Fever

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Fever
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Normal

• Axillary temperature 3637 .0 ?C
• Sublingual temperature 36.737.7 ?C
• rectal temperature 36.937.9 ?C

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• ??  Concept
• pyrogen set point of the thermoregulatory
  center body temperature

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• 
  sport
• physiological T pregnancy
• 
  luteal phase
• 
  hyperthermia
• pathological T (set point )
• 
  fever

T
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• Hyperthermia
• thermogenesis
• thermolysis
• dysfunction of thermoregulatory center

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• ?? Causes and pathogenesis of fever
• Pyrogen and activator of fever
• Activator the substance can activate the
  cells that can produce the pyrogen.
• pyrogen the substance can cause fever

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Activators of fever

• 
  microbe G- LPS, ET
• 
  G peptidoglycan
• 
  virus enveloped virus
• 
  particletransfuse response
• 2. internal production
• immune
  complexes
• 
  etiocholanolone

1. Extragenou pyrogen
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Endogenou pyrogen(EP)

• interleukin-1(IL-1)
  MC,fibroblast
• IL-6T,B lymphocyte,tumor
  cell
• TNF
• TNFa Mf
• TNFß (lymphotoxin)
  active T
• interferon ( IFN ) T
  lymphocyte

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Producing and releasing of EP
trigger NF-?B
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sCD14
LPS sCD14 complexes
T
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• ??Mechanism increase of set point
• 1.the pathway EP entry temperature
• center

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Pathways of EP signal transduction to the
thermoregulation center

• a. blood brain barrier

Cell of Producing EP
Activator
EP
Activator
Activator
Activator
blood brain barrier
SP?
T?
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• a.OVLT(organum vasculosum laminace terminalis)

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• O V L T
• 
  MC
• capillary
• POAH EP
• neuron
• third ventricles of brain
• optic chiasma

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• c. vago
• 2.The mechanism increase of set point
• a. Warm sensitive neuron thermolysis
• b. Cold sensitive neuron thermogenesis

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• Imbalance
• Normal
• warm sensitive neuron
• cold sensitive neuron

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Thermoregulation mechanism of fever

• ?. Thermoregulation center
• 1. The positive regulation
• preoptic anterior hypothalamus, POAH
• 2. The negative regulation
• medial amygdaloid nucleus,MAN
• ventral septal area,VSA

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Positive regulation mediators

• 1.PGE2 warm sensitive neuron
• cold sensitive neuron
• Effective medicineAsprin,buprofen (Fenbid)
• 2.CRH(corticotrophin releasing hormone)
• EP (IL-1ß, IL-6 ) CRH media fever
• TNFa, IL-1 a PGE2 media fever

SP
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• 3. cAMP SP
• EP hypothalamus Na /Ca2
  cAMP
• 
  SP
• 4. Na /Ca2
• 5. NO
• a. Activate metabolism Brown fat
• b. Inhibit Negative regulation mediators
• c. OVLT
• POAH T

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Negative regulation mediators

• Negative feedback
• Febrile ceiling lt 42?
• endogenous cryogens
• AVP
• a-MSH

T center
T
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??period and metabolism of fever

• The period of febrile
• 1.the fervescence period
• characteristic thermogenesisgtthermolysis
  
• chill
• brown adipose
  tissue(scapula
• 
  ,large vessle of thoracicand
• 
  cervical
• metabolic rate

Thermogenesis
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Manifestation

• pale , gooseflesh, chill
• warm sensitive neuron (POAH)
• Chill center
• Chill cold sensitive neuron (POAH)
  cold stimuli
• Chill center
• Chill
  skin T

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• Chill
• Rubro nucleus
• Lateral spinothalamic tract
• Rubrospinal tract Reticulospinal tract
• anterior motor cells

Up
Down
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2.the persistent febrile period

• The temperature reaches the new set
  point
• ? Thermogenesis thermolysis
• SP on higher level
• ?Manifestation
• febrile , headache
• metabolic rate and pulse
  rate
• anorexia(??)

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3.The defervescence period

• ? characteristic
• Thermogenesis lt thermolysis
• SP is reset to the normal level
• ? Manifestation
• the skin is warm and flush, sweat

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• fervescence persistent
  defervescence
  
  
  set point period period
  period
• 
  39?
  
  
• 38? T
• 37?
• 
  time

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metabolism change of fever

• 1. Glycometabolism
• Glycogenolysis Glycogen storage
• 2. Fat metabolism
• lipodieresis Fat storage
• Ketosis??
  magersucht
• 3. proteometabolism
• Protein catatabolism, negative nitrogen
• 4. water\eletrolyte metabolism\vitamin

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• metabolism
• T 1 ? metabolism rate 13
• acute phase response
• WBC

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Physiological changes

• 1.CNS headach , dizzy,drowsiness,
• febrile convulsion 24h
• inheritance
• hypoxia
• discharge

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• 2.immunity system
• IL-1 activator of lymphocyte
• IL-6differentiation factor
• IFN humoral factor
• TNF anti-tumor

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• 3.Digestion system
• Sympathetic digestive
  juice
• EP hypothalamus
• nauseated,vomit
• abdorminal
  distention
• constipation

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• 4. circulation system
• HR 1 ? HR 18/min
• CO
• induce heart failure
• 5. Respiratory system

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• ??principal of treatment
• 1.medicine
• Inhibit production of pyrogen glucocorticoid
  inhibit IL-6 and TNF
• Inhibit production of PGs
• salicylic mezolin
• 2. physics brain
• 1g water 2.5KJ(lose)

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Advantage and disadvantage

• 1.disadvantage
• 2. Advantage
• Signal
• malaria

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Case

• A 36-year-old man, One day prior to admission
  he was made worse by headach ,dizzy,aching pain
  and fever.
• Check
• T 39?,P100/min,R 20/min,Bp 100/70mmHg,congestion
  of throat,swelling of tonsil,respitatory
  rudeness,no bubbling sound

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Lab findings

• WBC13.3109/L,lymphocyte
• 16, neutrophil 83?
• Treatment
• He was given antibiotic.
• During transfusion, the patient suffer from
  chilly, shake, dysphoria and tempreture rose to
  T41.3?,
• P120/min, R 24/min,
• Dexamethasone intravenous injection

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Questions

• 1.What pathogenic mechanism account for this
  patients fever?
• 2.Why the patient shown chilly , shake, dysphoria
  and tempreture rose more?
• 3.How to treat and give medical order of nursing?

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