Chapter 89 - Fever

Summary

Fever commonly produces tachypnea out of proportion to the increase in metabolic acid production associated with illness, resulting in a respiratory alkalosis that may be profound. The excessive motor activity of generalized convulsions, especially generalized convulsive status epilepticus (GCSE), can raise core temperature. Central stimulant intoxication produces both seizures and hyperthermia. The clinician must distinguish febrile seizures from other types of seizures that may be triggered by fever. There are some epilepsies for which febrile exacerbation is characteristic, such as generalized epilepsy with febrile seizures plus, and severe myoclonic epilepsy of infancy (Dravet syndrome). Lowering the temperature of patients who are markedly febrile in the setting of status epilepticus involves termination of seizure activity as well as external cooling and treatment of any underlying condition producing fever, such as infection. Induced hypothermia is gaining attention as a potential therapy for refractory status epilepticus.