Fever in a hospitalized patient

Fever in the hospitalized patient

Definition

• Core temperature >38.3ºC

Pathophysiology

• Pyrogenic fever is caused by endogenous (IL-1, IL-6, TNF-alpha) or exogenous (from a microbe) pyrogen compounds
  • Either direct action or cytokine production that stimulates the organum vasculosum of the lamina terminalis (OVLT) in the hypothalamus
• Neurogenic
• Decoupling of oxidative phosphorylation, as in drug-induced

Differential Diagnosis

• Infectious
• Non-infectious
  • Inflammatory diseases
  • Drug-induced, including ß-lactam antibiotics, sulphonamides, antipsychotics, propofol
  • Traumatic brain injury or ischemic brain injury
  • Endocrine fever