Aproach To Patient With Fever 203f
This document was ed by and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this report form. Report 3i3n4
Overview 26281t
& View Aproach To Patient With Fever as PDF for free.
More details 6y5l6z
- Words: 1,546
- Pages: 61
Fever Introduction Types Causes History & Associated Symptoms Physical Examination WWW.SMSO.NET
Introduction Definition Some important facts Pathophysiology
WWW.SMSO.NET
Definition Fever is an elevation of body temperature above the normal circadian variation.
WWW.SMSO.NET
Every person's temperature varies slightly, but the average "normal" temperature for humans is 37°C (98.6°F). Various things influence body temperature, for example activity, metabolic rate, environmental temperature, and infection.
WWW.SMSO.NET
Pathophysiology of Fever stimulate
/ Monocytes / Macrophages / Endothelial cells Other cell types
release
Pyrogenic cytokines IL - 1 TNF ,IL - 6, IFNs stimulate
Infectious agents / Toxins / Mediators of inflammation (Pyrogens)
results in
FEVER
Anterior hypothalamus Mediated by PGE2(( )(Antipyretics/ NSAIDs act here
result in
Increased Heat conservation (Vasoconstriction/ behaviour changes) Increased Heat production ((involuntary muscular contractions
leads to
Elevated thermoregulatory set point WWW.SMSO.NET
Types How to classify fever? Types according to classification “I” Types according to classification “II”
WWW.SMSO.NET
How to Classify Fever? Fever can be classified in two ways: 1- Continued, Intermittent, Remittent, Relapsing. 2- Acute, Chronic.
WWW.SMSO.NET
Types according to classification “I” type
character
examples
Continued
Does not remit
Typhoid fever, typhus, drug fever, malignant hyperthermia.
Intermittent
Temperature falls to normal everyday
Pyogenic infection, lymphoma, military T.B.
Remittent
Daily fluctuation >2c .temperature dos not return to normal
Not characteristic for any particular disease.
Relapsing
Temperature returns to normal for days before rising again
Malaria: tertian-3days pattern, fever peaks every other day (plas. Vivax, plas.ovale), quatrain-4day pattern . fever peaks every third day (p.malaria) lymphoma: HODJKIN lymphoma Pyogenic infection WWW.SMSO.NET
Types according to classification “II” Acute Fever(fever takes 2-3weeks) Bartonellosis Chikungunya Dengue Fever Diphtheria Encephalitis Familial Mediterranean fever Hemorrhagic fevers (HFs): Malaria Melioidosis Meningitis
Pertussis Plague Pneumonia Q fever Relapsing fevers Typhoid and paratyphoid fever Typhus Yellow fever Viral diseases WWW.SMSO.NET
Types according to classification “II” MORE THAN 3 WEEKS Fever: Actinomycosis Brucellosis or undulant fever Familial Mediterranean fever Filariasis Histoplasmosis HIV/AIDS Relapsing fevers Tuberculosis Typhoid and paratyphoid fever WWW.SMSO.NET
Causes Fever of unknown origin Big 3 & Little 6 Causes of the PUO
WWW.SMSO.NET
Causes of Fever Fever of unknown origin: Fever more than 38 c persisting for more than 3 weeks with no clear diagnosis intelligent and intensive investigation. patient with HIV or immunosuppression conditions are normally excluded from the definition of (PUO) . WWW.SMSO.NET
Causes of Fever BIG 3 Infection Neoplasm Autoimmune diseases
Little 6 Drug fever Granulomatous diseases Regional enteritis Familial Mediterranean fever Pulmonary emboli Factitious fever WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 1-INFECTION:(20-40%) -pyogenic abscess -T.B. -infective endocarditis -EBV -CMV -brucellosis -fungal infection (histoplasmosis,blastomycosis)
-parasitic infection (malaria,toxoplasmosis WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 2-MALIGNANT DISEASE:(10-30%) -lymphoma -leukaemia -renal cell carcinoma -hepatocellular carcinoma
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 3-COLLAGEN VASCULAR DISEASE:(1520%) -SLE -RHEUMATOID ARTHRIRTIS -giant cell arteritis -wegener's granulomatosis
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 4-MISCELLANOUS:(10-20%) -drug fever(beta-lactam antibiotic) -thyrotoxicosis -inflammatory Bowel diseases -sarcoidosis -granulomatous hepatitis -factitious fever(self induced)
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 5-UNDIAGNOSED(5-25%)
WWW.SMSO.NET
History & Associated Symptoms
WWW.SMSO.NET
History QUESTION RELATED TO FEVER ITSELF: -1-onset -2-duration:*how long have you had it? *how long does it take? *at what time of the day? *how often do you get it (daily ,weekly or monthly) WWW.SMSO.NET
History -3-measured temp. : (value and site)
-4-relieving factors
-5-aggrevating factors
WWW.SMSO.NET
History ALSO, ask about the associated symptoms: most common associated symptoms with fever are : -sorethroat -headache -blurred vision -neck stifness -arthritis -chest pain with cough -abd. Pain or change in bowel habits -swelling in the neck or other parts of the body -skin rash ,blister or pruritis.
