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Orthostatic hypotension in children with acute febrile illness
Tzippora Shalem1, Michael Goldman, Rachel Breitbart
1Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Febrile children in the Pediatric Emergency Department (PED) are significantly more likely to experience orthostatic hypotension, a condition causing dizziness and fainting. This study highlights the importance of hydration and posture awareness in managing feverish children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Physiology
- Infectious Diseases
Background:
- Children with fever in the Pediatric Emergency Department (PED) often exhibit symptoms like lightheadedness, dizziness, fatigue, weakness, and pallor.
- These symptoms, along with syncope, may stem from orthostatic hypotension.
- Orthostatic hypotension is a condition characterized by a significant drop in blood pressure upon standing.
Purpose of the Study:
- To investigate the incidence of orthostatic hypotension in children with acute febrile illness.
- To compare the prevalence of orthostatic hypotension in febrile versus afebrile children.
Main Methods:
- A prospective cohort study involving 80 children (aged 4-18 years) at a university-affiliated hospital.
- Participants were divided into two groups: 39 febrile children (>38°C for 6-48 h) and 41 afebrile children.
- Blood pressure was measured supine and after 3 minutes of standing; orthostatic hypotension was defined as a systolic blood pressure drop of ≥20 mm Hg or diastolic drop of ≥10 mm Hg.
Main Results:
- No significant differences in gender, age, height, or weight were observed between the febrile and afebrile groups.
- Orthostatic hypotension was diagnosed in 25.6% of febrile children compared to 5% of afebrile children (p=0.012).
Conclusions:
- The incidence of orthostatic hypotension is notably high in febrile children presenting to the PED.
- Orthostatic hypotension may account for common symptoms like dizziness and syncope in febrile children.
- Recommendations include advising patients to maintain proper hydration and avoid abrupt postural changes.
Background:
Children presenting to the Pediatric Emergency Department (PED) with fever often describe symptoms such as lightheadedness, dizziness, fatigue, and weakness, and may appear pale. They may also present with a chief complaint of syncope. Such symptoms may result from orthostatic hypotension.
Objective:
To determine whether children with an acute febrile illness have a higher incidence of orthostatic hypotension compared to afebrile children.
Methods:
A prospective cohort study was conducted at the PED at Assaf Harofeh Medical Center, a university-affiliated hospital in Israel. Eighty children aged 4-18 years were recruited. Thirty-nine had fever (>38°C for 6-48 h) and 41 were afebrile. All subjects had their blood pressure measured in the supine position (after 5 min of rest) and again after standing for 3 min. The main outcome measure was orthostatic hypotension, that is, a reduction of systolic blood pressure of at least 20 mm Hg, or a fall in diastolic blood pressure of at least 10 mm Hg within 3 min of standing.
Results:
There were no differences between the groups in gender, age, height, or weight. Orthostatic hypotension was found in 10/39 (25.6%) of febrile children and in 2/41 (5%) of afebrile children (p=0.012).
Conclusions:
The incidence of orthostatic hypotension among febrile children in the PED is high, and may explain common symptoms such as dizziness or syncope. Such patients should be instructed to drink properly and to avoid rapid changes in body posture.
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