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Fever

Many mitochondrial patients have baseline temperatures that are below normal (by as much as 2-5 degrees Fahrenheit), and even lower baseline measurements at night.  Higher-than-normal temperatures also occur.  These baselines might also be variable and should be periodically checked.   It is important to assess fever based on the increase above the patient's unique baseline.  For example, a temperature of 99.5°F may not be worrisome in a typical child but if that represents a 3-4 degree increase above a sick-looking mitochondrial patient's baseline, it is not to be dismissed.  Patients can show a wider variability in body temperature when sick than at other times.

The increase in metabolic rate (and increased energy demands) associated with fever further complicates the course of an infection. 

In order to shorten the course of illness and conserve energy, it is recommended to treat fevers and intercurrent infections aggressively.  Most patients with mitochondrial disease respond well to extra hydration and calories.  It is useful to know their baseline fluid intake.  Some patients barely meet their fluid requirement on a "good day" so when sick, it does not take much to push them toward dehydration.  Oral hydration does not seem to be as effective as IV hydration, and patients frequently are limited in how much they can tolerate enterally (because of gut dysmotility), so even if the individual is drinking some, IV hydration may be indicated to improve symptoms and perhaps shorten their duration.

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