Antipyretics and delirious behavior during febrile illness
Aichi Shukutoku University, Koromo, Aichi, Japan Pediatrics International
(Impact Factor: 0.73).
03/2006; 48(1):40-3. DOI: 10.1111/j.1442-200X.2006.02171.x
The purpose of the present paper was to study the use of antipyretics in children with delirium associated with fever in order to clarify their possible adverse effects.
The use of antipyretics was investigated in 26 children with delirious behavior associated with fever. Temporal relation between delirious behavior and the use of antipyretics was recognized in six children.
In four children, delirious behavior was observed soon after administration of antipyretics. The antipyretics used were acetaminophen in two children, mephenamate in one, and diclofenac in one. In the other two children, delirious behavior was observed when body temperature began to fall 1-2 h after administration of antipyretics. The antipyretics used were acetaminophen in one child and mephenamate in one.
A temporal relationship between antipyretics and delirious behavior was observed in some patients with febrile delirium. This suggests that antipyretics can be a trigger of delirium.
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ABSTRACT: Deliryum akut başlangıçlı, dalgalı seyir gösteren mental durum değişikliği ile karakterize yaşamı tehdit eden bir tıbbi durumdur. Deliryumu başlatıcı ya da hazırlatıcı etme, hastaların yaklaşık %30'unda ilaç toksisitesidir. Bu nedenle hastaların öyküsü özenle alınmalı, başlangıç semptomları, kullandığı ilaçlar, bu ilaçların dozaj değişiklikleri, yeni eklenen ilaçlar not edilmeli ve ilaç-madde kötüye kullanımı dikkatlice sorgulanmalıdır. Diklofenak ağrı tedavisinde sıkça kullanılan non-steroid antienflamatuar bir ilaçtır. Biz bu yazımızda diklofenak ampul formunun oral kullanımını takiben akut, şiddetli ensefalopati tablosu ile acil servise başvuran bir hastayı sunduk. Hastanın etyolojik araştırmalarında diğer nedenler dışlandı ve ensefalopatinin olası nedeni olarak diklofenak sodyum düşünüldü. Anahtar Kelimeler: Ensefalopati, Diklofenak, EEG Acute Encephalopaty Due to Diclofenac: A Case Report Delirium is characterized by acute changes in mental state lasting for hours or days. The etiology of delirium is drug intoxication in approximately 30% of the patients. Therefore, the medical history should be assessed carefully and initiation of the symptoms, medications used, changes in dosage or medications currently added to the regimen, and drug abuse history should also be questioned carefully. Diclofenac is a nonsteroidal analgezic medication used in the symptomatic treatment of pain. In this report, a case of severe encephalopathy developing after oral diclofenac is presented, admitting to emergency service with delirium and then resolving spontaneously only by supportive treatment. During the assessments, no other etiologic factor that can result in an encephalopathy was detected, and the etiology of this case therefore was thought to be diclofenac most probably.
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ABSTRACT: We studied the relation among serum cytokine levels, EEG changes, and mild neurological complications (delirium and febrile seizure) in children with influenza. The serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and soluble tumor necrosis factor receptor-1 (sTNFR-1) were measured in 27 children with proven influenza infection with mild neurological complications (10 patients with delirium and 17 with febrile seizures) and seven control children. EEG was recorded in 14 children with neurological complications. EEG showed focal slowing in four of nine patients with delirium and in four of five with febrile seizures. Generalized slowing was observed in one patient with delirium. The median serum IL-6 level was 31.2+/-15.1 pg/ml (range, 7.5-64.5 pg/ml) in the delirium group, 42.3+/-44.0 pg/ml (range, 8.0-196.0 pg/ml) in the febrile seizure group, and 15.4+/-7.0 pg/ml (range, 7.2-28.0 pg/ml) in the control group. Serum TNF-alpha and sTNFR-1 levels were not different among three groups. Mild neurological complications associated with influenza were related to the mildly abnormal serum IL-6 levels and EEG findings. The combination of these parameters will be useful for early diagnosis and differentiation of neurological complications in children with influenza. Further studies will be necessary for investigating that IL-6 has the diagnostic value for differentiation between severe encephalopathy and mild neurological complications in children with influenza.
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ABSTRACT: Febrile seizures are a common occurrence in young children with incidence rates varying from 3-14%, depending on the geographic region. Studies have suggested that an elevated temperature is a factor in their development, though other factors may synergistically lower the seizure threshold. While it is recognized that excessive or rapid dilute fluid intake can cause seizures in young children, and in adults during strenuous physical activity, less focus has been paid to its involvement during febrile illnesses. Young children are more vulnerable to the development of febrile seizures due to their small skull size relative to brain volume. In animals, reduced serum sodium levels have been shown to lower the threshold to convulsive stimuli, while hypertonic saline has been shown to rapidly reverse these effects. Similarly vasopressin, frequently elevated during acute infections, enhances fluid retention and may also be a precipitating factor for febrile seizures. Although an elevated temperature may augment seizure risk, antipyretics have not been shown to prevent them. In fact, some may increase seizure risk through a reduction in urine output. It has long been observed that fluid retention occurs during febrile infections, followed by diuresis during convalescence. This characteristic observation led to recommendations for restricted fluid intake during acute infections dating back more than 2,000 years. Only recently has there been a return to restricted fluid intake for patients with potentially reduced free water excretion. Further studies are required to determine the role of the overall fluid balance in the etiology of childhood febrile seizures.
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