PP fiebre Flashcards
Definida como cambios en el ajuste del hipotálamo, elevación de la temp corporal por muchas razones y tercero que hay un valor de la fiebre más de 37.8 grados centígrados.
Fiebre
Body temperature is controlled by the
hypothalamus
core body temperature in the range of
36.5–37.5°C
A 45 yo male comes in with a systemic sepsis. His family members said he spiked a fever. Since you are such a good doctor what would you expect the onset of this fever to be like?
(hyperpyrexia) can be rapid in onset, and temperatures can exceed
40. 5°C.
Hyperthermia is often diagnosed on the basis of the events. What events could these be?
immediately preceding the elevation of core temperature—
e.g., heat exposure or treatment with drugs that interfere with thermoregulation.
A 37 yo biologist, who is currently working on a reforestation project in Arizona, comes into you consult. She says she hasn’t been feeling well for a while now. She started a fever and decided to come see a doctor because her next door neighbor kept bugging her about it. She goes on to tell you her 15 yo daughter bought her some acetaminophen (antipyretics) but it didn’t help.On physical examination what can you expect to find to differentiate between fever and hyperthermia. Also why didn’t the acetaminophen work?
In patients with heat stroke syndromes and in those taking drugs that block sweating, the skin is hot but dry, whereas in fever the skin can be cold as a consequence of vasoconstriction.
Antipyretics do not reduce the elevated temperature in hyperthermia,
whereas in fever—and even in hyperpyrexia—adequate doses
of either aspirin or acetaminophen usually result in some decrease in body temperature
Tx de hipertermia: Dantrolene
The term pyrogen (Greek pyro, “fire”) is
used to describe any substance that causes fever
Patient comes into the consult complaining of high fever and abdominal pain after attending a dinner at his friend’s party. His ex gf was there and she hates his guts. But strangely by the end of the night she was serving him drinks and giving him food. He tells you she might have given him food poisoning. You are thinking this could be e. coli. What is causing him the elevated body temperature?
lipopolysaccharide (endotoxin) produced
by all gram-negative bacteria.
A 25 yo male comes in with a beaten face from a fight at a bar with a guy that was hitting on his gf. His gf decided to put a tampon to stop his nose from bleeding. It took her a few hours to convince him to come to the ER. Patient has a sudden fever, a rash resembling a sunburn, particularly on your palms and soles, hypotension, Headache, redness in his eyes, throat and mouth. What is causing his fever?
And which atb would you use?
Pyrogenic products of gram-positive organisms include the enterotoxins of Staphylococcus aureus and the groups A and B streptococcal toxins, also called superantigens.
S. aureus causes
Toxic Shock Syndrome, which is what our patient has.
Tx: Clindamicina + Penicilina
Ambas cubren Staph pero de da porque la penicilina es bactericida y clinda en un bacteriostático= resolución del problema mas rápido.
A 7 yo boy comes in with a fever. He has been camping with his boy scouts team. His mom is super worried because she didn’t even want to let him go to the stupid camping trip. Which cytokines are involved in the boys fever?
The pyrogenic cytokines include IL-1, IL-6, tumor necrosis factor (TNF),
Un paciente que se congeló en artantica esperando que su novia lo perdonara por meterle los cuernos? de que se va a morir?
Se frenan todos los procesos enzimáticos y se muere. También aplica para canales de distribución de iones.
Si fuere que se muere de calor primero hay daños de las estructuras celulares pero eventualmente se desnaturalizan las proteinas y después ocurren los daños enzimáticos.
70 yo patient comes into the ER with a fever. He is inconscient and the paramedics said he had a fall. What are the three main causes of fever?
infecciones, neoplasias, trauma
Paciente joven llega con fiebre. Paciente dice tener una vida dificil, es un rockero famoso, su padre murió de cáncer, y su madre de un infarto. En examinación se descarta infección. En qué más puede pensar.
Linfoma
Uso de anfetaminas
Uso de cocaina (inhibición de la recaptación de la catecolaminas)
IAM (necrosis libera citocinas)
Lesion tisular. ( quemaduras, pancreatitis, ACV, tromboembolismo, trombosis)
entonces: medicamientos, tumores, cirugias, IAM
Un paciente se le realizó una apendicectomía. En el área al microscopio se observó migración de células inflamatorias. Cual IL se encontraba elevada?
IL-8, sirve como quimiotactico
Px tiene más de 50 años, presenta fiebre, cefalea intensa, dolores articulares, eritrosedimentacion en 100 o por encima. Px se complican con ceguera y se tratan con esteroides como prednisona un mg por cada kg de peso. Que podria tener la paciente?
vasculitis como la arteritis temporal.
Otras enfermedades autoinmunes que causan fiebre son lupus, artritis reumatoide.
