Acute fever - Revision history

Danbot: Add to Category:Symptoms - common EM chief complaint

2026-03-22T09:41:43Z

Add to Category:Symptoms - common EM chief complaint

← Older revision		Revision as of 09:41, 22 March 2026
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	<references/>		<references/>

			[[Category:Symptoms]]
	[[Category:ID]]		[[Category:ID]]

Danbot: Strip excess bold

2026-03-22T09:38:21Z

Strip excess bold

Danbot: Expand Evaluation, Management, and Disposition sections with EM-focused content and special populations guidance

2026-03-20T23:10:02Z

Expand Evaluation, Management, and Disposition sections with EM-focused content and special populations guidance

← Older revision		Revision as of 23:10, 20 March 2026
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	==Evaluation==		==Evaluation==
	~~See individual notes~~ for ~~specific~~ workup:		===General Approach===
	*[[~~Fever and Rash~~]]		*History: duration, recent travel, sick contacts, immunocompromised status, medications, recent procedures/hospitalizations, indwelling devices
	*[[~~Fever~~ of ~~Unknown Origin~~]]		*Physical exam: systematic search for source — HEENT (sinuses, pharynx, ears, dental), lungs, heart, abdomen, skin/wounds, GU, joints, spine
	*[[Neutropenic ~~Fever~~]]		*Not all fevers require a workup — well-appearing immunocompetent adults with clear viral URI symptoms may need only supportive care
	*[[AIDS ~~Fever~~ of ~~Unknown Origin~~]]		===Workup (when indicated)===
	*[[~~Heat Emergencies~~]]		*'''Basic:''' CBC with differential, BMP, urinalysis, blood cultures (x2 if concern for bacteremia), CXR
	*[[Fever ~~in Traveler~~]]		*'''Additional based on suspicion:'''
			**Lactate, procalcitonin — if sepsis suspected
			**[[Lumbar puncture]] — if meningitis/encephalitis suspected
			**CT imaging — guided by suspected source (abdomen/pelvis for abdominal source, CT chest for pulmonary, CT head if AMS)
			**LFTs, lipase — if hepatobiliary or pancreatic source suspected
			**Joint aspiration — if septic arthritis suspected
			**Wound cultures — if skin/soft tissue infection
			===Special Populations Requiring Lower Threshold for Workup===
			*See [[Pediatric fever of uncertain source]] for infants and children
			*See [[Neutropenic fever]] for oncology patients
			*See [[AIDS fever of unknown origin]] for HIV/AIDS patients
			*See [[Fever in traveler]] for returned travelers
			*See [[Fever and rash]] for fever with associated rash

	==Management==		==Management==
	*~~Consider~~ [[~~tylenol~~]] or [[~~ibuprophen~~]] ~~for fever relief~~		*'''Antipyretics:'''
	*Treat the underlying condition		**[[Acetaminophen]] 650-1000 mg PO/IV q4-6h (max 4g/day)
			**[[Ibuprofen]] 400-800 mg PO q6-8h
			**Antipyretics improve comfort but do not treat the underlying cause
			**Fever itself is generally not harmful in immunocompetent adults (except in [[hyperthermia]] where temperature >41C/106F can cause organ damage)
			*'''Treat the underlying condition:'''
			**Empiric antibiotics if bacterial infection suspected — do not delay for cultures
			**Source control (I&D of abscesses, removal of infected lines/devices)
			**See specific disease pages for targeted management
			*'''Fluid resuscitation:''' Fever increases insensible losses; ensure adequate hydration
			*'''Avoid "fever phobia":''' In immunocompetent patients, aggressive fever treatment is not required and may mask clinical trends

	==Disposition==		==Disposition==
	*~~Depends on underlying etiology~~		*'''Admit:'''
			**Suspected sepsis or bacteremia
			**Immunocompromised with fever (neutropenic fever)
			**Hemodynamic instability
			**Identified source requiring IV antibiotics or surgical intervention
			**Unreliable follow-up with concerning clinical picture
			*'''Discharge:'''
			**Well-appearing with clear viral syndrome
			**Identified source amenable to outpatient treatment (uncomplicated UTI, mild cellulitis)
			**Reliable follow-up with clear return precautions
			**Return precautions: worsening symptoms, inability to tolerate PO fluids, rigors, altered mental status

	==See Also==		==See Also==

Rossdonaldson1: /* See Also */

2025-11-05T19:17:31Z

Rossdonaldson1: /* Definition */

2020-04-29T22:16:14Z

Definition

← Older revision		Revision as of 22:16, 29 April 2020
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	*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.		*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.
	**Rectal or oral		**Rectal or oral
	**Rectal temperatures should not be performed in neutropenic patients		**Rectal temperatures should not be performed in neutropenic patients<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>
	<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>

	==Clinical Features==		==Clinical Features==

Lyssa1219: /* Definition */

2020-04-20T19:11:52Z

Definition

← Older revision		Revision as of 19:11, 20 April 2020
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	===Definition===		===Definition===
	*Defined as [[Celsius Fahrenheit Temperature Conversion\|temperature]] ≥38°C (100.4°F).		*Defined as [[Celsius Fahrenheit Temperature Conversion\|temperature]] ≥38°C (100.4°F).
	*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>		*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.
			**Rectal or oral
			**Rectal temperatures should not be performed in neutropenic patients
			<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Clinical Features */

