1. Fever

3. Normal rectal temperature 36.9~37.9 C
Axillary temperature 36~37 .0 C
Sublingual temperature 36.7~37.7 C
rectal temperature 36.9~37.9 C

4. 一、  Concept
pyrogen set point of the thermoregulatory center body temperature

5. T sport physiological T pregnancy luteal phase hyperthermia
pathological T （set point ±）
fever T

6. Hyperthermia :
thermogenesis
thermolysis
dysfunction of thermoregulatory center

7. 二、 Causes and pathogenesis of fever
Pyrogen and activator of fever
Activator : the substance can activate the cells that can produce the pyrogen.
pyrogen: the substance can cause fever

8. Activators of fever pyrogen G+ peptidoglycan virus: enveloped virus
microbe: G- LPS, ET
G+ peptidoglycan
virus: enveloped virus
particle:transfuse response
2. internal production
immune complexes
etiocholanolone
1. Extragenou
pyrogen

9. Endogenou pyrogen(EP)
interleukin-1(IL-1) :MC,fibroblast
IL-6:T,B lymphocyte,tumor cell
TNF :
TNFα Mφ
TNFβ (lymphotoxin) active T
interferon ( IFN ): T lymphocyte

11. Producing and releasing of EP
LPS joint pro
LPS
cell of producing EP
Toll receptor
Start transcription ,EP express
trigger NF-κB

12. LPS joint pro
sCD14
LPS
LPS –sCD14
complexes T

13. 三、Mechanism : increase of set point
1.the pathway: EP entry temperature
center

14. Pathways of EP signal transduction to the thermoregulation center
a. blood brain barrier
Cell of
Producing EP
Activator EP
Activator
Activator
Activator
blood brain barrier
Thermoregulation
center T
SP

15. a.OVLT(organum vasculosum laminace terminalis）

16. O V L T MC
capillary
POAH EP
neuron
third ventricles of brain
optic chiasma

17. c. vago:
2.The mechanism: increase of set point
a. Warm sensitive neuron: thermolysis
b. Cold sensitive neuron: thermogenesis

18. Imbalance:
Normal:
warm sensitive neuron
cold sensitive neuron

19. Thermoregulation mechanism of fever
一. Thermoregulation center
1. The positive regulation
preoptic anterior hypothalamus, POAH
2. The negative regulation
medial amygdaloid nucleus,MAN
ventral septal area,VSA

20. Positive regulation mediators
1.PGE2: warm sensitive neuron
cold sensitive neuron
Effective medicine:Asprin,buprofen (Fenbid)
2.CRH(corticotrophin releasing hormone)
EP (IL-1β, IL-6 ) CRH media fever
TNFα, IL-1 α PGE2 media fever SP

21. 3. cAMP : SP
EP hypothalamus: Na+ /Ca cAMP SP
4. Na+ /Ca :
5. NO:
a. Activate metabolism Brown fat
b. Inhibit Negative regulation mediators
c. OVLT
POAH T

22. Negative regulation mediators
Negative feedback:
Febrile ceiling: < 42℃
endogenous cryogens
AVP
α-MSH
T center T

23. 四、period and metabolism of fever
The period of febrile:
1.the fervescence period
characteristic: thermogenesis>thermolysis
chill
brown adipose tissue(scapula
,large vessle of thoracicand
cervical
metabolic rate
Thermogenesis

24. Manifestation: pale , gooseflesh, chill warm sensitive neuron (POAH)
Chill center
Chill cold sensitive neuron (POAH) cold stimuli
Chill skin T
Chill center

25. Lateral spinothalamic tract Rubrospinal tract Reticulospinal tract
Chill
Rubro nucleus
Lateral spinothalamic tract
Rubrospinal tract Reticulospinal tract
anterior motor cells Up
Down

26. 2.the persistent febrile period
The temperature reaches the new set point
★ Thermogenesis = thermolysis :
SP on higher level
★Manifestation:
febrile , headache
metabolic rate and pulse rate
anorexia(厌食) ※

27. 3.The defervescence period
★ characteristic:
Thermogenesis < thermolysis
SP is reset to the normal level
★ Manifestation:
the skin is warm and flush, sweat

28. fervescence persistent defervescence set point period period period
39℃
38℃ T
37℃
time

29. metabolism change of fever
1. Glycometabolism
Glycogenolysis Glycogen storage
2. Fat metabolism
lipodieresis Fat storage
Ketosis酮症 magersucht
3. proteometabolism
Protein catatabolism, negative nitrogen
4. water\eletrolyte metabolism\vitamin

30. metabolism
T ℃ metabolism rate %
acute phase response
WBC

31. Physiological changes:
1.CNS: headach , dizzy,drowsiness,
febrile convulsion: 24h
inheritance
hypoxia
discharge

32. 2.immunity system
IL-1: activator of lymphocyte
IL-6：differentiation factor
IFN: humoral factor
TNF: anti-tumor

33. 3.Digestion system
Sympathetic digestive juice
EP hypothalamus
nauseated,vomit
abdorminal distention
constipation

34. 4. circulation system
HR ℃ HR /min CO
induce heart failure
5. Respiratory system

35. 四、principal of treatment 1.medicine
Inhibit production of pyrogen: glucocorticoid: inhibit IL-6 and TNF
Inhibit production of PGs:
salicylic mezolin
2. physics: brain
1g water KJ(lose)

36. 50%
1~2%

37. Advantage and disadvantage
Signal:
malaria

38. Case
A 36-year-old man, One day prior to admission he was made worse by headach ,dizzy,aching pain and fever.
Check:
T 39℃,Ｐ100/min,R 20/min,Bp 100/70mmHg,congestion of throat,swelling of tonsil,respitatory rudeness,no bubbling sound

39. Lab findings: WBC：13.3×109/L,lymphocyte 16%, neutrophil 83%。
Treatment:
He was given antibiotic.
During transfusion, the patient suffer from chilly, shake, dysphoria and tempreture rose to Ｔ41.3℃,
Ｐ120/min, R 24/min,
Dexamethasone intravenous injection

40. Questions
1.What pathogenic mechanism account for this patient`s fever?
2.Why the patient shown chilly , shake, dysphoria and tempreture rose more?
3.How to treat and give medical order of nursing?