Fever does not cause brain damage, hearing loss, blindness, etc.

But doesn’t fever cause confused thinking, delirious behavior, as if dreaming processes are going while one is more
or less awake? Can anyone explain what’s going on then?

Welcome to the blog! (forgive me if you’ve been here a while, I’m not very good at remembering everyone who comments) I’m sure we on this blog (readers and writers alike) are all pleased that the information provided on this blog has been of benefit.

I appreciate your replies. The topic of fever generally puts a bad taste in my mouth due to the emotionally traumatic experience I had with my daughter. But this post actually makes me feel much better about fever in general. I have no medical background, so I come only from the vantage point of “concerned mother.” If our pediatrician had, even once, discussed the actual physiology of fever (along with the fact that it is nothing to fear), I would have spent all those fever-filled nights sleeping soundly instead of getting up every couple of hours to check temperatures. Without that information from the pediatrician, all I had to go on was a lifetime of television shows, movies, and books that fueled my fever phobia.

It would also be helpful if some certain deadly diseases did not end in “Fever.” That does nothing to assuage fever phobia for the masses. ;o)

http://daedalus2u.blogspot.com/2008/01/resolution-of-asd-symptoms-with-fever.htm l

and mitochondria destruction.

http://daedalus2u.blogspot.com/2008/06/mechanism-for-mitochondria-failure.html

The symptoms of Reyes Syndrome are characteristic of mitochondria destruction. Fatty liver, fatty kidney, ammonia elevation, encephalopathy.

In the context of a fever or other immune system activation, the body raises NO levels. In the case of sepsis, NO levels are raised so high that the high NO by itself can cause death through hypotension. NO levels may get as high as a 10 nM/L (yes, 10 nM/L is an extremely high NO level) in the blood stream. The reason physiology does this is to prevent bacteria in the blood stream from forming a biofilm in the vasculature. As bad as bacteria in the blood is, if they form a biofilm it is ~100 times worse.

During sepsis, the NO level outside the vasculature gets even higher (hemoglobin in the blood is the sink for NO, and is the lowest NO level (normally)). This very high NO level has the effect of raising the ATP level through their combined action on sGC. This very high ATP level has the effect of shutting down mitochondria (which is good because mitochondria can’t function in a high NO environment). This high level of ATP is produced through glycolysis. Physiology also makes you feel weak and crappy. Feeling weak and crappy are important “features” so that you lie in bed and don’t do anything that might consume ATP. What causes the multiple organ death of sepsis (my hypothesis) is when physiology is unable to sustain ATP levels through glycolysis (usually because of lack of glucose after cachexia cannot be sustained) so ATP levels fall and mitochondria turn on in a high NO environment with irreversibly destroys them. If enough mitochondria in a tissue compartment are destroyed, the result is organ failure and death.

I suspect that a lot of the function of fever is as a signal to each cell to upregulate heat shock proteins which serve to keep the human cells in proteins from denaturing. Viral proteins are very likely less resistant, and there may be human protein-viral protein interactions which lead to degradation of the viral proteins.

Feeling weak and crappy are important signals to tell you to not use ATP on things less important than staying alive. Blocking those signals lets you use ATP for less important things. If you exceed your capacity to produce ATP through glycolysis, you are setting yourself up for multiple organ failure (my hypothesis).

A doctor should educate patients and parents to direct their concern to important warning signs of an illness. Once the type of illness becomes clear, I often ask the parents or the patient to stop taking the temperature. We should focus on the patient’s comfort level, level of consciousness, respiratory and fluid status. Treat the patient, not the thermometer.

Ibuprofen and acetaminophen are fine if there is significant pain or discomfort, if used reasonably. If we focus on dosing medications according to the number on the thermometer, we will use far too much medication and lose focus on the above important signs and symptoms.

An ill child is not necessarily healthier when the temperature is 99, nor is an ill child necessarily sicker when it fluctuates up to 102.

Absolutely. I always recommend treating symptomatic fever. Any potential benefit of fever is likely minimal and the acetaminophen and ibuprofen are very safe medications. Nothing is without risk but still the risks are quite low. I didn’t include this in my post, but there is a newish trend to give acetaminophen (paracetamol) at the same time as ibuprofen. This is not supported by evidence of safety or increased efficacy. It is also not recommended to alternate them. There are benefits and risks with each. Tylenol probably kicks in faster and motrin probably works a little longer. But tylenol when overdosed can destroy the liver and motrin, especially when given to a dehydration kid, can ding the kidneys pretty bad. I generally recommend tylenol as first line for fever, and ibuprofen when the issue is more pain/inflammation such as with a bad pharyngitis. Tylenol can be given to kids of any age while ibuprofen should not be given to kids under 6 months.

