Temperature Regulation and the Pathogenesis of Fever

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high of 37.7° C (99.9° F) at 4 PM. Comparison of initial temperature recordings obtained on admission to the research ward in which these observations were recorded, with ones obtained the same hour the day after admission revealed no significant difference in variability (F tests for individual studies, P ≥.12). Age did not significantly influence temperature within the age range studied (18 to 40 years) (linear regression, P = .99). Figure 47-1 Frequency distribution of 700 baseline oral temperatures obtained during 2 consecutive days of observation in 148 healthy young volunteers. Arrow indicates location of 98.6° F (37° C). (From Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.6°F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268:1578–1580.)
Figure 47-2 Mean oral temperatures and temperature ranges in 148 healthy young volunteers according to time of day. The four temperatures shown at each sample time are the 99th percentile (top), the 95th percentile (second), the mean (third), and the fifth percentile (bottom) for each sample set. (The numbers in parentheses are the temperatures in degrees Fahrenheit.) The numbers in parentheses on the x-axis indicate the number of observations analyzed at each sample time. (From Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.6°F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268:1578–1580.) Women had a slightly higher average oral temperature than men (36.9° C [98.4° F] versus 36.7° C [98.1° F]; t test, P < .001, df = 698) but did not exhibit greater average diurnal temperature oscillations than male counterparts (0.56° C [1.0° F] versus 0.54° C [0.97° F]). Black subjects exhibited a slightly higher mean temperature and slightly lower average diurnal temperature oscillations than white subjects (36.8° C [98.2° F] versus 36.7° C [98.1° F] and 0.51° C [0.93° F] versus 0.61° C [1.09° F], respectively); these differences approached, but did not quite reach, statistical significance (t test, P = .06, df = 98). Oral temperature recordings of smokers did not differ significantly from those of nonsmokers. There was a statistically significant linear relationship between temperature and pulse rate (regression analysis, P < .001), with an average increase in heart rate of 4.4 beats per minute for each 1° C (2.44 beats/minute for each 1° F) rise in temperature over the range of temperatures examined (96.0° to 100.8° F).
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Temperature Regulation and the Pathogenesis of Fever

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