TEMPERATURES

Temperatures are present in many conditions ranging from common colds to septicaemia (blood infections). The raised temperature is caused by the body's response to infection rather than the infection itself. In many ways it is a sign of a robust response by the body since the elderly and frail can get quite sick without a temperature.

When to worry? Rapid temperature rises in a few children under five can cause fits though most children don't get this. It is a reason though to try very hard to keep temperatures down in this age group. In the over fives the temperature itself isn't the worry so much as what might be causing it. Most temperatures are due to relatively mild viral infections and are self-limiting However in the following cases you should seek advice from the doctor on call:

• Recent return from a malaria zone - even if your plane just stopped there to refuel.
• Recent contact with a serious infectious illness such as meningitis.
• Splenectomy and other conditions affecting immunity such as cancer treatment and HIV.
• Feeling generally ill with symptoms such as severe headache, productive cough, abdominal pains, drowsiness, confusion etc. This may just be a flu-like illness but if you are worried talk it through with the doctor on call so that a decision can be made as to whether you need a visit.

Treatment.

• Symptomatic treatment to lower the temperature. It could be argued that a raised temperature is a natural response to infection and shouldn't be interfered with however in the very young there is a risk of convulsion with a rapidly rising or high fever and this makes it very important to treat it promptly. With older children and adults high fevers are very unpleasant and can even cause delerium, hallucinations etc.
  • Paracetamol, aspirin and non-steroidals such as ibuprofen (Nurophen, Brufen) are all effective but for most patients - and especially for the under twelves who shouldn't take aspirin - paracetamol is the main drug. It probably works by resetting the body's thermostat.
  • Stripping the patient off and keeping the room cool with a flow of air is also important. Our mothers and grandmothers might have advocated the opposite in the past, especially since feverish people often complain of feeling very cold, but we now know that for babies especially wrapping up warm in this situation is potentially quite dangerous with a possible link to cot death.
  • Tepid sponging and tepid baths can be helpful - note not cold sponging and bathing which is very unpleasant and may provoke an opposite response to raise the temperature
• Specific treatment. Most fevers are due to self-limiting viruses and need no specific treatment at all but some specific illnesses may need antibiotic therapy. In most cases this can wait till normal hours but if the patient seems very unwell or has additional symptoms beside the temperature and a few "aches and pains" then ring to seek advice as to what to do.

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