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
History Constitutional symptoms: (sweat , loss of appetite , loss of weight and fever) the constitutional symptoms can give differential diagnosis for a lot of cases as,in cancer ,infections …..etc WWW.SMSO.NET
History -ask the patient if he had with febrile or T.B patient. -ask about any previous exposure to infection -ask about any s with animals (toxoplasmosis) WWW.SMSO.NET
History -ask if the patient ingest raw milk before ,raw fish or poorly cooked brucellosis.
WWW.SMSO.NET
History Prior or current medications Agents that may mask fever Agents that may preclude positive bacterial cultures Agents that may select out resistant microorganisms Agents that may mask signs and symptoms of infection
WWW.SMSO.NET
History Past history: What is the patient’s immune status? Has there been a surgical intervention? Recent manipulations or surgery? Ask if he had any blood transfusion? *Underlying diseases Valvular lesions: endocarditis Splenectomized patients Biliary or GI disease Immunocompromised state
WWW.SMSO.NET
History Social history: *ask about sexual for sexual transmitted disease. *ask about the job if he has with animals . *ask about travel histrory *alcohol and smoking. WWW.SMSO.NET
Drug Fever: Causative Agents Antimicrobial agents Carbapenems Cephalosporins Minocycline HCl Nitrofurantoin Penicillins Rifampin Sulfonamides Iodides Herbal remedies Phenothiazines Antihistamines Salicylates
Cardiovascular drugs Hydralazine HCl Procainamide HCl Quinidine Histamine2 (H2) blockers Cimetidine Ranitidine HCl Nonsteroidal antiinflammatory drugs Ibuprofen Sulindac Anticonvulsants Barbiturates Carbamazepine WWW.SMSO.NET Phenytoin
History SYSTEMIC REVIEW: 1-C.V.S 2-RESPIRATORY SYSTEM 3-HEMATOLOGY SYSTEM 4-GIT 5-GENITOURINARY 6-MUSCULOSKELETAL 7-OTHER SYSTEMS…. WWW.SMSO.NET
Physical Examination Sites for temperature measurement The commonest Sites for temperature measurement Body normal temperature Oral temperature Systemic physical examination of fever WWW.SMSO.NET
Common Sites for Temperature Measurement Site
Oral cavity
Rectum
Axilla
Ear
Pros
Cons
Uses
Easy access Familiar Minimally invasive
Affected by eating, drinking, etc. Temperature varies within oral cavity. Hard to keep thermometer in place, esp. if edentulous.
Most common site in adults and children over 5.
Preferred by MDs.
Site records highest temp in body. Lags behind other core sites when temp is changing rapidly.
Often requested by MDs as the 'most accurate' site for core temperature.
Easy access Familiar Minimally invasive. Preferred by American Academy of Pediatrics for use in infants.
Reflects skin temperature. Not always a good indicator of core temperature. Must be held in place. Takes long time to reach equilibrium.
Most common site in children under 5. Sometimes used during surgery.
Easy access Familiar Minimally invasive. Two sites available. Reflective of brain temperature.
Requires thorough training and attention to technique.
Commonly used in hospitals and clinics.
WWW.SMSO.NET
Body Normal Temperature
Mouth
36.8 c
Axilla
36.4 c
Rectum
37.7 c
Ear
36.8 c
WWW.SMSO.NET
Oral Temperature
The maximum oral temperature at 6.00 A.M is37.2 c The maximum oral temperature at 4.00 P.M is37.7 c
WWW.SMSO.NET
HANDS : LOOK FOR FEATURES OF : -CLuBBING -SPLINTER HEMORRHAGE -PALLOOR……..ETC.
