Treating fever: the controversy in sepsis

There are at least 2 situations, in which we currently treat fever aggressively (independent of the cause): MI, stroke.

In septic patients, caution is advised. There are several theoretical reasons, why treating fever might be counterproductive, as this (german) article suggests. There is even a recent observatory study describing serious (lethal) harm by drug treatment of fever in sepsis. So here is my take on this topic:

  • In stroke and MI use standard guidelines to aggressively treat fever.
  • In your average infected patient, look out for stroke and MI (do a troponin if in doubt); if everything is okay, so is drug treatment.
  • In septic patients, always have a troponin ready. If negative, wait until at least 40° before intervening.

As for the particular drugs, I recommend a slow infusion of paracetamol – at least 1hr. After 1/2h you can start adding external cooling methods.

By the way: how do you mix a lytic cocktail? Any resources on that?

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