What causes a 104 degree fever. How dangerous is a temperature of 104 degrees Fahrenheit. When should you seek medical attention for a high fever. What are the most effective ways to treat a 104 degree fever at home. How long can a 104 degree fever last safely. What complications can arise from an extremely high body temperature.

Understanding Fever: Definition and Classification

Fever, also known as pyrexia, is a common physiological response characterized by an elevation in core body temperature above the normal set point. The body’s thermoregulatory center in the hypothalamus controls this process. While the average normal body temperature is approximately 37°C (98.6°F), it can fluctuate by about 0.5°C throughout the day due to various factors such as metabolic changes, sleep-wake cycles, hormonal variations, and activity levels.

Fevers are typically classified into categories based on their severity:

• Low-grade fever: 37.3°C to 38.0°C (99.1°F to 100.4°F)
• Moderate-grade fever: 38.1°C to 39.0°C (100.6°F to 102.2°F)
• High-grade fever: 39.1°C to 41°C (102.4°F to 105.8°F)
• Hyperthermia: Greater than 41°C (105.8°F)

A temperature of 104°F (40°C) falls within the high-grade fever category, indicating a significant elevation in body temperature that requires careful monitoring and potential medical intervention.

Causes of a 104 Degree Fever

A fever of 104°F (40°C) can be triggered by various factors, both infectious and non-infectious. Some common causes include:

1. Viral infections (e.g., influenza, COVID-19, dengue fever)
2. Bacterial infections (e.g., pneumonia, urinary tract infections, sepsis)
3. Parasitic infections (e.g., malaria)
4. Inflammatory conditions (e.g., rheumatoid arthritis, lupus)
5. Certain medications or drug reactions
6. Heat exhaustion or heatstroke
7. Malignancies or tumors
8. Thyroid storm (severe hyperthyroidism)

Is a 104 degree fever always caused by an infection. While infections are a common cause of high fevers, non-infectious conditions can also lead to elevated body temperatures. It’s essential to consider the full range of potential causes when evaluating a high-grade fever.

Symptoms Accompanying a 104 Degree Fever

When experiencing a fever of 104°F (40°C), individuals may exhibit various symptoms in addition to the elevated body temperature. These symptoms can include:

• Severe sweating
• Chills and shivering
• Headache
• Muscle aches and weakness
• Dehydration
• Rapid heart rate
• Rapid breathing
• Confusion or delirium
• Loss of appetite
• Fatigue and weakness

Can a 104 degree fever cause hallucinations. Yes, in some cases, especially in children and elderly individuals, a high fever can lead to fever-induced hallucinations or delirium. This condition, known as febrile delirium, is typically temporary and resolves as the fever subsides.

The Physiological Impact of a 104 Degree Fever

A fever of 104°F (40°C) can have significant effects on various organ systems and physiological processes within the body. Understanding these impacts is crucial for recognizing the potential risks associated with high-grade fevers:

Metabolic Effects

A 1°C rise in body temperature requires a 10-12.5% increase in metabolic rate. At 104°F, the body’s metabolism is significantly elevated, leading to:

• Increased oxygen demand
• Elevated heart rate
• Accelerated respiratory rate
• Enhanced protein catabolism for energy
• Shift from glucose to protein and fat utilization

Immune System Enhancement

Fever can boost immune function through various mechanisms:

• Increased white blood cell motility and activity
• Enhanced T-cell activation
• Accelerated B-cell proliferation
• Improved natural killer cell function
• Increased production of acute phase reactants

Does a 104 degree fever always indicate a stronger immune response. While fever generally enhances immune function, an extremely high fever doesn’t necessarily correlate with a more effective immune response. In some cases, it may indicate an overactive immune system or a severe underlying condition.

Diagnosing and Measuring a 104 Degree Fever

Accurate measurement of body temperature is crucial for diagnosing and monitoring a high-grade fever. Various methods and considerations come into play when assessing body temperature:

Temperature Measurement Sites

Different body sites yield varying temperature readings:

• Axillary (armpit): 35.97°C (96.75°F)
• Oral: 36.57°C (97.83°F)
• Urine: 36.61°C (97.90°F)
• Tympanic (ear): 36.64°C (97.95°F)
• Rectal: 37.04°C (98.67°F)

Which temperature measurement method is most accurate for detecting a 104 degree fever. Rectal temperature measurement is generally considered the most accurate method for assessing core body temperature, especially in cases of high-grade fever. However, other methods like oral and tympanic can also provide reliable readings when used correctly.

Individual Baseline Temperatures

It’s important to consider an individual’s normal baseline temperature when assessing for fever. Some people naturally run “cooler” or “warmer” than the average, which can affect the interpretation of temperature readings.

