Chills is a feeling of coldness after being exposed to a cold environment, or during fever, but sometimes is also a common symptom which happen alone in specific people. The word can also refer to an episode of shivering along with paleness and feeling cold. During fever, it occurs due to the release of cytokines and prostaglandins as part of the inflammatory response, which increases the set point for body temperature in the hypothalamus. The increased set point causes the body temperature to rise, but also makes the person feel cold until the new set point is reached. Shivering also occurs along with chills because the patient's body produces heat during muscle contraction in a physiological attempt to increase body temperature to the new set point.
When chills does not accompany a high fever, it is normally a light chill. Sometimes a chill of medium power and short duration may occur during a scare, or when people are frightened or shocked. Severe chills with violent shivering are called rigors.
Signs
- Shiver or tremble
- Shake
- Have chattering teeth (jaw feels like it’s rattling, sometimes with teeth bumping together)
- Have goosebumps (small rash-like bumps on the skin), also known as gooseflesh or goose pimples
Pathophysiology
Chills occur when the hypothalamic temperature set point suddenly rises. This can happen due to various reasons, such as tissue damage, pyrogenic substances, or dehydration. Since the body temperature is below the new set point, the body activates mechanisms to increase temperature, like vasoconstriction and shivering. Despite potentially having a higher body temperature than normal, the person feels extremely cold during this period. As the body temperature rises to match the new set point, the chills stop, and the person no longer feels hot or cold. If the cause of the high temperature is removed, the hypothalamic set point decreases, but the body temperature remains elevated. This leads to the body initiating cooling mechanisms to lower the temperature to the new set point, resulting in intense sweating and hot skin due to vasodilation. This phase of the febrile state is referred to as the "crisis" or the "flush."
Causes
- Exposure to cold environment
- Body's core temperature drops below the normal temperature range.
- Bacterial, Parasitic, and viral infections
- Cancers
- Drug withdrawal
- Hangover
- Low blood sugar level
- Menopausal
- Sepsis
Nursing Interventions
Regulate the room temperature: Keep the room temperature warm but comfortable. Avoid extremes of hot or cold.
Offer loose-fitting clothing: Dress the person in thin, breathable layers that can be easily adjusted as their temperature changes. Avoid tight-fitting clothing that can trap heat.
Use blankets: Provide one or two lightweight blankets that can be added or removed as needed. Avoid using heavy blankets that can make the person feel overheated.
Warm compress: Apply a warm, damp cloth to the forehead or temples.
Warm socks: Provide warm socks to help increase heat retention.
Lukewarm bath: If the person is comfortable, offer a lukewarm bath. Avoid using hot water, which can cause shivering.
Encourage fluids: Offer plenty of fluids, such as water, broth, or clear juices, to help prevent dehydration. Avoid caffeinated or alcoholic beverages, which can worsen dehydration.
Antipyretics: Over-the-counter medications such as acetaminophen or ibuprofen can help reduce fever and chills. However, it is important to follow the dosage instructions carefully and to consult with a doctor before giving these medications to children or people with certain medical conditions.