irregular heat
Introduction
Introduction Irregular heat means that the range of body temperature fluctuations during fever is extremely irregular, the duration is not necessarily, and the body temperature curve is irregular. The body temperature is usually around 38 ° C or fluctuates between 37 and 40 ° C. Clinically seen in a variety of diseases, such as respiratory infections, mycoplasmal pneumonia, tuberculosis, pleurisy, infective endocarditis, rheumatic fever, leukemia, etc., can also be seen in the interference of drugs or physical cooling. Generally, there is no need to rush to cool down. You should look for the cause of fever and deal with it as appropriate.
Cause
Cause
Irregular heat is clinically common in influenza, bronchial pneumonia, exudative pleurisy, subacute bacterial endocarditis, rheumatic fever, falciparum malaria, tuberculosis; when lobar pneumonia causes complications such as empyema and sepsis, heat The type can be changed from the heat of recovery to the heat of relaxation to form an irregular heat type. In addition, fever patients use certain drugs, such as antipyretic analgesics, adrenocortical hormone drugs cause fever, can make the original heat type into an irregular heat type.
Examine
an examination
Related inspection
Body temperature measurement
In the clinical, when you see irregular heat, you must first look at the history, symptoms and signs of infection, identify influenza, bronchial pneumonia, exudative pleurisy, subacute bacterial endocarditis, rheumatic fever, falciparum malaria, tuberculosis Irregular fever caused by the second; to check blood routine, chest X-ray examination, sputum bacteria test and rheumatism test, tuberculin test, etc. to determine the cause and severity of irregular heat, for the next treatment Provide evidence.
Diagnosis
Differential diagnosis
(1) The heat of detention
The temperature of the retained hot body is usually above 39 °C. The range of body temperature changes during the night is small. Generally, the body temperature in the morning is lower than that in the afternoon, but the variation within 24 hours does not exceed 1 °C. This type of heat can last for several days or weeks, and the fever can gradually decrease. Retreat or retreat. It is common in the extreme stages of acute fever such as lobar pneumonia, intestinal typhoid, typhus, and tsutsugamushi.
(2) Relaxation heat
The temperature of the relaxation heat is different. The body temperature fluctuation range is large between day and night. The body temperature can be above 39 °C during fever, and the body temperature difference is 1.5 °C ~ 2.0 °C or more within 24 hours, but the lowest temperature is still above normal body temperature. Clinically common in sepsis, severe tuberculosis, sepsis, liver abscess, bronchial pneumonia, subacute bacterial endocarditis, rheumatic fever, typhoid fever, malignant histiocytosis.
(3) Intermittent heat
Intermittent hot body temperature can suddenly reach as high as 39 ° C or more, first aversion to cold or chills, after a few hours, the body temperature returns to normal, sweating, after a few hours or 1 to 2 days, the body temperature suddenly rises again, repeated attacks, such high fever It alternates with no heat and is called intermittent heat. It is common in malaria, such as vivax malaria or three-day malaria, suppurative focal infection, and pyelonephritis.
(4) Heat consumption
The temperature range of the consumed body temperature is significantly higher than the relaxation heat, and the body temperature difference is between 3 ° C and 5 ° C within 24 hours. Clinically common in sepsis, severe active tuberculosis and so on.
(5) Regression fever (re-heating)
Regression heat means that the body temperature suddenly rises to over 39 °C, and then falls to normal after a few days. After a certain period of time, it re-heats. After several days, it drops to normal again, that is, the high-heat period and the no-heat period last for several days. Periodically alternate with each other, also known as re-heating. It is common in mice to bite heat, or to combine other fevers on the basis of certain febrile diseases.
(6) wavy heat
The body temperature gradually rises to a peak within a few days, then gradually drops to a slight heat or normal temperature, and then re-emerges, the body temperature curve is undulating, called wavy heat. Clinically common in brucellosis, malignant lymphoma, pleurisy, cycle heat and so on.
(7) Reverse heat
In the morning or morning, the body temperature is higher, lower in the afternoon or evening, and the general heat law (lower morning or morning temperature, and higher in the afternoon or evening) is called reverse heat. Clinically common in persistent sepsis, Pseudomonas aeruginosa pneumonia, occasionally seen in patients with tuberculosis. Inverted heat is also not hot during the day, high fever at night, such as filariasis.
(8) Double peak heat
The high-heating temperature curve has two small fluctuations within 24 hours, forming a double peak, called bimodal heat. Clinically common in kala-azar, falciparum malaria, E. coli sepsis, Pseudomonas aeruginosa sepsis.
(9) Dual phase heat
That is, the first heat course lasts for several days, and then after one to several days of the antipyretic period, the second heat process suddenly occurs, and after a few days, the whole heat is completely decomposed, which is called duplex heat. It is clinically common in certain viral infections such as polio, lymphocytic plexus meningitis, dengue fever, measles, smallpox, viral hepatitis and the like.