Limitations of Subjective Assessment

While patients may report feeling feverish, diagnosis based on palpation or subjective sensation is unreliable and can be inaccurate in up to 40% of cases. For accurate diagnosis of a 104 degree fever, an objective temperature measurement is essential.

Treatment Options for a 104 Degree Fever

Managing a 104°F (40°C) fever requires a combination of supportive care and, in some cases, medical intervention. Here are some treatment approaches:

Home Care Measures

• Rest and hydration: Encourage fluid intake to prevent dehydration
• Cool compresses: Apply to forehead, wrists, and back of neck
• Lightweight clothing and bedding: Avoid overheating
• Room temperature control: Maintain a comfortable, cool environment

Over-the-Counter Medications

Antipyretic medications can help reduce fever:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Aspirin (not recommended for children due to risk of Reye’s syndrome)

How quickly can over-the-counter medications reduce a 104 degree fever. Antipyretic medications typically begin to lower body temperature within 30-60 minutes after administration. However, the time to reach a normal temperature can vary depending on the individual and the underlying cause of the fever.

Medical Interventions

In severe cases or when underlying conditions are present, medical treatment may be necessary:

• Intravenous fluids for dehydration
• Antibiotics for bacterial infections
• Antiviral medications for specific viral infections
• Treatment of underlying conditions (e.g., malignancies, autoimmune disorders)

When to Seek Medical Attention for a 104 Degree Fever

A fever of 104°F (40°C) is considered high-grade and may require medical evaluation, especially if accompanied by certain symptoms or in specific populations. Here are some guidelines for seeking medical attention:

Adults

Seek immediate medical care if a 104°F fever is accompanied by:

• Severe headache
• Confusion or altered mental state
• Difficulty breathing
• Chest pain or abdominal pain
• Persistent vomiting
• Seizures
• Signs of dehydration (dark urine, decreased urination)

Children

For children, medical attention is warranted if:

• The fever persists for more than 24 hours in children under 2 years
• The fever lasts more than 3 days in older children
• The child appears very ill, lethargic, or unresponsive
• There are signs of dehydration (dry mouth, no tears, decreased urination)
• The child has a seizure

Can a 104 degree fever cause brain damage in children. While fever itself rarely causes brain damage, extremely high temperatures (typically above 107.6°F or 42°C) can potentially lead to neurological complications. However, it’s important to note that fever-induced brain damage is very rare, and most fevers, even high-grade ones, do not cause permanent harm when properly managed.

High-Risk Groups

Certain individuals should seek medical attention promptly for a 104°F fever:

• Elderly individuals (65 years and older)
• Pregnant women
• Immunocompromised individuals
• People with chronic medical conditions (e.g., heart disease, diabetes, lung disease)

Potential Complications of a 104 Degree Fever

While fever is generally a protective mechanism, a high-grade fever of 104°F (40°C) can lead to various complications if left untreated or if it persists for an extended period:

Dehydration

High fevers increase fluid loss through sweating and rapid breathing, potentially leading to severe dehydration. This can result in:

• Electrolyte imbalances
• Decreased blood volume
• Organ stress, particularly on the kidneys

Febrile Seizures

While more common in children, adults can also experience fever-induced seizures, especially with rapid temperature elevations. These seizures are generally short-lived and do not cause long-term damage but can be frightening for patients and caregivers.

Cognitive Effects

High fevers can lead to temporary cognitive impairments, including:

• Confusion
• Delirium
• Hallucinations
• Memory problems

Metabolic Stress

The increased metabolic rate associated with high fevers can strain various body systems:

• Increased cardiac workload
• Respiratory stress
• Accelerated muscle breakdown

How long can a person safely sustain a 104 degree fever. The duration a person can safely maintain a 104°F fever varies depending on individual factors such as age, overall health, and underlying conditions. Generally, it’s advisable to seek medical attention if a fever of this magnitude persists for more than a few hours, especially if accompanied by severe symptoms or in high-risk individuals.