2018-03-12T01:14:43Z

Clinical Features

← Older revision		Revision as of 01:14, 12 March 2018
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	==Clinical Features==		==Clinical Features==
			*Fever directly causes an increase in:<ref>Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009 Sep;26(9):641-3. doi: 10.1136/emj.2008.061598.</ref>
			**Heart rate: 10 beats per minute per degree centigrade
			**Respiratory rate

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T09:07:35Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 09:07, 23 July 2016
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	**[[Endocarditis]]		**[[Endocarditis]]

	==~~Diagnosis~~==		==Evaluation==
	See individual notes for specific workup:		See individual notes for specific workup:
	*[[Fever and Rash]]		*[[Fever and Rash]]

Rossdonaldson1: /* Management */

2016-04-04T21:46:34Z

Management

← Older revision		Revision as of 21:46, 4 April 2016
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	*Consider [[tylenol]] or [[ibuprophen]] for fever relief		*Consider [[tylenol]] or [[ibuprophen]] for fever relief
	*Treat the underlying condition		*Treat the underlying condition

			==Disposition==
			*Depends on underlying etiology

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2016-04-04T21:46:00Z

Management

← Older revision		Revision as of 21:46, 4 April 2016
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	==Management==		==Management==
			*Consider [[tylenol]] or [[ibuprophen]] for fever relief
			*Treat the underlying condition

	==See Also==		==See Also==

← Older revision		Revision as of 19:17, 5 November 2025
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	*[[Environmental heat diagnoses]]		*[[Environmental heat diagnoses]]
	*[[Fever in traveler]]		*[[Fever in traveler]]

			==External Links==

	==References==		==References==

← Older revision		Revision as of 09:38, 22 March 2026
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	*Not all fevers require a workup — well-appearing immunocompetent adults with clear viral URI symptoms may need only supportive care		*Not all fevers require a workup — well-appearing immunocompetent adults with clear viral URI symptoms may need only supportive care
	===Workup (when indicated)===		===Workup (when indicated)===
	*~~'''~~Basic:~~'''~~ CBC with differential, BMP, urinalysis, blood cultures (x2 if concern for bacteremia), CXR		*Basic: CBC with differential, BMP, urinalysis, blood cultures (x2 if concern for bacteremia), CXR
	*~~'''~~Additional based on suspicion:~~'''~~		*Additional based on suspicion:
	**Lactate, procalcitonin — if sepsis suspected		**Lactate, procalcitonin — if sepsis suspected
	**[[Lumbar puncture]] — if meningitis/encephalitis suspected		**[[Lumbar puncture]] — if meningitis/encephalitis suspected
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	==Management==		==Management==
	*~~'''~~Antipyretics:~~'''~~		*Antipyretics:
	**[[Acetaminophen]] 650-1000 mg PO/IV q4-6h (max 4g/day)		**[[Acetaminophen]] 650-1000 mg PO/IV q4-6h (max 4g/day)
	**[[Ibuprofen]] 400-800 mg PO q6-8h		**[[Ibuprofen]] 400-800 mg PO q6-8h
	**Antipyretics improve comfort but do not treat the underlying cause		**Antipyretics improve comfort but do not treat the underlying cause
	**Fever itself is generally not harmful in immunocompetent adults (except in [[hyperthermia]] where temperature >41C/106F can cause organ damage)		**Fever itself is generally not harmful in immunocompetent adults (except in [[hyperthermia]] where temperature >41C/106F can cause organ damage)
	*~~'''~~Treat the underlying condition:~~'''~~		*Treat the underlying condition:
	**Empiric antibiotics if bacterial infection suspected — do not delay for cultures		**Empiric antibiotics if bacterial infection suspected — do not delay for cultures
	**Source control (I&D of abscesses, removal of infected lines/devices)		**Source control (I&D of abscesses, removal of infected lines/devices)
	**See specific disease pages for targeted management		**See specific disease pages for targeted management
	*~~'''~~Fluid resuscitation:~~'''~~ Fever increases insensible losses; ensure adequate hydration		*Fluid resuscitation: Fever increases insensible losses; ensure adequate hydration
	*~~'''~~Avoid "fever phobia":~~'''~~ In immunocompetent patients, aggressive fever treatment is not required and may mask clinical trends		*Avoid "fever phobia": In immunocompetent patients, aggressive fever treatment is not required and may mask clinical trends

	==Disposition==		==Disposition==
	*~~'''~~Admit:~~'''~~		*Admit:
	**Suspected sepsis or bacteremia		**Suspected sepsis or bacteremia
	**Immunocompromised with fever (neutropenic fever)		**Immunocompromised with fever (neutropenic fever)
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	**Identified source requiring IV antibiotics or surgical intervention		**Identified source requiring IV antibiotics or surgical intervention
	**Unreliable follow-up with concerning clinical picture		**Unreliable follow-up with concerning clinical picture
	*~~'''~~Discharge:~~'''~~		*Discharge:
	**Well-appearing with clear viral syndrome		**Well-appearing with clear viral syndrome
	**Identified source amenable to outpatient treatment (uncomplicated UTI, mild cellulitis)		**Identified source amenable to outpatient treatment (uncomplicated UTI, mild cellulitis)