June 28, 2011
Do you really want to treat a fever? After all, isn’t fever a part of the body’s natural defenses? The answers to these questions aren’t as clear cut as you may think. Yes, fever is part of the body’s defenses; but, at times, it can be harmful.
As with everything in medicine, what to do about fever boils down to the individual situation. Each and every individual is unique; and each and every time an individual gets sick, his/her illness is unique. In the old days, there wasn’t much that could be done for a fever. Actually, many used to “sweat” the illness out by wrapping the infirmed in heavy blankets. I always thought that Dorothy, in the “Wizard of Oz,” was hallucinating due to fever, her family waiting at her bedside hoping she would recover.
While fever can lead to dehydration, hallucinations, and seizures, most fevers will resolve spontaneously and are harmless. Fevers up to 101 are generally well tolerated and may actually be helpful. Since one of the risks of fever is dehydration, patients are advised to stay well-hydrated. I recommend “sports” drinks for febrile illnesses, as they help replace essential salts often lost due to profuse sweating. When the body’s core temperature goes up, so does the body’s metabolic rate. “Sports” drinks are also a good source of carbohydrates.
Fever should be treated aggressively if there are any signs of dehydration. One of the best ways to judge hydration is by measuring urine output. In children, diminished urine output (dry diapers) is a potentially threatening sign. Fever should also be treated aggressively if you have other, concomitant illnesses.
In addition to hydration, acetaminophen and ibuprofen are the mainstays of treatment. Ibuprofen can be used every 6 hours and acetaminophen can be used every 4 hours as needed. Acetaminophen and ibuprofen can be used simultaneously when either product fails to adequately lower the temperature into a safe and comfortable range. Remember, when treating fever, your target is under 101.
Fever without an obvious cause demands a visit to the doctor’s office. I believe in erring on the safe side. It’s better to be seen than be sorry. Persistent fevers for days also require a visit to your doctor. Shaking chills are a warning sign!
When bacteria is released into your blood stream (bacteremia), the immune system usually reacts strongly causing shaking chills. If the bacteria survives your immune system’s response, sepsis (severe blood borne infection) ensues and is a life threatening event. If you have shaking chills (rigors), see your doctor or go to the emergency room.
Remember, the life you save may be your own.