Potential for Heat Stroke

If body temperature continues to rise unchecked, it can lead to heat stroke, a life-threatening condition characterized by:

• Core body temperature above 104°F (40°C)
• Central nervous system dysfunction
• Multi-organ failure

Prevention and Long-Term Management of High Fevers

While it’s not always possible to prevent fevers, certain strategies can help reduce the risk of developing high-grade fevers and manage them effectively when they occur:

Infection Prevention

• Practice good hygiene, including frequent hand washing
• Stay up-to-date on vaccinations
• Avoid close contact with individuals who are ill
• Maintain a healthy lifestyle to support immune function

Early Intervention

Addressing fevers promptly can help prevent them from reaching dangerous levels:

• Monitor body temperature regularly when feeling unwell
• Begin fever-reducing measures at the onset of elevated temperature
• Seek medical advice for persistent or high-grade fevers

Chronic Condition Management

For individuals with conditions that predispose them to fevers:

• Adhere to prescribed treatment plans
• Regular check-ups with healthcare providers
• Be aware of potential fever triggers and how to manage them

Can recurrent high-grade fevers indicate an underlying health problem. Yes, frequent episodes of high-grade fever (104°F or higher) may suggest an underlying health condition such as autoimmune disorders, recurrent infections, or even certain types of cancers. If experiencing recurrent high fevers, it’s crucial to consult with a healthcare provider for a comprehensive evaluation.

Environmental Considerations

To prevent heat-related fevers:

• Stay hydrated, especially in hot weather
• Avoid prolonged exposure to high temperatures
• Use appropriate cooling measures during physical activities

By understanding the causes, symptoms, and management strategies for high-grade fevers, individuals can take proactive steps to protect their health and seek appropriate care when needed. Remember that while a 104°F (40°C) fever is a significant elevation in body temperature, with proper management and medical attention when necessary, most individuals recover without long-term complications.

Physiology, Fever – StatPearls – NCBI Bookshelf

Introduction

Fever, or pyrexia, is the elevation of an individual’s core body temperature above a ‘set-point’ regulated by the body’s thermoregulatory center in the hypothalamus. This increase in the body’s ‘set-point’ temperature is often due to a physiological process brought about by infectious causes or non-infectious causes such as inflammation, malignancy, or autoimmune processes. These processes involve the release of immunological mediators, which trigger the thermoregulatory center of the hypothalamus, leading to an increase in the body’s core temperature.

The normal temperature of the human body is approximately 37 degrees Celsius (C), or 98.6 degrees Fahrenheit (F), and varies by about 0.5 C throughout the day.[1] This variation in the core body temperature results from normal physiological processes throughout the human body, including metabolic changes, sleep/wake cycles, hormone variability, and changing activity levels. However, in the case of a fever, the increase in the core body temperature is often greater than 0.5 C and is attributed to a fever-inducing substance (pyrogen).

While these numbers may vary slightly based on the source, below is a summary of how to categorize fever.[2]

• Low-grade: 37.3 to 38.0 C (99.1 to 100.4 F)

• Moderate-grade: 38.1 to 39.0 C (100.6 to 102.2 F)

• High-grade: 39.1 to 41 C (102.4 to 105.8 F)

• Hyperthermia: Greater than 41 C (105.8 F)

It is essential to understand that the definition of fever is not the same as that of hyperthermia (hyperpyrexia). In fever, there is an increase in the ‘set-point’ temperature brought about by the hypothalamus, enabling the body to maintain a controlled increase in the core temperature and general functionality of all organ systems. In hyperthermia, however, the rise in the body’s core temperature is beyond the confines of the set-point temperature and regulation of the hypothalamus.

Issues of Concern

An issue of concern that should be addressed when discussing the concept of fever is understanding that the site of measurement influences body temperature readings. The average axillary temperature reading is 35.97 degrees C (96.75 degrees F), oral is 36.57 degrees C (97.83 degrees F), urine is 36.61 degrees C (97.90 degrees C), tympanic is 36.64 degrees C (97.95 degrees F), and rectal is 37.04 degrees C (98.67 degrees F).[3]

It is also important to consider the patient’s normal baseline body temperature. If a patient typically runs “cold” or “hot,” then their baseline body temperature may be decreased or elevated above what is considered “normal” and does not necessarily indicate a fever or febrile illness.

A final issue of concern is that, while patients can state they have a fever because they “feel warm,” it is noted that the diagnosis of fever based on palpation is unreliable and inaccurate in up to 40% of individuals. If a fever is suspected, an official reading should be obtained.

Cellular Level

Milton and Wendlandt demonstrated that fever is mediated by the pyrogenic activity of prostaglandins (PGs), specifically PGE2. The synthesis of PGE2 begins with membrane phospholipids being converted to arachidonic acid (AA) by phospholipase A2 (PLA2). AA is then converted to PGh3 via cyclooxygenase (COX), after which PGh3 undergoes isomerization to PGE2 by PGE synthase. PGE2 acts via the EP3 receptor to affect specific neurons within the hypothalamus that aid in thermoregulation. Medications that inhibit COX are a mainstay of treatment for fevers, as it halts the conversion of AA into PGE2 and, thus, other prostanoids that can lead to fever.

