated temperature or tactile fever?

· Duration and pattern of the fever

· Getting better or worse (Temperature)? Am Pm

Day1

Day2

…

· Associated symptoms: chills or sweating, rash, cough, rhinorrhea, earache, sore throat, dysuria…?

· Sick contacts? Travel? Pets? Exposure to unclean water/food?

· Previous illnesses or antibiotic use

Physical Exam

· General condition and vital signs

· Dermatologic signs of infection?

· ENT

· Thyroid gland (thyroiditis etc)

· Lymph nodes?

· Lung exam for wheezing, crackles, consolidation, pleural effusion etc

· Acute abdomen, hepatomegaly, splenomegaly

· Joint pain?

Labs and Imaging Tests

· CBC, urinalysis, cultures, ESR, CRP, complement levels, LFTs, viral titers…

Differential Diagnosis and Management

	Infection		Drug Reaction	Vasculitic	Other
	Viral	Bacteria
Causes	Virus	Bacteria, varies depending on etiology	Medications, vaccine, malignant hyperthermia, serum sickness	Kawasaki, JRA, HSP, SLE, acute rheumatic fever, Stevens Johnson	FUO, fever without localizing symptoms, dehydration, heat, hemolysis, poisoning Metabolic Acute intermittent porphyria, thyrotoxicity, Diabetes insipidus Fungal or parasitic
S & S	UPI GI Skin rashes	Dermatologic ENT Respiratory Meningitis UTI	Fever due to vaccines is usually self limited	Joint pain, fever, skin lesions/rashes, weight loss, loss of appetite,
Treatment	Antipyretics Supportive	Supportive Antibiotics Antipyretics Labs	Removal of drug or irritant for a period of time	Varies e.g. steroids, IVIG, treat symptoms, immunosuppresants

Sources:

http://www.pediatriceducation.org/2007/08/27/

http://dmri.in/clinicalpracticeguideline_feverhistoryexam.pdf

www.uptodate.com – Evaluation and management of fever in the neonate and young infant