Alterations in Body Temperature (Pyrexia) (complete) Flashcards
What is a fever?
- elevation in body temperature exceeds normal variations in response to a pyrogen
– pyrogens: bacteria, viruses, MI, malignancies - one of the most prominent manifestations of the acute inflammatory response
- aka hyperpyrexia
What is the normal body temperature?
97-99.5 F (36-37.5C)
- varies about 0.5 degrees throughout day
Different in every person, diurnal variations
- is a dynamic process
What are the diurnal variations of body temperatures?
- lowest temperature in the early morning
- highest temperature in the late afternoon/evening
What is the role of the hypothalamus?
Thermoregulatory center in the hypothalamus regulates body temperature (thermostatic set point)
Helps to balance heat production and heat loss
How does the hypothalamus help to balance heat production and heat loss (other body experiences)?
To cool body:
- sweat glands excrete sweat
- blood vessels dilate
- heat loss through radiation and conduction
To heat body:
- erector muscles constrict, traps air (goosebumps)
- shivering: increases metabolic rate, increasing temp
- blood vessels constrict: decreases blood flow to conserve heat
What is the thermostatic set point
keeps the core temperature at a normal level (either raises or lowers)
Hypothalamus and core temperature; effects of extreme temperature
When core temp is greater than 105.8F or less than 93.2F
- the ability to regulate temperature is impaired
- hypothalamus is no longer in control
Can lead to increased risk of denaturalization of brain cells, leading to cell death, and death
What is heat production?
Derived from metabolic activity in the muscles and liver
SNS neurotransmitters play a role (epinephrine and norepinephrine)
- released when an increase in body temp is needed
- heat production rather than energy generation
- often feel weak and tired due to the amount of energy being used
What does shivering do?
leads to increased heat production by increasing metabolic rate
side note: non-shivering heat production by the liver can increase core temperature
What are goosebumps and what do they do?
contraction of the pilomotor muscles of skin reduce the surface area for heat loss
- surface insulation
What does exercise/exertion do to body temperature?
Increases it
Causes of heat production
- work/exercise
- heat stroke (overwhelms body, impairs organs)
- drug-induced
- malignant hyperthermia
- neuroleptic malignant syndrome
- CNS damage (can’t regulate temp especially if hypothalamus is impacted)
What are the 5 processes through which heat loss occurs?
- radiation (most common)
- conduction
- convection
- evaporation (sweat)
- respiration (insensible)
What is radiation heat loss?
- transfer of heat from one place to another
What is conduction heat loss?
Requires direct contact
Ex: cool cloth, ice pack
What is convection heat loss?
Requires fluid flow, such as air or water
Ex. fan
What is the febrile response?
During fever, thermostatic set point is reset at a higher level
- caused by a cytokine-induced disruption of the set point in the hypothalamus (inflammatory response)
- cytokines –> arachidonic acids –> prostaglandins –> increased set point
- set point rises, existing body temp is sensed as too cool
– heat production will occur until new set point reached
- once pyrogens decreased or antipyretic given: set point will reset downward
– process of heat loss occurs
What are the stages of fever?
- prodrome
- chill
- defervescence (fever breaks)
What occurs in the prodrome stage of fever?
non-specific complaints (aches, pains, etc)
What occurs in the chill stage of fever?
- shivering, which causes the core temperature to rise
- complaints of “freezing to death”
- vasodilation causes red flushed skin once set point has been reached
What occurs during the defervescence stage of fever?
- complains of burning up
- diaphoresis
- fever breaks
Associated symptoms of a fever
- heart rate: should go up but does not have to happen
– because of SNS kicking in and NE and E - myalgias (b/c prostaglandins)
- fatigue
- joint pain
- respirations increase (trying to blow off heat)
- dehydration:
– sweating and increase vapor loss through rapid breathing - chills come with pyrogens which enter the system
- headache: from vasodilation of cerebral vessels
- decreased perfusion causes delirium, confusion, agitation
symptoms come from increased need for metabolic rate increased, increase oxygen and use of body proteins as a resource
What is heat stroke?
- type of hyperthermia
- person so overheated that heat regulating ability of hypothalamus fails
- leading cause of death in athletes
– seen with those with no fans or air conditioning
Treatment for heat stroke?
- cool the person
- antipyretics do not work