The action of PGE2 begins when exogenous pyrogens (e.g., bacteria, viruses) stimulate endogenous pyrogens such as IL-1, IL-6, tumor necrosis factor (TNF), and interferon (IFN) to alter the hypothalamic set point via the organum vasculosum of the lamina terminalis (OVLT) and raise the core body temperature. Endogenous pyrogens also act to trigger an immune and inflammatory response. The immune response includes leukocytosis, T cell activation, B cell proliferation, NK cell killing, and increased white blood cell adhesion. The inflammatory response includes increased acute phase reactants, increased muscle protein breakdown, and increased synthesis of collagen.[4]

Organ Systems Involved

Fever induction in humans occurs at a high metabolic cost, such that only a 1 C rise in body temperature requires a 10–12.5% increase in metabolic rate.[5]

Metabolic effects associated with a febrile state: 

• Increased oxygen demand

  • Increased heart rate

  • Increased respiratory rate

• Increased use of body proteins as an energy source

• Metabolism switches from utilizing glucose (an excellent medium for bacterial growth) to utilizing the breakdown products of protein and fat

• Enhanced immune function

  • Increase in the motility and activity of white blood cells

  • Stimulates interferon production and activation of T cells

• Growth inhibition of specific microbial agents

A sustained, severely elevated fever can lead to lethal effects within multiple organ systems:

• Brain

  • Acute neurologic and cognitive function may occur after an episode of hyperthermia, with approximately 50% of heatstroke survivors experiencing chronic neurologic damage. Specifically, the Purkinje cells in the cerebellar cortex are sensitive to heat damage, which can lead to long-lasting cerebellar dysfunction.[6]

• Cardiovascular

  • Acutely, a hyperthermic patient will tend to be hypotensive with a high cardiac output due to blood redistribution and nitric-oxide-induced vasoconstriction. In severe fever, such as heatstroke, an electrocardiogram may show T-wave abnormalities, QT and ST changes, and conduction defects. In addition, serum troponin I levels may be significantly raised.[7]

• Gastrointestinal

  • Above 40 C (104 F), there is a reduction in blood flow to the GI tract. In addition, oxidative stress, denatured proteins, and damaged cell membranes are evident, increasing the potential for releasing pro-inflammatory cytokines, GI inflammation, and edema.[8]

• Liver

  • Elevated liver enzymes (AST/ALT) are observed in individuals with body temperatures above 40 C, with severe cases leading to permanent hepatocellular damage requiring a liver transplant. It is important to note that liver function may continue to decline even after correcting hyperthermia. For this reason, a clinician should trend the patient’s liver enzymes to ensure no ongoing liver damage exists.[9]

• Kidney

  • Patients with an increased body temperature are at a significantly greater risk for acute kidney injury (AKI). An increase in body temperature by only 2 C leads to a decrease in the glomerular filtration rate (GFR), which continues to fall with a further rise in temperature. Lab studies will show an increase in plasma creatinine and urea. Additionally, a hyperthermic state stimulates the renin-angiotensin-aldosterone system (RAAS), leading to a subsequent reduction in blood flow to the kidney.[10]

• Hemostasis

  • Inhibition of platelet aggregation, spontaneous bleeding, increased clotting times, thrombocytopenia, and increased plasma fibrin degradation productions are classically seen in hyperthermic patients. [11]

Function

The fever response is a systemic reaction to an infection that has evolved in warm-blooded animals for over 600 million years. An increase in core body temperature is known to improve survival and resolve infections. While an increased body temperature subsequently leads to an increased metabolic cost, it is known that the survival benefits outweigh the metabolic cost associated with a fever. An increase in core body temperature acts as an alert system to activate immune surveillance via different cell types, including natural killer cells, dendritic cells, macrophages, T and B lymphocytes, neutrophils, and vascular endothelial cells.[5]

Mechanism

The mechanism of initiation of fever results from complex interactions between cells in the periphery that are then transmitted centrally to the hypothalamus, specifically to the ventral medial preoptic (VMPO) area. Multiple studies showed that the VMPO houses fever-activated neurons, specifically localized near the vascular organ of lamina terminalis (VOLT), which lacks a blood-brain barrier (BBB). This lack of a BBB allows circulating substances access to the brain, which includes fever-related molecules from the immune system.[12] A recent study has stated that VMPO neurons’ primary function during infection is to translate immune signals from the periphery into changes within brain activity to ultimately bring about symptoms of illness.[13]

Related Testing

A diagnostic approach to fever or hyperthermia includes the following:

Diagnostic Testing

• ESR and CRP

• Procalcitonin-elevated in certain bacterial infections

• Tuberculin skin test

• HIV

• Serum LDH

• Routine blood cultures

• RF, ANA, heterophile antibody in children and young adults

• CPK

• Serum protein electrophoresis

• Imaging studies based on history

• CNS signs should prompt lumbar puncture

• Patients with a travel history to malaria-endemic regions should be tested with thick and thin peripheral smears.

