Central  South  Dakota  Medical News
The Clinical View
 by P.E. Hoffsten, M.D.
10/25/2001

FEVER – WHAT TO DO

             Human beings are so called warm blooded animals.   In today’s world, some might wonder if that is really universally applicable.  Be that as it may, the normal human temperature is 98.6° F with a variation of about a half of a degree in either direction.  During the last half of a lady’s menstrual cycle her temperature rises by about a half of a degree and this is one method used to time ovulation for women trying to become pregnant.

            Abnormal temperatures above 99.1° F are called fever.  It has been known since antiquity that individuals with fever had something wrong.  This needs to be qualified because at the end of a vigorous basketball game, trained athletes have temperatures as high as 104 to 106°F and they are not sick at all.  They simply have exerted and spent more energy than their body can dissipate in a short period of time and that high temperature by itself seems to have no deleterious effect on their body.

            However,  if a person hasn’t been exercising vigorously and a fever develops, there is usually “something wrong”.  The list of things that can cause fevers is pages long.  It’s commonly believed that fevers mean a person has an infection and certainly this is a common finding.    Fevers can also come from allergic conditions, cancer and malignant conditions, intoxications, and many, many different drugs.  When an individual has a fever,  perhaps the most important single consideration is looking for the cause of the fever.  This is relatively easy if there are associated problems such as a cough, chest pain, shortness of breath which might indicate a pneumonia.  Finding the cause of a fever can be a much more difficult problem when the person has a hidden malignancy, a drug reaction, or some of the more rare inflammatory conditions such as rheumatoid arthritis.

            Fever in children is generally not as serious a consideration as is fever in adults.  Young children frequently get fevers as they encounter one after another of the many infectious agents in our environment.  Most of the time they recover from these without difficulty.   When the child is significantly ill and not taking fluids or food, has vomiting, diarrhea, a severe cough or becoming too sleepy, then the child does need medical attention for the possibility of more serious illness.

            For adults, fever is a much more critical consideration and searching for a cause more important.  Most adults with a low grade fever and a cough or cold will pass it off as not important.  But fever in adults almost always means “something is wrong” and medical attention is a warranted step.

The question of what to do for individuals with fever depends upon the circumstance.  For young children keeping their temperature below 104°F is recommended.  Thus if the child has a very high fever such as a 103° or higher, the use of Tylenol (acetaminophen) to keep their temperature lower is an important part of the care.  Seizures in children with temperatures above 103° are relatively common.  Seizures are relatively uncommon in temperatures below 103°F.  Thus preventing very high temperatures in young children is an important part of care.  Aspirin is to be avoided in young children because of the possibility of a disease called Reye’s syndrome which may be caused by aspirin.

            The question of what to do with fever in adults is not as clear.  Nature has provided human beings with fever as one tool that helps the body fight an infection.  Lowering the body temperature in times of stress and need may actually diminish the bodies ability to deal with an infectious process.   The knee jerk response to give anyone with fevers some aspirin or Tylenol to get their temperature down is not always the best choice.

            As special example, the fever curve that an individual has can be a useful index of effective treatment of an infection and also can give clues to the cause of the fever.  Thus if the person takes intermittent Tylenol to bring a temperature down the illness may be masked and become much more difficult to diagnosis.  Especially in hospitalized patients, I try to avoid the use of Tylenol or aspirin so that the person’s response to antibiotics can be measured as a fever decreases.

            One of the most common comments I hear patients make is, “I only take the medicine if I need it”.  Thus if an individual has a fever, they may take the Tylenol or aspirin when the temperature goes up and then not again until the temperature goes back up at another time.  Basically, this means the person is constantly cycling between sweats and chills as the drug has an effect that then wears off.  In addition, whatever the illness is, is being hidden.  When an adult has a heart problem and it is overtaxed by a high fever, the use of aspirin or Tylenol is an important part of care.  The most important step of treating that person is to give the person Tylenol or aspirin on a continuous basis so that the chills and sweats of recurrent fevers that occur when the Tylenol wears off is avoided. For adults, Tylenol still seems to be the most favored drug for bringing a high temperature back to normal.  Aspirin, Motrin and several other arthritis meds are effective in lowering temperatures but they carry the side effect of causing gastric irritation, high blood pressure, and salt retention.  Tylenol would be the favored drug for bringing fevers down in adults.  It might be added that for resistant cases, Motrin is more effective than Tylenol.

            To summarize, the knee jerk response of treating fever with aspirin or Tylenol is not recommended.  For children tending to have high fevers that may go as high as 104°, the use of Tylenol is a recommended step to avoid seizures.  For adults with heart problems or a very weakened condition in which fever puts an undo tax on the body, suppressing the fever with Tylenol may be helpful but it must be remembered and recognized that when an anti-fever medicine is given, the patient looses an important diagnostic handle in following the progress of the condition and diagnosing it to begin with.  The healthcare providers at your local clinics can be a big help in providing advice and treatment for conditions that cause fever.  The most important step  they take is finding the cause of the fever.