Acute Fever (DDX)

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Definition

Defined as Temp >37.8 C (100.4 F)

>41.0 C (105 F) needs urgent Tx (damage neurons)


DDX

A. Infectious 

    1) Critical
  • Sepsis
  • PNA w/ resp failure
  • Peritonitis
  • Meningitis
  • Cavernous sinus thrombosis
  • Necrotizing fasciitis
    2) Emergent
  • PNA
  • Peritonsillar abscess
  • Retropharyngeal abscess
  • Epiglottitis
  • Endocarditis
  • Pericarditis
  • Appendicitis
  • Cholecystitis
  • Diverticulitis
  • Intra-abdominal abscess
  • Pyelo
  • Tubo-ovarian abscess
  • Encephalitis
  • Brain abscess
  • Cellulitis
  • Abscess
  • Malaria
    3) Non-emergent
  • OM
  • Sinusitis
  • Pharyngitis
  • Influenza
  • Tb
  • UTI
  • Epididymitis
  • Prostatitis

B. Non-infectious 

    1) Critical
  • AMI
  • PE
  • Intracranial hemorrhage
  • CVA
  • NMS
  • Thyroid storm
  • Acute adrenal insufficiency
  • Transfusion Rx
  • Pulmonary edema
  • Heatstroke
  • Malignant hyperthermia
    2) Emergent
  • CHF
  • Dehydration
  • Recent Seizure
  • Sickle cell dz
  • Transplant rejection
  • Pancreatitis
  • DVT
  • Serotonin Syndrome
   3) Non-emergent
  • Drug fever (except as in NMS, Serotonin syndrome)
  • Malignancy
  • Gout
  • Sarcoidosis
  • Crohn's dz
  • Postmyocardiotomy sy


DDx by Heart Rate

Fever 0.55 C increases HR ~10bts/min

A. Relative bradycardia

  • Concomitant medication
  • Drug fever
  • Typhoid
  • Brucellosis
  • Leptospirosis

B. Frank bradycardia

  • Rheumatic fever
  • Lyme dz
  • Viral myocarditis
  • Endocarditis


Source

2/26/06 DONALDSON (adapted from Rosen)

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