• Rule out thrombophlebitis and infective endocarditis in IV drug abuse

Several other specific tests can be performed based on the history and physical exam findings in patients of varying age groups. A detailed history and thorough physical examination of all body systems can help narrow the list of differential diagnoses.

Pathophysiology

Patients with fever usually exhibit warm, flushed skin, tachycardia, involuntary muscular contractions or rigors, and sweating or night sweats. Piloerection and positioning of the body to minimize exposed surface area are also seen. Occasionally these signs are absent or minimal, and dry, cold skin or extremities are detected despite a significant rise in core temperature.

• Fever occurs when either endogenous or exogenous pyrogens cause an elevation in the body’s thermoregulatory set-point. In hyperthermia, the set-point is unaltered, and the body temperature becomes elevated in an uncontrolled fashion due to exogenous heat exposure or endogenous heat production.

• Hyperpyrexia is the term for exceptionally high fever (greater than 41 C), which can occur in patients with severe infections. Hyperpyrexia may also be seen in patients with CNS hemorrhages and is associated with a poor outcome.[14] Elevated brain temperature may lead to increased intracranial pressure, ischemic brain injury, exacerbation of cerebral edema, and death. 

• Inhibitors of cyclooxygenases, for example, aspirin and acetaminophen, can help reduce fever.[15]

• Observation of a pattern of fever can be helpful in certain conditions. For example, a fever that occurs every 48 to 72 hours occurs in certain types of malaria, and a fever that occurs predominately in the evening is typical of tuberculosis.

• The everyday highs and lows of typical temperatures are emphasized in many fevers. However, these variations might be turned around in typhoid fever and disseminated tuberculosis. Temperature-pulse dissociation occurs in typhoid fever, brucellosis, leptospirosis, some medication-prompted fevers, and factitious fever. In healthy individuals, the temperature-pulse relationship is directly proportional, with an expansion in the pulse of 4.4 beats/minute for each 1 degree C (2.44 beats/minute for each 1 degree F) increase in core temperature.

• During infections, fever may not be observed in babies, older adults, patients with chronic kidney disease, or patients taking corticosteroids; instead, hypothermia may be present.

The Most Common Causes of Fever in the Clinical Setting

• Sepsis accounts for up to 74% of fever in hospitalized patients.[16]

• Malignancy, tissue ischemia, and drug reactions account for most of the remainder of the fevers seen in the hospitalized setting.[17]

• Rare causes of fever include neurogenic fever and fevers associated with endocrinopathy.

Clinical Significance

While we have talked in detail about what constitutes a ‘normal’ and ‘abnormal’ temperature, given the many factors influencing the results of temperature measurements in humans, there can never be a single, universally accepted temperature cutoff defining a fever. This clinical reality, however, does not remove the need for precision in measuring and reporting fever. 

Instruments Used in Diagnosing Fever

• Digital sublingual thermometer

  • A temperature probe is placed under the patient’s tongue, with the lips closed around the instrument. The patient should not have recently smoked or consumed hot or cold substances. Digital thermometers are recommended over glass thermometers, as they have a disposable probe cover and give results in approximately 10 to 20 seconds, as opposed to 3 to 5 minutes for a glass probe.[18]

• Digital rectal thermometer

  • They are indicated in children and patients who cannot fully cooperate. A lubricated blunt-tipped thermometer should be inserted approximately 4 to 5 cm into the anal canal at a 20-degree angle from the horizontal, with the patient in a prone position. A rectal temperature reading is the preferred method in patients suspected of hypothermia. A rectal probe and a thermocouple are essential for measuring temperatures as low as 25 C (77 F).[19]

Before each new measurement with a digital thermometer, the device should be reset to below 35 C (95 F).

• Infrared forehead thermometer

  • This method involves taking a temperature measurement a short distance from the frontal bone without contacting the skin. Devices such as these function by converting infrared radiation from the forehead into an electrical signal, which is then used to determine a temperature reading.[20] This is the preferred method for non-contact temperature readings, as it requires no cleaning between individual readings.

