The Caloric Equivalent of Fever

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Abstract
Four different examples of major trauma have been studied with respect to the relationship between body temperature and energy expenditure. During the first 9 to 18 days after trauma, fever was accompanied by energy expenditure equal to or in excess of that predicted by the DuBois relationship. After this initial period, long-term trauma with depletion of body cell mass was associated with a reduction in energy expenditure, despite continued fever. After anesthesia and operation, there was an immediate reduction in oxygen consumption which lasted for 1 to 3 days. By contrast, the fever accompanying large third degree burns or severe sapsis may be associated with sustained, excessive metabolic expenditure. Treatment of this hypermetabolism depends upon its etiology. A major part of the hypermetabolism of burns can be explained by heat loss from evaporation through the burned skin. If large evaporative losses are present, measures can be taken to reduce evaporation as well as to provide for quantitative replacement of water and heat losses. Extensive sepsis is also associated with an increased energy expenditure. Further studies are in progress to determine whether increased evaporative losses contribute to this increased energy expenditure. Hypermetabolism, from whatever cause, makes important demands upon cardiopulmonary reserve, rendering the patient more vulnerable to coincident hemorrhage, myocardial infarction, atelectesis or pneumonia.

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