'Don't use paracetamol for fever'

[enjoynz]

This is the headline in a news article on resent flu related studies, here in New Zealand.

Article as attached:
http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10737700

The information in this study goes against the way we have dealt with flu related fevers.
It was only a few years ago the New Zealand ambulance service, started to carry paracetamol on the ambulance again.
Mainly as a pain relief and also for controlling fever!
I assume a perticentage of you would have been to a call for a child having had a febrile convulsion. (I know my very first call, was to one).
This research is saying that the convulsion is caused by the infectious illness, rather than the fever.
What are you thoughts with regards to this research?

 

[Smash]

I don't think that there is too much that is new in that article. There has been a great deal of conjecture over the years as to whether anti-pyretics are of any use in managing febrile illnesses. They certainly make the sufferer feel better, and that may be a valid reason for using them.

The mechanism behind seizures in febrile illness is very poorly (or not at all) understood. It seems that at some stage the hypothalamus say "enough is enough" and propagates a wave of uncoordinated electrical activity - voilà, a seizure. Exactly how or why this happens is a bit of a mystery. There are theories that say it is related to the absolute temperature, and others that say that it is related to the rate of change of temperature, and still others (such as in this article) that say it is nothing to do with either, but a result of the infection itself.

The position I have is that unless the patient actually feels rotten (headaches, myalgia that sort of thing) let nature take it's course, manage seizures symptomatically if need be and investigate for cause (particularly important where you are enjonz, with the atrocious rates of the B serotype of N. Menigitidis

 

[Crossword]

The article suggests that reducing the fever with Paracetamol may be counterproductive, but the research suggests it (Paracetamol) is no better than placebo for fever reduction anyway.. May as well feel better and get some sleep by reducing aches and pains.

My first post - Hi everyone!

 

[sir.shocksalot]

Sounds like that data didn't say much of anything. It seems common sense that viral proteins are denatured by high temperatures as well as our immune system works better at high temperatures to say that fever is probably in our benefit. That being said I don't think this changes much other than maybe hesitate before reaching for the antipyretic when you're crook.

I would be interested to see the data and methods that they used to study febrile seizures in kids and how they came to the conclusion that antipyretics had no effect on the chance of febrile seizure. I also wonder whether this only applies to the flu, or other diseases that cause fever as well (common sense probably says yes for most diseases.)

And crossword, welcome. Were is the data on the effectiveness of paracetamol vs a placebo for fever reduction? The article seemed to say that paracetamol was still an effective antipyretic, just that its routine use for influenza isn't recommended.

PS. For us Americans unfamiliar with paracetamol it is the Australian/New Sheepland/English version of Acetaminophen.

 

[katgrl2003]

New Sheepland

That made me :rofl:

 

[Smash]

I haven't got the articles to hand as I'm typing with my thumbs on my iWhatsamacallit. There are pretty good trials going back to the mid 70s I think. Your best bet until I get home and post some is the Cochrane review that was done around 2000ish.

And funnily enough there are more sheep per capita in Straya than in New Sheepland... Strayans just have this strange obsession with sheep jokes, which I think reflects more on their unhealthy desires than it does on Kiwis.

 

[MrBrown]

Rubbish, Brown will continue to dish out panadol

It makes it really easy to leave people at home ..... less calls and more telly for Brown

 

[enjoynz]

Gosh I'm feeling a little sheepish now!

I thought this study was being done in NZ...guess you don't believe everything you hear..lol.

I've been looking up a little more into febrile seizures.... and found this Fact Sheet.
Link As Attached:
http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

It says that while fever-lowering drugs such as acetominophen (paracetamol, etc) or ibuprofen, will make the child feel better,
there are no studies that prove they will reduce the risk of a seizure.

Although most statements about the drug that I have looked at, say it acts on the hypothalamus that regulates the temperature of the body.

So would this not also prevent another fever related seizure?
Sorry if it looks like I'm talking double dutch.
I'm still trying to figure out why not using a acetominophen, will help and not hinder a patients recovery from the flu
and prevent young patients having more febrile convulsions.

 

[Smash]

The trouble is that no-one really knows why febrile seizures occur. Febrile seizures may in fact be a bit of a misnomer, as there may be a temporal, but not necessarily causal, relationship between the fever and the seizure. Febrile seizures also occur when the temperature of the patient is actually declining. It may be that it is in fact the presence of circulating cytokines, or endotoxins, or who knows what, that causes the hypothalamus to get grumpy.

I guess what I'm trying to say is that the seizures are associated with, but not necessarily caused by, fever.

There is a definite genetic factor to febrile seizures, but no specific gene has yet been identified that causes predisposes a patient to them.

There seems to be a link to brain development as most febrile seizures occur between about 6 months and 5 years, which corresponds to a large change in the structure of the brain. It may be that the lack of myelination and increased neuronal excitability play a role.

So although paracetamol may reduce temperature by direct action on the hypothalamus, it is not necessarily the fever itself that is triggering the seizure.

Let me dig up some references (in no particular order)

Jensen FE, Sanchez RM. Why does the developing brain demonstrate heightened susceptibility to febrile and other provoked seizures? Febrile seizures. Academic Press: San Diego; 2002

Hauser WA, Annegers JF, Anderson VE, Kurland LT. The risk of seizure disorders among relatives of children with febrile convulsions. Neurology 1985;35:1268-73

Hirtz DG, Nelson KB. The natural history of febrile seizures. Ann Rev Med 1983;34:453-71

Iwasaki N, Nakayama J, Hamano K, Matsui A, Arinami T. Molecular genetics of febrile seizures. Epilepsia 2002;43:32-5

Holtzman D, Obana K, Olson J. Hyperthermia-induced seizures in the rat pup: a model for febrile convulsions in children. Science 1981;213:1034-6

McCaughran JA Jr, Schechter N. Experimental febrile convulsions: long-term effects of hyperthermia-induced convulsions in the developing rat. Epilepsia 1982;23:173-83.

Meremikwu MM, Oyo-Ita A. Paracetamol versus placebo or physical methods for treating fever in children. Cochrane Database of Systematic Reviews 2002, Issue 2

Vestergaard M, Basso O, Henriksen TB, Ostergaard JR, Olsen J. Risk factors for febrile convulsions. Epidemiology 2002;13:282-7

Virta M, Hurme M, Helminen M. Increased plasma levels of pro- and anti-inflammatory cytokines in patients with febrile seizures. Epilepsia 2002;43(8):920-3

 

[Crossword]

There are loads of articles on the subject but this:



Paracetamol versus placebo or physical methods for treating fever in children (Review) 6
Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Gives a good analysis.

 

[Smash]

there are loads of articles on the subject but this:



paracetamol versus placebo or physical methods for treating fever in children (review) 6
copyright © 2009 the cochrane collaboration. Published by johnwiley & sons, ltd.

gives a good analysis.

meremikwu mm, oyo-ita a. Paracetamol versus placebo or physical methods for treating fever in children. Cochrane database of systematic reviews 2002, issue 2

.