• Infrared tympanic thermometer

  • This method detects infrared radiation from the tympanic membrane and converts it into an electrical signal, which is then interpreted as a temperature reading. This method involves patient contact and requires cleaning after each patient. [20]

• Infrared temporal artery thermometer

  • This method utilizes a thermometer that records temperature by slowly moving the device from the center of the forehead over to the lateral hairline. This detects infrared radiation emitted from the skin over the superficial temporal artery. This thermometer takes up to 1,000 readings/second and reports the highest temperature.[21] An algorithm is used to adjust for ambient temperature and calculate the core temperature. 

Fever Suppression

• Fevers are typically managed with antipyretics, which work by inhibiting the enzyme cyclooxygenase (COX), thereby reducing the levels of PGE2 within the hypothalamus. Other mechanisms of antipyretics have been suggested, which include reduction in proinflammatory mediators and enhancement of anti-inflammatory signals at the site of injury. While one may feel inclined to give an antipyretic to all febrile patients, this is not recommended. Some antipyretics may cause patient discomfort, predispose patients to adverse effects from other medications ingested, or interfere with the accurate assessment of patients receiving antibiotics.[22] Over-the-counter antipyretics include acetaminophen and NSAIDs such as aspirin, naproxen, and ibuprofen. 

While most patients with an elevated body temperature have a typical fever, there are some instances in which the body temperature increases above the fever threshold, termed hyperthermia or hyperpyrexia. Hyperpyrexia may typically be seen in heat-related illnesses such as heat exhaustion and heat stroke, which are usually caused by overexertion and dehydration in a hot environment. Other causes include obesity, metabolic conditions, adverse drug reactions (malignant hyperthermia or neuroleptic malignant syndrome), and age, with individuals under four and greater than 65 years old at an increased risk for a heat-related illness.[23] In contradiction to fever, in hyperpyrexia, the thermoregulatory set-point remains unaltered at normothermic levels, while body temperature elevates in an uncontrolled manner and beyond the capacity to lose heat. [24]

Heat Exhaustion: Temperature above 38 degrees C (100 degrees F) in the presence of any of the following symptoms[25]

• Increased sweating

• Pale, clammy, cold skin

• Generalized weakness

• Tachycardia with weak pulse

• Nausea or vomiting

• Dizziness, lightheadedness, or fainting

Heat Stroke: Temperature above 40 degrees C (104 degrees F) in the presence of any of the following symptoms[26]

• Hot, red, dry skin

• Tachycardia with a strong pulse

• Delirium, convulsions, or coma

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Kidane AS, Peters R. [Heat stroke on the hottest day of the year]. Ned Tijdschr Geneeskd. 2020 Aug 06;164 [PubMed: 32779922]

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Angilletta MJ, Youngblood JP, Neel LK, VandenBrooks JM. The neuroscience of adaptive thermoregulation. Neurosci Lett. 2019 Jan 23;692:127-136. [PubMed: 30449698]

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Kenny GP, Wilson TE, Flouris AD, Fujii N. Heat exhaustion. Handb Clin Neurol. 2018;157:505-529. [PubMed: 30459023]

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Hifumi T, Kondo Y, Shimizu K, Miyake Y. Heat stroke. J Intensive Care. 2018;6:30. [PMC free article: PMC5964884] [PubMed: 29850022]

Disclosure: Swetha Balli declares no relevant financial relationships with ineligible companies.

Disclosure: Karlie Shumway declares no relevant financial relationships with ineligible companies.

Disclosure: Shweta Sharan declares no relevant financial relationships with ineligible companies.

Fever – Helgemo & Liou

The Problem

Your child has a fever if:

• The rectal temperature is over 100.4 degrees F
• The oral temperature is over 100.4 degrees F

The body’s average temperature, when measured orally is 98. 6 degrees F, but it normally fluctuates during the day. Exercise, excessive clothing, a hot bath, or hot weather can cause mild elevations of 100.4 degrees F to 101.3 degrees F. Warm food or drink can also raise the oral temperature. If you suspect that one of these factors is affecting your child’s temperature, wait 30 minutes and take it again.

Fever is a symptom, not a disease. It is the body’s normal response to infections and plays a role in fighting them. In other words, fever activates the body’s immune system. The usual fevers up to 104 degrees F, that all children get are not harmful. Most are caused by bacterial illnesses. Teething rarely causes fever and never a fever over 101 degrees F.

Most fevers that occur with viral illness range from 101-104 degrees F and last for two to three days. Low-grade fevers are 100.4-102 degrees F and moderate fevers are 102-104 degrees F. A fever isn’t “high” until it’s over 104 degrees F or 105 degrees F. In general, the height of the fever isn’t related to the seriousness of the illness. What counts is how sick your child acts. Fever causes no permanent harm until it reaches 107 degrees F or higher. Fortunately, the brain’s “thermostat” keeps fevers caused by infection, even if untreated, below this level. Fevers over 107 degrees F usually result from environmental heat overload, such as overdressing a child with a fever or leaving a child in a closed car.

