FIEBRE Y USO DE ANTIPIRETICOS EN PEDIATRIA

CENTRO DE SALUD HUACHOCOLPA

2013

Lic. Enf. Rocío Del Pilar Aliaga López

INTRODUCCION

• Los padres no saben tomar la temperatura y no conocen la definición de Fiebre.

• Frecuentemente administran dosis inadecuadas de antipiréticos en niños con temperatura normal o con fiebre mínima.

The most common indications for initiating antipyretic therapy by pediatricians are a

temperature higher than 38.3°C.

FISIOLOGIA DE LA FIEBRE

• Es la fiebre una enfermedad o es un mecanismo fisiológico de defensa con efecto benéfico en el combate de la infección?

Fever retards the growth and reproduction of bacteria and viruses, enhances neutrophil production and T-

lymphocyte proliferation, and aids in the body’s acute-phase reaction.

FISIOLOGIA DE LA FIEBRE

• Será igual hablar de fiebre y de hipertermia?

Fever is a common and normal physiologic responsethat results in an increase in the hypothalamic “setpoint” in response to endogenous and exogenouspyrogens. In contrast, hyperthermia is a rare andpathophysiologic response with failure of normalhomeostasis (no change in the hypothalamic setpoint) that results in heat production that exceeds thecapability to dissipate heat

FISIOLOGIA DE LA FIEBRE

• Que puede producir la Hipertermia?

Characteristics of hyperthermia include hot, dryskin and central nervous system dysfunction thatresults in delirium, convulsions, or coma.Hyperthermia should be addressed promptly,because at temperatures above 41°C to 42°C,adverse physiologic effects begin to occur.

TRATAMIENTO

• Está bien utilizar alcohol para bajar la fiebre?

• Porque tratar rápidamente la fiebre?

The use of alcohol baths is not an appropriatecooling method, because there have beenreported adverse events associated withsystemic absorption of alcohol

The most consistently identified serious concernof caregivers and health care providers is that high fevers, if left untreated, are associated with seizures, brain damage, and death

TRATAMIENTO

• Cual es la terapia de primera línea?

Acetaminophen doses of 10 to 15 mg/kg per dose givenevery 4 to 6 hours orally are generally regarded as safeand effective. Typically, the onset of an antipyretic effectis within 30 to 60 minutes; approximately 80% ofchildren will experience a decreased temperature withinthat time.

TRATAMIENTO

• Está indicado el ibuprofeno?

Studies in which the effectiveness of ibuprofen andacetaminophen were compared have yielded variableresults; the consensus is that both drugs are moreeffective than placebo in reducing fever and thatibuprofen (10 mg/kg per dose) is at least as effective as,and perhaps more effective than, acetaminophen (15mg/kg per dose) in lowering body temperature wheneither drug is given as a single or repetitive dose.

TRATAMIENTO

• Es seguro utilizar ibuprofeno u otros AINEs?

Similar to other nonsteroidal antiinflammatory drugs(NSAIDs), ibuprofen can potentially cause gastritis,although no data suggest that this is a commonoccurrence when used on an acute basis, such as duringa febrile illness. However, there have been case reportsof bleeding, gastritis, and ulcers of the stomach,duodenum, and esophagus associated with manyNSAIDs, including ibuprofen, even when used in typicalantipyretic and analgesic doses

TRATAMIENTO

• Que otros cuidados debo tener al utilizar AINEs

In numerous case reports, children with febrile illnessesdeveloped renal insufficiency when treated with ibuprofen orother NSAIDs. Thus, caution is encouraged when usingibuprofen in children with dehydration or with complexmedical illnesses. In children with dehydration, prostaglandinsynthesis becomes an increasingly important mechanism formaintaining appropriate renal blood flow. The use ofibuprofen or any NSAID interferes with the renal effects ofprostaglandins, which reduces renal blood flow andpotentially precipitates or worsens renal dysfunction.

Acetaminophen is the most common single ingredientimplicated in emergency department visits formedication overdoses among children, and more than80% of these emergency visits are a result ofunsupervised ingestions81; therefore, proper handlingand storage of antipyretics should be encouraged.

GRACIAS