Thursday, August 13th
ProJR Fever Pulse Temperature Dissociation aka Fagets sign aka sphygmothermic dissociation
[5:37 pm, 13/08/2026] hu2: Liebermeister's rule concerns the increment ratio between an adult individual's cardiac frequency and temperature when in fever. Each Celsius grade of body temperature increment corresponds to an 8 beats per minute increase in cardiac frequency, although the exact number of this rule varies significantly across different sources.[1][2]
An exception to this rule by creating a relative bradycardia is known as Faget sign (pulse-temperature dissociation) common in some diseases, especially yellow fever, tularaemia and salmonella typhi.
The rule is named for Carl von Liebermeister.
Liebermeister is notable for his research on fever, body-temperature regulation and antipyretic treatment, particularly in typhoid fever. He formulated Liebermeister's rule, relating changes in body temperature to pulse rate. He is also a significant figure in early attempts to bringing statistical inference methods into clinical medicine, having published a Bayesian method for evaluating comparative therapeutic data. The method calculated the probability that one treatment was superior using studies of any size and has been described as anticipating, by more than half a century, an exact-test approach comparable in mathematical structure to Fisher's exact test.
[5:40 pm, 13/08/2026] hu2: This ProJR will try to attempt prospectively checking out how many of our fever patients satisfy or violate Liebermeister's rule and how that may effect their overall fever outcomes.
Our fever ProJRs have looked at various aspects in the past as documented here:
Origins:
1 Resolving undifferentiated fever diagnostic uncertainty 2000-2002
2) Fever pattern recognition as a tool to optimise antibiotic stewardship in the community curtailing it's overuse in common viral fevers with diagnostic uncertainty
3) Follow up to the Bangalore study in a Bhopal PG thesis
4) Optimising clinical complexity in fever
Narketpally:
https://medicinedepartment.blogspot.com/2022/08/resolving-diagnostic-and-therapeutic.html?m=1
Conversational transcripts:
Summary learning points from the first case logged by ET Dr Aneef here: https://feverprojr.blogspot.com/2024/05/75m-unclassified-fever.html
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