Few children with fever, about 4%, develop a brief convulsion. This type of seizure, called a febrile seizure, is harmless and not a cause for medical concern. Although a febrile seizure can be very frightening to parents, it does not cause brain damage, lower IQ or learning disabilities.

Home Treatment

Try to keep fever in perspective. “Fever phobia” is a term that describes the unwarranted fears many parents have about the normal fevers that all children experience. A study in 1980 found that 80% of parents mistakenly believed that fevers between 100-106 degrees F could cause brain damage or death. About 20% of parents thought that if they didn’t treat the fever, it would keep going higher. Neither statement is true. Because of the misconceptions many parents treat low-grade fevers unnecessarily with medicines and sponging. They also spend sleepless nights worrying about fevers. Try to keep fever in perspective when your child’s temperature is elevated.

Give acetaminophen to reduce fever

Children older than 2 month’s of age can be given an acetaminophen product to reduce fever.

Remember that fever is helping your child fight infection. Use medication only if the fever is over 102 degrees F and preferably only if your child is also uncomfortable. Give the correct dosage for your child’s age no more than every 4 to 6 hours. The accompanying table show oral acetaminophen dosages for children.

Two hours after they are taken, these drugs will reduce the fever by 2 degrees F to 3 degrees F. Repeated doses of the drugs are necessary because the fever will go up and down until the illness runs its course. Remember that the fever’s response to medicine tells little about the severity of the infection. If your child smiles, plays and drinks adequate fluids you need not worry about the fever. If your child is sleeping, don’t wake him up to give medicines. If the fever is high enough to need medication, your child will awaken.

Caution

• Do not switch droppers from one brand of liquid acetaminophen to another
• Do not use medications for more than three days or give them to children under 2 month’s of age without consulting your physician
• Since all of these drugs are poisonous if an overdose is taken, keep them out of sight and reach of children

Liquid Ibuprofen

Liquid ibuprofen (children’s Motrin or children’s Advil) was approved in 1989 for treating fever in children 6 month’s to 12 years of age.

Ibuprofen and acetaminophen have similar safety records and abilities to lower fever. One advantage that ibuprofen has over acetaminophen is a longer effect – 6 to 8 hours instead of 4 to 6 hours. In most situations, however, acetaminophen is still the drug of choice for controlling fever. Some children with high fevers that do not respond well to acetaminophen may do better with ibuprofen.

Do not give aspirin without consulting your doctor. The American Academy of Pediatrics has recommended that children and adolescents through 21 years of age should not take aspirin if they have chicken pox, flu or any cold, cough, or sore throat symptoms. This recommendation is based on several studies that have linked aspirin to Rye syndrome, a severe illness. Most pediatricians have stopped using aspirin for fevers associated with any illness.

Sponge your child only when necessary

Sponging is usually not necessary to reduce fever. Do not sponge your child without giving acetaminophen first, except in emergencies such as heatstroke, delirium, febrile seizure or fever over 106 degrees F. In other cases, sponge your child only if the fever is still over 104 degrees F when you retake the temperature 30 minutes after giving acetaminophen, and your child is still uncomfortable. Until acetaminophen takes effect, sponging will just cause shivering, which is the body’s attempt to raise the temperature.

If you do sponge your child, use lukewarm water (85 to 90 degrees F) or slightly cooler water for emergencies. Sponging works much faster than immersion so have your child sit in 2 inches of water and keep wetting the skin surface over the entire body. If your child shivers, raise the water temperature or wait another 10 to 20 minutes for the acetaminophen to take effect. Don’t expect to get the temperature below 101 degrees F.

Encourage extra fluids

The body loses fluids during fevers because of sweating. Encourage your child to drink extra fluids, but do not force her to drink. Popsicles and iced drinks are helpful.

Dress your child in light clothing

Clothing should be kept to a minimum because most heat is lost through the skin. Do not bundle up your child. It will cause a higher fever and can be dangerous. During the time your child feels cold or is shivering (the chills), give him a light blanket.

Discourage vigorous activity

Vigorous activities produce additional heat that the body must release. Normal quiet play is fine.

When to take your child’s temperature

In general, take the temperature once a day in the morning until the fever is gone. Take it more often if your child feels very hot or is acting miserable despite taking acetaminophen. She may also need sponging. Take the temperature just before calling your physician.

