SWAMEDIK

ASI
DEMAM

Fakultas Farmasi Universitas Jember

2020
 DEFINITION
 Fever is defined as a body temperature that is higher than the
normal core temperature of 100F (37.8℃)
 Hyperpyrexia is a body themperature greater than 106f
(41.1℃) that typically results in mental and physical
consequences
Fever / hyperthermia / hyperpyrexia, is it same ???
 Fever  is regulated rise in body temperature maintainated by
the hypotalamus in response to a pyrogen, its sign of an
increase in the body’s thermoregulatory set point
 Hyperthermia  represent a malfunctioning of the normal
thermoregulatory process at the hypothalamic level
 Tahun 2002 EPIDEMIOLOGY
 12.250.000 medical office visits, with men making a slightly greater
number of visits
 1 of 5 emergency room visits for children is related to fever, 19%-30%
of children presenting to their pediatrician’s office have fever as a
complaint. Over all 69,6% of all fever in children younger than 5 years
are referred to a health care provider for medical evaluation; however
only 57,2% of patients with fever in the total population seek medical
care.
 Children have fevers more often than adults do. The rate of reported
fevers in children younger than 5 years is 10 in 100 persons vs the
rate 0,5 in 100 adults.
 In US the rate of fever doesn’t seem to differ significantly when
distinguishing among gender, race, or geographic area of residence
 PATHOPHYSIOLOGY OF FEVER
 Temperature tubuh normal 97,5F – 98,9F (36,4℃ - 37,2℃)
 Core temperature : temperature of the blood that surrounds the hypothalamus, which
may differ form that of the surrounding body or skin temperature.
 Core temperature is regulated by a feedback system that involves information
transmitted between the thermoregulatory center located in the anterior hypothalamus
and the thermosensitive neurons located in the skin and central nervous system (CNS)
 Body temperature is regulated by physiologic and behavioral mechanism.
 Physiologic compensation  heat dissipation (menghilangnya) (sweating,
vasodilatation, hyperventilation in response to heat; heat production or conservation
(shivering (gemetar), goose bumps (merinding) and vasoconstriction) in response to
cold
 Behavioral adaptations  wearing addition clothing, rubbing the hands together,
adjusting air conditioning and seeking shade for relief from the hot sun.
 THERMOREGULASI
 Temperatur normal manusia 37ºC ±
1ºC
 In resting state, metabolic activity of
vital organ contributes 60% (liver 25%;
brain 20%; heart 8%; kidney 7%)total
heat production.
 On exercise muscle can generate up to
90% heat production
 Set point temperature is programmed
THERMOREGULASI in the hypothalamic thermoregulatory
center
GANGGUAN TERMOREGULASI
 High dose ethanol and
barbiturate depress the
termoregulatory center
 Pyrogen elevate the set poin of
the hypothalamic temperature
controller (through mediation PG
or IL1)
 The body responds by restricting
heat loss (cutaneous
vasoconstriction → chills) and by
elevating heat production
(shivering/gemetar), in order to
adjust to the new set point
(fever).
 ETIOLOGY

 Infection
 Idiopathic
 Drug induce hyperthermia
 Illness (ex. Hyperthiroid)
DRUGS INDUCED HYPERTHERMIA
HOW TO FIND OUT IF WE
HAVE A FEVER ??????
CLINICAL
PRESENTATIONS ???
GUIDELINE
THERMOMETER
USED
RECTAL
THERMOMETER
GUIDELINE
PRIMARY OBJECTIVE S OF
TREATING FEVER

 Relieve the discomfort of fever by returning

the body temperature to the normal level
 Prevent complications associated with fever
 M ETER
ER MO
A N IC TH
TYM P
EL I N E
GUID
 AXILLARY
THERMOMETER
TEMPORAL GUIDELINE
THERMOMETER
GUIDELINE
GENERAL
TREATMEN
T
APPROACH

EXCLUSIONS
FOR SELF
TREATMENT
NON PHARMACOLOGIC THERAPY

 Adequate fluid intake  febrile

children 30-60 ml fluid per
hours (sports drinks, fruit juice,
water, ice pops) or 60-120 ml
fluid per hours in adults, unless
fluids are contraindicated
 Wearing lightweight clothing
 Removing blankets, maintaining
room temperature at 78F
(25.6C)
 Sponging ???
 PHARMACOLOGY
THERAPY
Agent Dose (mg/kgBB) Note

Acetaminophen 10-15 mg/kgBB every Max 5 doses per day

4-6 hours

Ibuprofen 5-10 mg/kgBB every Max. 4 doses per day

6-8 hours Some studies have shown that ibuprofen more
effective at higher doses (10 mg/kgBB) especially
when temperature exceed 102,5F (39,2C).
Approve for patient older than 6 month

 Should note be used more than 3 days

 Medication error : overdosing, duplicating therapy, inappropriate dosing for pediatrics
patients (calculating or measuring device)
 Recent study show  30% parents were able to measure an accurate dose of
acetaminophen, 51% received an inaccurate dose medication (62% acetaminophen,
26% ibuprofen
FDA
RECOMENDATION
FOR IMPROVING
SAFETY OF
ANTIPYRETICS
AGENTS
 DRUG-DRUG
INTERACTION WITH
NONPRESCRIPTION
ANALGESIK/ANTIPY
RETICS AGENTS
 PATIENT
COUNSELING
 Improve patient outcomes :
 by educating patient anda caregiver about fever
 By teaching patients self-assessment skills and the
proper method for measuring body temperature and
interpretation
 If patient use mercury in glass thermometer they
should be urged to dispose of them according to
their local environmental standards
 Explain the appropriate nonpharmacologic and
pharmacologic treatment
 EVALUATION OF PATIENT
OUTCOME
 Monitoring temperature and discomfort
 Body temperature should be monitored only
2-3 times a day  to avoid “fever phobia”
 Check associated symptopmp like headache,
diaphoresis, general malaise (rasa tidak
enak), chills (menggigil), tachicardia,
athralgia, myalgia, irritability and anorexia
daily
 If the symptomp are not improving 
contact healtcare provider
PATIENT
EDUCATIO
N FOR
FEVER
KEY
POINTS
TERIMA
KASIH
Parasetamol (Asetaminofen)
 Efektif untuk sakit gigi dan sakit kepala
 Efek antiinflamasi minimal, tdk untuk visceral
pain
 Dimetabolisme lewat konjugasi sulfat atau
glukoronat
 Metabolit reaktif (N-asetil-p-benzoquinonimine)
didetoksifikasi oleh glutation
 ESO : liver damage
 Antidotum : N-asetilsistein

ANTIPIRETIK
ANALGESIK