WWW.SMSO.NET
ARMS: -BRUISES -DRUG INJECTION SITES -EPITROCHLEAR AND AXILLARY LYMPH NODES
WWW.SMSO.NET
Systemic physical examination of fever
Skin Furuncles/track marks Intravenous sites Peripheral stigmata of bacterial endocarditis
WWW.SMSO.NET
Systemic physical examination of fever Skin findings Ecthyma gangrenosum – Pseudomonas Petechial rash Rocky Mountain Spotted Fever
WWW.SMSO.NET
Systemic physical examination of fever HEENT: -Feel the temporal arteritis -Eyes: -pallor -jaundice(balck water fever , ascending cholangitis) -iritis and conjuctivitis -fundi:-choroidal tubrecle in miliary T.B. -roth’s spots in infective endocarditis
WWW.SMSO.NET
-face : as, fly rash in SLE -mouth: -ulcers -gum diseases or hemorrhage -dental abscess -tonsillar infection
WWW.SMSO.NET
-ears: -otitis media -neck : -cervical lymph nodes -thyroid enlargment and tenderness. -meningism WWW.SMSO.NET
CHEST EXAMINATION: -palpate for bony tenderness -full examination of respiratory system and look for : pneumonia,T.B.,empyema and carcinoma. -heart: murmur :(infective endocard. it is, atrial myxoma) -rubs : pericarditis. WWW.SMSO.NET
WWW.SMSO.NET
Systemic physical examination of fever
Abdomen and pelvis: Look for splenectomy scar Findings may be subtle in the elderly or those on steroids Liver and spleen span. Inguinal lymph nodes. Suprapubic tenderness Renal tenderness ascitis WWW.SMSO.NET
evidence of: * hepatomegaly and ascitis: -bacterial peritonitis -hepatic carcinoma -pancreatitis *spleenomegaly: -infective endocarditis -malaria -haemopoitic malignancy WWW.SMSO.NET
*renal enlargment: -renal cell carcinoma
Rectal Important in neutropenic patients or those with IBD (perirectal abscess) WWW.SMSO.NET
CNS: -level of consiousness: score
Eye Opening
Best Verbal Response
Best Motor Response
1
non
non
non
2
To pain
Incomprehensible Sounds
Extensor posturing
3
To voice
Inappropriate Words
Flexor posturing
4
spontanous
Conversant; Disoriented
Withdraws to pain
Conversant; Oriented
Localizes to pain
5 6
Obeys Command WWW.SMSO.NET
- Obtundation -Focal neurologic defects -Signs of meningeal inflammation -Cranial nerves examination.
WWW.SMSO.NET
Repeated Examinations Are Very Important!
WWW.SMSO.NET
WWW.SMSO.NET
Medications: Drug Fever The occurrence of fever is predictable for some drugs, such as biologic response modifiers, amphotericin B, and bleomycin. For many other drugs, drug fever is a diagnosis of exclusion.
WWW.SMSO.NET
Medications: Drug Fever Contamination of drug with pyrogen or micro-organism Related to the pharmacologic action of the drug itself (ie Amphotericin B) Allergic (hypersensitivity) reaction
WWW.SMSO.NET
Medications: Drug Fever Pattern of fever variable. Rigors, myalgias, rashes, headache, leukocytosis, eosinophilia may also occur. Typical onset within 10 days. Duration is variable but usually resolves within 24 hrs depending on 1/2 life of drug.
WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
(NMS) is a rare but potentially fatal syndrome that may develop during treatment with neuroleptic drugs for conditions such as psychotic disorders, delirium, nausea, and vomiting. It is marked by fever, rigidity, confusion, and autonomic instability, as well as by elevations in white blood cell count, creatinine phosphokinase, and urine myoglobin. WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
NMS should be considered in the differential diagnosis of the delirious patient receiving neuroleptic agents who develops rigidity and whose condition does not improve on neuroleptics
WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
Hyperthermia (T 41° C or more) Hypertonicity Fluctuating consciousness Autonomic nervous system lability Causative agents: butyrophenones, loxapine, phenothiazines, thioxanthenes, antidepressants, antiemetics WWW.SMSO.NET
Thank You WWW.SMSO.NET
Introduction Definition Some important facts Pathophysiology
WWW.SMSO.NET
Definition Fever is an elevation of body temperature above the normal circadian variation.
