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Fever

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Fever

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  1. Fever

  2. Normal Axillary temperature 36~37 .0 C Sublingual temperature 36.7~37.7 C rectal temperature36.9~37.9 C

  3. 一、Concept pyrogen set point of the thermoregulatory center body temperature

  4. sport • physiological Tpregnancy • luteal phase • hyperthermia • pathological T (set point ±) • fever T

  5. Hyperthermia : thermogenesis thermolysis dysfunction of thermoregulatory center

  6. 二、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

  7. Activators of fever microbe: G- LPS, ET G+ peptidoglycan virus: enveloped virus particle:transfuse response 2. internal production immune complexes etiocholanolone 1.Extragenou pyrogen

  8. Endogenou pyrogen(EP) interleukin-1(IL-1) :MC,fibroblast IL-6:T,B lymphocyte,tumor cell TNF : TNFα Mφ TNFβ (lymphotoxin) active T interferon ( IFN ): T lymphocyte

  9. LPS LPS joint pro Toll receptor Start transcription ,EP express cellof producingEP Producing and releasing of EP trigger NF-κB

  10. LPS LPS joint pro sCD14 LPS –sCD14 complexes T

  11. 三、Mechanism : increase of set point 1.the pathway: EP entry temperature center

  12. Thermoregulation center 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 T SP

  13. a.OVLT(organum vasculosum laminace terminalis)

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

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

  16. Imbalance: Normal: warm sensitive neuron cold sensitive neuron

  17. Thermoregulation mechanism of fever 一. Thermoregulation center 1. The positive regulation preoptic anterior hypothalamus, POAH 2. The negative regulation medial amygdaloid nucleus,MAN ventral septal area,VSA

  18. Positive regulation mediators 1.PGE2:warm sensitive neuron cold sensitive neuron Effective medicine:Asprin,buprofen (Fenbid) 2.CRH(corticotrophin releasing hormone) EP (IL-1β, IL-6 ) CRH media fever TNFα, IL-1 α PGE2 media fever SP

  19. 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

  20. Negative regulation mediators Negative feedback: Febrile ceiling: < 42℃ endogenous cryogens AVP α-MSH T center T

  21. 四、period and metabolism of fever The period of febrile: 1.the fervescence period characteristic: thermogenesis>thermolysis chill brown adipose tissue(scapula ,large vessle of thoracicand cervical metabolic rate Thermogenesis

  22. Manifestation: pale , gooseflesh, chill warm sensitive neuron (POAH) Chill center Chill cold sensitive neuron (POAH) cold stimuli Chill center Chill skin T

  23. Up Chill Rubro nucleus Lateral spinothalamic tract Rubrospinal tract Reticulospinal tract anterior motor cells Down

  24. 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(厌食)

  25. 3.The defervescence period ★ characteristic: Thermogenesis < thermolysis SP is reset to the normal level ★ Manifestation: the skin is warm and flush, sweat

  26. fervescencepersistentdefervescence set pointperiodperiodperiod 39℃ 38℃ T 37℃ time

  27. metabolism change of fever 1. Glycometabolism Glycogenolysis Glycogen storage 2. Fat metabolism lipodieresis Fat storage Ketosis酮症magersucht 3. proteometabolism Protein catatabolism, negative nitrogen 4. water\eletrolyte metabolism\vitamin

  28. metabolism T 1 ℃ metabolism rate 13% acute phase response WBC

  29. Physiological changes: 1.CNS: headach ,dizzy,drowsiness, febrile convulsion: 24h inheritance hypoxia discharge

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

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

  32. 4. circulation system HR 1 ℃ HR 18/min CO induce heart failure 5. Respiratory system

  33. 四、principal of treatment 1.medicine Inhibit production of pyrogen: glucocorticoid: inhibit IL-6 and TNF Inhibit production of PGs: salicylicmezolin 2. physics: brain 1g water 2.5KJ(lose)

  34. 50% 1~2%

  35. Advantage and disadvantage 1.disadvantage 2. Advantage Signal: malaria

  36. Case A 36-year-old man, One day prior to admission he was made worse byheadach ,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

  37. Lab findings: WBC:13.3×109/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

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