Fever

Toxic / Ill-Appearing
  • Consider ED transfer; OR
  • Consider single-dose Acetaminophen (Adults: 1300 mg, Peds 20 mg/kg)
  • Observe in 30-45 min.  If appearance unchanged, send to ED.

Fever ≤3 Days’ Duration

Seek localizing signs or symptoms.
If nothing but malaise, myalgias, ? mild headache  →  Dx Viral Syndrome
Be sure there’s no obscure-but-potentially-lethal possibility:
  • Malaria (recent foreign travel in rural tropics)
  • Rocky Mountain Spotted Fever (fever + headache, April to Sept., in endemic area)
  • Meningococcemia (unexplained macules or petichiae)
  • Endocarditis (Injection Drug Use, Prosthetic Valve, diseased Native Valve, Hx of Endocarditis)
  • Diabetic Ketoacidosis (tachypnea; urinary glucose & ketones elevated)
  • AIDS (known HIV+ with low T-cells; risk factors; clinical clues on exam)
  • Stevens-Johnson / Toxic Epidermal Necrolysis / Toxic Shock (excessive skin / muscle pain; target lesions, bullae, or “sunburn,” esp. if mucus membrane involvement)
  • Caution with Elderly & Compromised Hosts
  • Measles: “3 C’s” (Coryza + Conjunctivitis + Cough); Koplik”s Spots

Fever ≥4 Days’ Duration

Consider diseases listed above.  Seek new rashes (measles, rubella, roseola, B19 parvovirus).

Also Order Basic Tests:
  • CBC (high WBCs = occult bacterial infection; neutropenia)
  • Urinalysis (Pyelonephritis)
  • Chest X-ray (Pneumonia)
  • Consider LFTs (for hepatitis, Mono)
  • Consider HIV Viral Load (PCR) if risk factors

If appears at all ill: send to ED for imaging, cultures, & I.D. evaluation / admission

If doesn’t appear ill, constitutional symptoms not progressive:  consult I.D. if fever persists 7 days.  Seek exposure clues:
  • Travel
  • Pets
  • Tick bites
  • Foods
  • Occupational
  • Sexual
Consider non-infectious causes:
  • Drug fever
  • Venous thrombosis
  • Connective tissue disease
  • Malignancy

See posting Fever.

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