WWW.SMSO.NET
Every person's temperature varies slightly, but the average "normal" temperature for humans is 37°C (98.6°F). Various things influence body temperature, for example activity, metabolic rate, environmental temperature, and infection.
WWW.SMSO.NET
Pathophysiology of Fever stimulate
/ Monocytes / Macrophages / Endothelial cells Other cell types
release
Pyrogenic cytokines IL - 1 TNF ,IL - 6, IFNs stimulate
Infectious agents / Toxins / Mediators of inflammation (Pyrogens)
results in
FEVER
Anterior hypothalamus Mediated by PGE2(( )(Antipyretics/ NSAIDs act here
result in
Increased Heat conservation (Vasoconstriction/ behaviour changes) Increased Heat production ((involuntary muscular contractions
leads to
Elevated thermoregulatory set point WWW.SMSO.NET
Types How to classify fever? Types according to classification “I” Types according to classification “II”
WWW.SMSO.NET
How to Classify Fever? Fever can be classified in two ways: 1- Continued, Intermittent, Remittent, Relapsing. 2- Acute, Chronic.
WWW.SMSO.NET
Types according to classification “I” type
character
examples
Continued
Does not remit
Typhoid fever, typhus, drug fever, malignant hyperthermia.
Intermittent
Temperature falls to normal everyday
Pyogenic infection, lymphoma, military T.B.
Remittent
Daily fluctuation >2c .temperature dos not return to normal
Not characteristic for any particular disease.
Relapsing
Temperature returns to normal for days before rising again
Malaria: tertian-3days pattern, fever peaks every other day (plas. Vivax, plas.ovale), quatrain-4day pattern . fever peaks every third day (p.malaria) lymphoma: HODJKIN lymphoma Pyogenic infection WWW.SMSO.NET
Types according to classification “II” Acute Fever(fever takes 2-3weeks) Bartonellosis Chikungunya Dengue Fever Diphtheria Encephalitis Familial Mediterranean fever Hemorrhagic fevers (HFs): Malaria Melioidosis Meningitis
Pertussis Plague Pneumonia Q fever Relapsing fevers Typhoid and paratyphoid fever Typhus Yellow fever Viral diseases WWW.SMSO.NET
Types according to classification “II” MORE THAN 3 WEEKS Fever: Actinomycosis Brucellosis or undulant fever Familial Mediterranean fever Filariasis Histoplasmosis HIV/AIDS Relapsing fevers Tuberculosis Typhoid and paratyphoid fever WWW.SMSO.NET
Causes Fever of unknown origin Big 3 & Little 6 Causes of the PUO
WWW.SMSO.NET
Causes of Fever Fever of unknown origin: Fever more than 38 c persisting for more than 3 weeks with no clear diagnosis intelligent and intensive investigation. patient with HIV or immunosuppression conditions are normally excluded from the definition of (PUO) . WWW.SMSO.NET
Causes of Fever BIG 3 Infection Neoplasm Autoimmune diseases
Little 6 Drug fever Granulomatous diseases Regional enteritis Familial Mediterranean fever Pulmonary emboli Factitious fever WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 1-INFECTION:(20-40%) -pyogenic abscess -T.B. -infective endocarditis -EBV -CMV -brucellosis -fungal infection (histoplasmosis,blastomycosis)
-parasitic infection (malaria,toxoplasmosis WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 2-MALIGNANT DISEASE:(10-30%) -lymphoma -leukaemia -renal cell carcinoma -hepatocellular carcinoma
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 3-COLLAGEN VASCULAR DISEASE:(1520%) -SLE -RHEUMATOID ARTHRIRTIS -giant cell arteritis -wegener's granulomatosis
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 4-MISCELLANOUS:(10-20%) -drug fever(beta-lactam antibiotic) -thyrotoxicosis -inflammatory Bowel diseases -sarcoidosis -granulomatous hepatitis -factitious fever(self induced)
WWW.SMSO.NET
Causes of Fever CAUSES OF THE PUO: 5-UNDIAGNOSED(5-25%)
WWW.SMSO.NET
History & Associated Symptoms
WWW.SMSO.NET
History QUESTION RELATED TO FEVER ITSELF: -1-onset -2-duration:*how long have you had it? *how long does it take? *at what time of the day? *how often do you get it (daily ,weekly or monthly) WWW.SMSO.NET
History -3-measured temp. : (value and site)
-4-relieving factors
-5-aggrevating factors
WWW.SMSO.NET
History ALSO, ask about the associated symptoms: most common associated symptoms with fever are : -sorethroat -headache -blurred vision -neck stifness -arthritis -chest pain with cough -abd. Pain or change in bowel habits -swelling in the neck or other parts of the body -skin rash ,blister or pruritis.
