What is the treatment for fever, chills, and abdominal pain?

Immediate Medical Evaluation Required - Do Not Self-Prescribe

You need urgent medical evaluation in an emergency department or urgent care facility immediately, as fever, chills, and abdominal pain represent a potentially serious condition requiring diagnostic workup before any treatment can be safely prescribed. 1

Why Immediate Evaluation is Critical

The combination of fever, chills, and abdominal pain has a broad differential diagnosis that includes life-threatening conditions requiring different treatments:

• Common serious causes include acute cholecystitis, appendicitis, diverticulitis, pancreatitis, bowel obstruction, intra-abdominal abscess, spontaneous bacterial peritonitis (in those with liver disease), and perforated viscus 1
• Approximately one-third of patients presenting with abdominal pain never have a diagnosis established without imaging, one-third have appendicitis, and one-third have other documented pathology 1
• Fever with abdominal pain raises clinical suspicion for intra-abdominal infection or abscess requiring immediate surgical or medical attention 1

What Will Happen at the Emergency Department

Diagnostic Workup Required Before Treatment

Initial evaluation must include:

• Physical examination focusing on abdominal tenderness, rebound, guarding, and location of pain 1
• Complete blood count with differential to assess for infection and white blood cell count 1
• Comprehensive metabolic panel to evaluate organ function 1
• Blood cultures if infection is suspected 1
• Urinalysis and urine culture to exclude urinary tract infection 1

Imaging is essential for diagnosis:

• CT scan of abdomen and pelvis with IV contrast is the preferred initial imaging modality for nonlocalized abdominal pain with fever, as it changes the leading diagnosis in 51% of patients and alters admission decisions in 25% of cases 1
• CT is superior to plain radiographs, which have limited sensitivity for detecting sources of abdominal pain and fever 1
• Ultrasound may be appropriate for suspected cholecystitis or in pregnant patients 1

Why Self-Prescribing is Dangerous

Empirical antibiotics should only be started after appropriate cultures are obtained and only if there is strong suspicion for infection, particularly in the presence of hemodynamic instability 1

• Delaying diagnosis by masking symptoms with medications can worsen outcomes, as mortality increases by 10% for every hour's delay in initiating appropriate antibiotics in septic patients with cirrhosis 1
• Different conditions require completely different treatments: surgical intervention for appendicitis or perforated viscus, antibiotics for spontaneous bacterial peritonitis, drainage for abscess 1
• Acetaminophen 2 may temporarily reduce fever but will not treat the underlying cause and may delay critical diagnosis

Specific Red Flags Requiring Immediate ER Visit

Seek emergency care immediately if you have:

• Severe or worsening abdominal pain 1
• Inability to keep down fluids, persistent vomiting 1
• Signs of shock: rapid heart rate, low blood pressure, confusion 1
• Abdominal rigidity or severe tenderness 1
• Jaundice (yellowing of skin or eyes) 1

Do not take NSAIDs (ibuprofen, naproxen) if you have any possibility of bleeding disorders, liver disease, or dengue fever, as these increase bleeding risk 3