With most infections, the level of fever bounces around for 2 or 3 days. Shivering or feeling cold means the fever is going up. A flu shed (pink) appearance means the fever has peaked. Sweating means it is coming down. The main purpose of taking temperatures is to determine whether fever is present or absent, not to chart it’s every move.

Call our office immediately if:

• Your child is less than 3 month’s old, unless the fever is caused by a DtaP vaccine
• The fever is over 105 degrees F
• Your child is crying inconsolably or whimpering
• Your child is difficult to awaken
• Your child cries if you touch him or move him
• Your child’s neck is stiff
• Any purple spots are present on the skin
• Breathing is difficult and no better after you clear the nose
• Your child is unable to swallow anything and is drooling saliva
• Your child looks and acts very sick (if possible, check your child’s appearance one hour after he has taken acetaminophen).

Call within 24 hours if:

• The fever is 104 degrees F, especially if your child is less than 2 years old
• Burning or pain occurs when urinating
• Your child has had a fever for more than 24 hours without an obvious cause or location of infection

Call during regular office hours if:

• Your child has had a fever for more than 72 hours
• The fever went away for more than 24 hours and then returned
• Your child has a history of febrile seizures
• You have other questions or concerns

Acetaminophen Dosage (for fever and pain)
Child’s weight more than (pounds)	7	14	21	28	42	56	84	112	lbs
Total Amount (mg)	40	80	120	160	240	325	480	650	mg
Infant Drops 80 mg/0. 8 ml	0.4	0.8	1.2	1.6	2.4	—	—	—	ml
Syrup: 160 mg/5 ml (1 tsp)	—	½	¾	1	1½	2	2½	4	tsp
Chewable 80 mg tablets	—	—	1½	2	3	4	5-6	8	tabs
Chewable 160 mg tablets	—	—	—	1	1½	2	3	4	tabs
Adult 325 mg tablets	—	—	—	—	—	1	1½	2	tabs

• Acetaminophen (e. g., Tylenol) Dosage: determine by finding your child’s weight in the top row of the dosage table
• Adult dose = 650 mg
• Repeat every 4-6 hours as needed. Don’t give more than 5 times a day
• Note: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth)
• Use with caution under 3 months of age for pain. Don’t use under 3 months of age for fever. (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation.)

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

104 Fahrenheit Celsius

Fahrenheit

• Delisle
• Degrees Newton
• Kelvin
• Gas grade
• Shoots
• Fahrenheit
• Rankin
• Réaumur
• Celsius

=

Celsius

• Delisle
• Degrees Newton
• Kelvin
• Gas grade
• Shoots
• Fahrenheit
• Rankin
• Réaumur
• Celsius

Formula 104 °F = (104 – 32) x 5/9 °C = 40 °C

104 Celsius to Fahrenheit

104 °F = 40 °C

104 °F is equivalent to 40 °C .

Conversion table from 104 Fahrenheit to Celsius

Fahrenheit (°F)	Celsius (°C)
104.1°F	40.056 °C
104.2°F	40.111 °C
104.3°F	40.167 °C
104.4°F	40.222°C
104.5°F	40.278 °C
104.6°F	40.333 °C
104.7°F	40.389 °C
104.8°F	40.444 °C
104.9°F	40. 5 °C

Convert 104 °F to other units

Various units Fahrenheit to Celsius

• 94 Fahrenheit to Celsius
• 95 Fahrenheit to Celsius
• 96 Fahrenheit to Celsius
• 97 Fahrenheit to Celsius
• 98 Fahrenheit to Celsius
• 99 Fahrenheit to Celsius
• 100 Fahrenheit to Celsius
• 101 Fahrenheit to Celsius
• 102 Fahrenheit to Celsius
• 103 Fahrenheit to Celsius
• 105 Fahrenheit to Celsius
• 106 Fahrenheit to Celsius
• 107 Fahrenheit to Celsius
• 108 Fahrenheit to Celsius
• 109 Fahrenheit to Celsius
• 110 Fahrenheit to Celsius
• 111 Fahrenheit to Celsius
• 112 Fahrenheit to Celsius
• 113 Fahrenheit to Celsius

Are temperatures up to 104 degrees Fahrenheit dangerous?

According to All Children’s Hospital, a temperature of 100 to 104 degrees Fahrenheit is normal when someone is fighting an infection. When the temperature rises above 102 F, it is usually recommended to take antipyretic drugs to ease comfort.

According to All Children’s Hospital, fever should be reduced by 2 to 3 degrees when medication is used to treat fever. Once body temperature reaches 108 F, brain damage can occur. However, this temperature is never reached due to infection or fever. The high body temperature needed to cause permanent damage only comes from extreme environmental conditions, such as a child locked in a closed car in hot weather.

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