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
History Constitutional symptoms: (sweat , loss of appetite , loss of weight and fever) the constitutional symptoms can give differential diagnosis for a lot of cases as,in cancer ,infections …..etc WWW.SMSO.NET
History -ask the patient if he had with febrile or T.B patient. -ask about any previous exposure to infection -ask about any s with animals (toxoplasmosis) WWW.SMSO.NET
History -ask if the patient ingest raw milk before ,raw fish or poorly cooked brucellosis.
WWW.SMSO.NET
History Prior or current medications Agents that may mask fever Agents that may preclude positive bacterial cultures Agents that may select out resistant microorganisms Agents that may mask signs and symptoms of infection
WWW.SMSO.NET
History Past history: What is the patient’s immune status? Has there been a surgical intervention? Recent manipulations or surgery? Ask if he had any blood transfusion? *Underlying diseases Valvular lesions: endocarditis Splenectomized patients Biliary or GI disease Immunocompromised state
WWW.SMSO.NET
History Social history: *ask about sexual for sexual transmitted disease. *ask about the job if he has with animals . *ask about travel histrory *alcohol and smoking. WWW.SMSO.NET
Drug Fever: Causative Agents Antimicrobial agents Carbapenems Cephalosporins Minocycline HCl Nitrofurantoin Penicillins Rifampin Sulfonamides Iodides Herbal remedies Phenothiazines Antihistamines Salicylates
Cardiovascular drugs Hydralazine HCl Procainamide HCl Quinidine Histamine2 (H2) blockers Cimetidine Ranitidine HCl Nonsteroidal antiinflammatory drugs Ibuprofen Sulindac Anticonvulsants Barbiturates Carbamazepine WWW.SMSO.NET Phenytoin
History SYSTEMIC REVIEW: 1-C.V.S 2-RESPIRATORY SYSTEM 3-HEMATOLOGY SYSTEM 4-GIT 5-GENITOURINARY 6-MUSCULOSKELETAL 7-OTHER SYSTEMS…. WWW.SMSO.NET
Physical Examination Sites for temperature measurement The commonest Sites for temperature measurement Body normal temperature Oral temperature Systemic physical examination of fever WWW.SMSO.NET
Common Sites for Temperature Measurement Site
Oral cavity
Rectum
Axilla
Ear
Pros
Cons
Uses
Easy access Familiar Minimally invasive
Affected by eating, drinking, etc. Temperature varies within oral cavity. Hard to keep thermometer in place, esp. if edentulous.
Most common site in adults and children over 5.
Preferred by MDs.
Site records highest temp in body. Lags behind other core sites when temp is changing rapidly.
Often requested by MDs as the 'most accurate' site for core temperature.
Easy access Familiar Minimally invasive. Preferred by American Academy of Pediatrics for use in infants.
Reflects skin temperature. Not always a good indicator of core temperature. Must be held in place. Takes long time to reach equilibrium.
Most common site in children under 5. Sometimes used during surgery.
Easy access Familiar Minimally invasive. Two sites available. Reflective of brain temperature.
Requires thorough training and attention to technique.
Commonly used in hospitals and clinics.
WWW.SMSO.NET
Body Normal Temperature
Mouth
36.8 c
Axilla
36.4 c
Rectum
37.7 c
Ear
36.8 c
WWW.SMSO.NET
Oral Temperature
The maximum oral temperature at 6.00 A.M is37.2 c The maximum oral temperature at 4.00 P.M is37.7 c
WWW.SMSO.NET
HANDS : LOOK FOR FEATURES OF : -CLuBBING -SPLINTER HEMORRHAGE -PALLOOR……..ETC.
