What to do in case of a sudden spike of fever (pyrexia)?

From the Guidelines

For a sudden spike in fever, take paracetamol (such as acetaminophen) if you have fever and other symptoms that antipyretics would help treat, as recommended by the most recent guidelines 1. When experiencing a sudden spike in fever, it is essential to prioritize symptomatic treatment to reduce discomfort and prevent potential complications.

Key Considerations

• The temperature threshold for initiating antipyretic treatment is higher than 38.5 ℃, as stated in the guideline for the diagnosis and treatment of 2019 novel coronavirus infected pneumonia 1.
• The use of antipyretics should be aimed at relieving symptoms, not solely reducing body temperature, as advised in the guidelines for managing COVID-19 symptoms in the community 1.
• Patients should be advised to drink fluids regularly to avoid dehydration, with a recommended intake of no more than 2 liters per day 1.

Treatment Approach

• Paracetamol is preferred over non-steroidal anti-inflammatory drugs (NSAIDs) for patients with COVID-19, according to the guidelines for managing COVID-19 symptoms in the community 1.
• The dosage and frequency of paracetamol administration should be guided by the patient's symptoms and medical history, with a typical dose ranging from 325-650 mg every 4-6 hours as needed.
• It is crucial to monitor the patient's temperature regularly and seek medical attention if the fever exceeds 103°F (39.4°C), lasts more than three days, or is accompanied by severe symptoms such as headache, stiff neck, persistent vomiting, difficulty breathing, chest pain, confusion, or seizures.

Additional Measures

• Applying a lukewarm compress to the forehead or taking a lukewarm bath can help lower body temperature and relieve discomfort.
• Removing excess clothing or blankets can help prevent overheating and promote a comfortable environment for recovery.
• Rest and hydration are essential for allowing the body to fight the underlying cause of the fever, and patients should be encouraged to prioritize these aspects of their care.

From the Research

Immediate Response to Sudden Spike of Fever

In case of a sudden spike of fever, it is essential to remain calm and take appropriate measures. The following steps can be taken:

• Monitor the patient's temperature closely and record it at regular intervals 2
• Administer antipyretic drugs if possible, as they are the preferred method of reducing temperature 2
• Avoid any procedure that induces shivering, as it can worsen the condition 2

Evaluation of Fever

Fever can be due to various causes, including infectious and non-infectious etiologies 3. A thorough evaluation is necessary to determine the underlying cause. This includes:

• Considering the patient's medical history and physical examination results 3, 4
• Conducting adjunctive tests, such as C-reactive protein, erythrocyte sedimentation rate, and procalcitonin, if necessary 3
• Obtaining blood cultures in cases of septic shock or if the results will change clinical management 3

Special Considerations

In certain populations, such as the elderly and immunocompromised patients, fever may not always be present in true infection 3. Additionally:

• Oral temperatures may not be reliable in diagnosing fever, and core temperatures should be used if concern is present 3
• Non-infectious causes of elevated temperature should be considered based on the clinical situation 3
• Fever of unknown origin (FUO) requires a thoughtful and focused approach to diagnosis, taking into account the patient's history, physical examination, and laboratory results 4

Parental Education and Healthcare Seeking Behavior

Parents often have misconceptions about fever, leading to inappropriate use of medication and non-urgent visits to emergency departments 5. It is essential to educate parents on proper fever management, including:

• The appropriate use of antipyretics and the dangers of overheating 5
• When to seek medical attention and how to communicate effectively with healthcare workers 5