In the presence of constant ambient conditions, a fall in effective circulating blood volume causes peripheral vasoconstriction which is reflected in a fall in peripheral (great toe) temperature and thus in an increase in the central (rectal)/peripheral temperature gradient. We report 5 illustrative clinical situations showing the value of this technique in the medical care of critically ill children. We suggest that such measurements are useful, first in the recognition of dehydration and in assessing the response to treatment, secondly in managing shock, and finally, in differentiating dehydration fever from other causes of fever.
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