WWW.SMSO.NET
ARMS: -BRUISES -DRUG INJECTION SITES -EPITROCHLEAR AND AXILLARY LYMPH NODES
WWW.SMSO.NET
Systemic physical examination of fever
Skin Furuncles/track marks Intravenous sites Peripheral stigmata of bacterial endocarditis
WWW.SMSO.NET
Systemic physical examination of fever Skin findings Ecthyma gangrenosum – Pseudomonas Petechial rash Rocky Mountain Spotted Fever
WWW.SMSO.NET
Systemic physical examination of fever HEENT: -Feel the temporal arteritis -Eyes: -pallor -jaundice(balck water fever , ascending cholangitis) -iritis and conjuctivitis -fundi:-choroidal tubrecle in miliary T.B. -roth’s spots in infective endocarditis
WWW.SMSO.NET
-face : as, fly rash in SLE -mouth: -ulcers -gum diseases or hemorrhage -dental abscess -tonsillar infection
WWW.SMSO.NET
-ears: -otitis media -neck : -cervical lymph nodes -thyroid enlargment and tenderness. -meningism WWW.SMSO.NET
CHEST EXAMINATION: -palpate for bony tenderness -full examination of respiratory system and look for : pneumonia,T.B.,empyema and carcinoma. -heart: murmur :(infective endocard. it is, atrial myxoma) -rubs : pericarditis. WWW.SMSO.NET
WWW.SMSO.NET
Systemic physical examination of fever
Abdomen and pelvis: Look for splenectomy scar Findings may be subtle in the elderly or those on steroids Liver and spleen span. Inguinal lymph nodes. Suprapubic tenderness Renal tenderness ascitis WWW.SMSO.NET
evidence of: * hepatomegaly and ascitis: -bacterial peritonitis -hepatic carcinoma -pancreatitis *spleenomegaly: -infective endocarditis -malaria -haemopoitic malignancy WWW.SMSO.NET
*renal enlargment: -renal cell carcinoma
Rectal Important in neutropenic patients or those with IBD (perirectal abscess) WWW.SMSO.NET
CNS: -level of consiousness: score
Eye Opening
Best Verbal Response
Best Motor Response
1
non
non
non
2
To pain
Incomprehensible Sounds
Extensor posturing
3
To voice
Inappropriate Words
Flexor posturing
4
spontanous
Conversant; Disoriented
Withdraws to pain
Conversant; Oriented
Localizes to pain
5 6
Obeys Command WWW.SMSO.NET
- Obtundation -Focal neurologic defects -Signs of meningeal inflammation -Cranial nerves examination.
WWW.SMSO.NET
Repeated Examinations Are Very Important!
WWW.SMSO.NET
WWW.SMSO.NET
Medications: Drug Fever The occurrence of fever is predictable for some drugs, such as biologic response modifiers, amphotericin B, and bleomycin. For many other drugs, drug fever is a diagnosis of exclusion.
WWW.SMSO.NET
Medications: Drug Fever Contamination of drug with pyrogen or micro-organism Related to the pharmacologic action of the drug itself (ie Amphotericin B) Allergic (hypersensitivity) reaction
WWW.SMSO.NET
Medications: Drug Fever Pattern of fever variable. Rigors, myalgias, rashes, headache, leukocytosis, eosinophilia may also occur. Typical onset within 10 days. Duration is variable but usually resolves within 24 hrs depending on 1/2 life of drug.
WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
(NMS) is a rare but potentially fatal syndrome that may develop during treatment with neuroleptic drugs for conditions such as psychotic disorders, delirium, nausea, and vomiting. It is marked by fever, rigidity, confusion, and autonomic instability, as well as by elevations in white blood cell count, creatinine phosphokinase, and urine myoglobin. WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
NMS should be considered in the differential diagnosis of the delirious patient receiving neuroleptic agents who develops rigidity and whose condition does not improve on neuroleptics
WWW.SMSO.NET
Medications: Neuroleptic Malignant Syndrome
Hyperthermia (T 41° C or more) Hypertonicity Fluctuating consciousness Autonomic nervous system lability Causative agents: butyrophenones, loxapine, phenothiazines, thioxanthenes, antidepressants, antiemetics WWW.SMSO.NET
Thank You WWW.SMSO.NET
Related Documents 3h463d
Aproach To Patient With Fever 203f
November 2019 22
Approach To A Patient With Paraplegia 6l3q6w
December 2019 24
Approach To A Patient With Adenomyosis Final 4nk8
April 2020 14
Approach To A Patient With Hemiplegia 2p4p18
October 2019 52
A Semianalytical Aproach To Pseudopressure Canculations fk5x
May 2020 5