I feel uneasy about a present trend to use other NSAIDS in young children with fever. This is advertised on TV locally, and a paediatrician advised my daughter-in-law to use ibuprofen in conjunction with paracetamol, leading to a bit of a family squabble. Any thoughts?

“I disagree with those recommendations but it is hard to have a easy set that takes into account different ages and multiple variables so many folks go with being over cautious. But then again those recs are not cautious enough in some ways. It is just too nuanced an issue.”

Thanks for the response. My 4 month old had his checkup today and I mentioned this post and we discussed it. He said, except for infants under 3mos old, the temperature doesn’t matter, just how long the fever has been lasting. He said if it has been going for 5 days, then you really need to see a doctor. He agreed with the 100.4* for infants under 3mos.

I’m not sure of the sources, but my professor gave us those recommendations from the point of view that if we were a retail pharmacist and someone comes in asking for fever medicine, these are the parameters when we should recommend a doctor visit, as opposed to self-care (OTC’s, etc.)

Not for coughing, but an effective home treatment for sore throats is cayenne pepper sprinkled in a hot drink. As I understand it, it has an anti-inflammatory effect, plus the brief burn from the pepper distracts you from the pain in your throat, making it feel better afterwards. It’s particularly good in hot chocolate, which was actually part of the original recipe in South America (albeit without sugar back then, meaning it was bitter and spicy).

Thank you all for the responses regarding aspirin. It’s one of those things where, on one hand, I couldn’t find any research results supporting the link past that initial one, but on the other hand, it had the feel of a “modern medicine is so smug that it forgot to actually check its results” story. I suppose that even a very minor link would be enough to contraindicate it, although the very low risk level means that parents who slip up shouldn’t beat themselves up for it (it reminds me of the cases of moderate alcohol consumption during pregnancy, or marrying your first cousin. Neither has a significant negative effect, but people avoid them anyhow because a) they’ve been told all of their life that it’s a horrible thing to do with the risks blown out of proportion, and b) it is a risk, however minor, and it’s easier to skip those steps than more rigorous practices such as proper nutrition and regular exercise.

cough medicine = bad; honey = good as long as over a year of age

Thermometer stickers = useless unless your child is also a fish tank

Jim Henson didn’t die of strep throat, he died of group a strep sepsis from what looks like group a strep pneumonia, an uncommon but often very severe form of community acquired pneumonia. I don’t have much info to be honest but he might have had Lemierre’s. I’m just shootin’ from the hip though and would need to dig. His case should not be a reason for a parent to fear strep throat. Fine, my next post will be on this…..maybe. I want to write about the 2nd most useless test in medicine really bad though. What is the first most useless you ask? The APGAR. My apologies Virginia.

@ The Dave, I disagree with those recommendations but it is hard to have a easy set that takes into account different ages and multiple variables so many folks go with being over cautious. But then again those recs are not cautious enough in some ways. It is just too nuanced an issue.

Maybe I should have said, the Ped office always sends the strep test out for the more reliable test and calls with the result two to three days later.

*Actually, I shouldn’t gripe about the kids, they do actually work hard in school. I just wish they would pick up their socks.

In any event, a negative rapid strep test actually has a low enough negative predictive value that it warrants a more thorough culture to be sure it isn’t strep and then treat with Abx if positively diagnosed. You have about 10 days from the onset of symptoms to treat and prevent rheumatic fever. But with ~30% false negatives from the rapid test, we still recommend doing a confirmatory test since the sequelae of RF are not worth it. A positive test is enough to treat though, which is why we use still use it as an effective first cheap screen.

Our pediatrician recommended warms water with lemon and honey for a cough. Very hard to overdose, gets them some liquids, is a bit soothing and cuts down on the sense parental helplessness.

*The medicines, not the children…although actually the children don’t work much either.

That said, I’ve never called a doctor in the middle of the night for anything. We have a good after hours clinics and pediatric ER, if I felt a child was in danger from an illness, I would take them there. And if the doctor runs a strep test and it’s negative, I’m good. I don’t fuss for antibiotics for a negative strep result. So maybe I’m not that phobic.