OBIECTIVE

• HOMEOSTAZIA TERMICA
• TEMPERATURA CORPORALA NORMALA
• FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE

• IMPLICATII IN PRACTICA MEDICALA

OBIECTIVE
• HOMEOSTAZIA TERMICA
• TEMPERATURA CORPORALA NORMALA
• FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE

• IMPLICATII IN PRACTICA MEDICALA

OBIECTIVE
• HOMEOSTAZIA TERMICA
• TEMPERATURA CORPORALA NORMALA
• FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE

• IMPLICATII IN PRACTICA MEDICALA

rectala [ > 0.d.orala ] • T. orala ] • T. ORALA • T. axilara [ < 0.9 F) f. t.7 F) f.TEMPERATURA CORPORALA NORMALA Masurare • T. centrala  esofag inferior • T. timpanica .5 C (0.d. t.4 C (0.

TEMPERATURA CORPORALA NORMALA T.9 F • T.7 F • t.7 C / 99.9 F .40 de ani 36. minima .4 C / 98.4 PM = 37.8  0.99% din indivizii sanatosi 18 .2 C / 98. MAXIMA . ORALA .6 AM = 37.2  0.

8 C / 1.d.6 F f. centrala actuala (studii clinice) • variatii foarte mari .afisarea valorii actuale absolute valori < 0.TEMPERATURA CORPORALA NORMALA T. timpanica •mod neajustat . rectala • mod ajustat .afisarea unei valori calculate automat din valoarea absoluta actuala citita pe baza unor nomograme ce coreleaza temperatura radianta masurata cu t. t.

postprandial  febra • lunare .sarcina • sezoniere . t.neconsacrate • cu varsta . febrila > 1 C . (AM) cu 0.6 C / 1 F in etapa progesteronica .recuperare afect.0.9 F .TEMPERATURA CORPORALA NORMALA Variatii fiziologice • circadiene .5 C / 0.

OBIECTIVE • HOMEOSTAZIA TERMICA • TEMPERATURA CORPORALA NORMALA • FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • IMPLICATII IN PRACTICA MEDICALA .

2 C / 98.9 F .FEBRA •  t. > limitelor de variatie fiziologice > 37.9 F .AM > 37.7 C / 99. de referinta hipotalamice set-point -ul HT: normotermic  febril PASTRAREA TERMOREGLARII .PM + •  t.

OBIECTIVE • HOMEOSTAZIA TERMICA • TEMPERATURA CORPORALA NORMALA • FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • IMPLICATII IN PRACTICA MEDICALA .

NU supranormale ..t. > 41. ambientale .HIPERPIREXIA •  t. / functionale HT .mediat de neuropeptide antipiretice • FEBRA HIPOTALAMICA / CENTRALA .malfunctie HT . corporale subnormale.raspuns anormal / brusc la modificari minime ale t.leziuni anat.lipsa variatiilor circadiene .5 C / 106.7 F „plafon termic“ .

OBIECTIVE • HOMEOSTAZIA TERMICA • TEMPERATURA CORPORALA NORMALA • FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • IMPLICATII IN PRACTICA MEDICALA .

 productiei endogene de Q • PIERDEREA CAPACITATII DE TERMOREGLARE • ABSENTA VARIATIILOR CIRCADIENE . externe .expunerea la t. centrala de referinta = nemodificata set-point HT = normotermic + •  necontrolata a t.HIPERTERMIA • t. corporale > capacitatea de termoliza .

neconditionate .imbracaminte neadecvata . in timpul „valurilor de caldura“ . anticolinergice.tineri . medicamente • clasic (nonextertional) . antiparkinsoniene .efort fizic intens .varstnici.medicamente:diuretice.HIPERTERMIA SOCUL CALORIC / HEAT STROKE • prin suprasolicitare (extertional) .mediu excesiv de cald / umed .spatii neventilate.

cocaina .inhibitori MAO .dietilamina acidului lisergic (LSD) .amfetamine • STUPEFIANTE .antidepresive triciclice .HIPERTERMIA INDUSA MEDICAMENTOS • PSIHOTROPE .phenciclidina .

rhabdomioliza .rigiditate mm. .instabilitate cardiovasculara . scheletici   rapida a Ca++ ic dupa halotan / anestezice inhalatorii . metabolismului muscular .HIPERTERMIA MALIGNA • indivizi cu anomalii ereditare ale RS mm.acidoza .hipertermie .

anomalii SNV • inhibarea rec. . haloperidol) .hipertermie .HIPERTERMIA SINDROMUL NEUROLEPTIC MALIGN (fenotiazine.rigiditate mm. dopaminergici HT .

HIPERTERMIA ENDOCRINOPATII • feocromocitomul • tirotoxicoza .

tricyclic dibenzodiazepines. thiothixene. butyrophenones. including antihistamines. Causes of Hyperthermia Syndromes Heat stroke Exertional: Exercise in higher-than-normal heat and/or humidity Nonexertional: Anticholinergics. phenothiazines Drug-induced hyperthermia Amphetamines. loxapine.Table 17-1. monoamine oxidase inhibitors. antiparkinsonian drugs. domperidone. diuretics. succinylcholine Endocrinopathy Thyrotoxicosis Pheochromocytoma . tricyclic antidepressants. LSD Neuroleptic malignant syndrome Phenothiazines. including haloperidol and bromperidol. fluoxetine. metoclopramide. molindone Malignant hyperthermia Inhalational anesthetics. cocaine. phencyclidine.

including antihistamines. molindone. hypothalamic injury . loxapine. salicylates. including haloperidol and bromperidol.Heat Stroke Exertional: Exercise in higher-than-normal heat and/or humidity Nonexertional: Anticholinergics. fluoxetine. antiparkinsonian drugs. tricyclic dibenzodiazepines. lithium. phencyclidine (PCP). thiothixene. butyrophenones. phenothiazines Drug-Induced Hyperthermia Amphetamines. diuretics. cocaine. metoclopramide. pheochromocytoma Central Nervous System Damage Cerebral hemorrhage. monoamine oxidase inhibitors (MAOIs). "ecstasy"). withdrawal of dopaminergic agents Serotonin Syndrome Selective serotonin reuptake inhibitors (SSRIs). status epilepticus. domperidone. sympathomimetics Neuroleptic Malignant Syndrome Phenothiazines. tricyclic antidepressants Malignant Hyperthermia Inhalational anesthetics. lysergic acid diethylamide (LSD). succinylcholine Endocrinopathy Thyrotoxicosis. anticholinergics. methylenedioxymethamphetamine (MDMA.

clinic (aspectul tegumentelor ) .terapeutic . etiologic greu.anevoios. anamnestic . DAR ESENTIAL .FEBRA # HIPERTERMIE • dg.

OBIECTIVE • HOMEOSTAZIA TERMICA • TEMPERATURA CORPORALA NORMALA • FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • IMPLICATII IN PRACTICA MEDICALA .

MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • RESETAREA TEMPERATURII CENTRALE DE REFERINTA (SET-POINT-UL HIPOTALAMIC) •Set-point-ul HT: NORMOTERMIC → FEBRIL • Termoreglarea se va face avand ca reper aceasta noua temperatura centrala de referinta .

PIROGENII • EXOGENI • ENDOGENI .

toxinele Streptococcus A si B Super Ag .endotoxina G (-) .PIROGENII EXOGENI • agenti infectiosi exogeni (componente.LPZ .enterotoxinele Staphylococcus Aureus .G (+) . produse) Exemple clasice: .

1940 .inducerea febrei din produse de leucocite activate • IL-1 • IL-6 • TNF (Tumor Necrosis Factor) • CNTF (Ciliary Neurotropic Factor) • IFN .PIROGENI ENDOGENI (CITOKINE PIROGENE) .

retea de capilare ce inconjoara c. max.tesutul HT . PGE 2 in : .V III cerebral • conc.PIROGENI ENDOGENI • conc. in organele vasculare circumventriculare OVLT (organum vasculosum al laminei terminalis) . HT al termoreglarii BBB .

artralgii.endoteliul capilarelor din afara SNC  mialgii. maleza .endoteliul capilarelor HT (activarea receptorilor toll-like)  modif. set-point-ului termic HT .endoteliul capilarelor ariei circumventriculare (activarea receptorului EP-3 de la nivelul celulelor gliale → ↑ AMPc = neurotransmitator) .PIROGENI ENDOGENI .sursa PGE 2 : .

.

infectiile SNC . CNTF) → hiperpirexia din – hemoragiile . IL-6.Exista o sursa de CK pirogene si dincolo de BBB ? • celulele gliale / neuronii pot sintetiza CK pirogene (IL-1. TNF.traumatismele .

centrala) .Tipuri de curbe febrile • Febra intermitenta / septica (hectica) • Febra remitenta • Febra cu recadere (relapsing fever) • Febra continua (hipotalamica.

OBIECTIVE •HOMEOSTAZIA TERMICA • TEMPERATURA CORPORALA NORMALA • FEBRA • HIPERPIREXIA • HIPERTERMIA • MECANISMUL FIZIOPATOLOGIC AL REACTIEI FEBRILE • IMPLICATII IN PRACTICA MEDICALA .

TRATAMENTUL FEBREI TRATAM FEBRA ? • Febra   necesitatilor tisulare de O2 :  t cu 1°C >37 °C   consumului de O2 cu 13% • Mijloace fizice • Medicamente antipiretice .

MECANISMUL DE ACTIUNE AL ATIPIRETICELOR .

Sign up to vote on this title
UsefulNot useful