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Alterations in vital signs temperature, pulse, respiratory rate, and blood pressure are important aids in diagnosis. Fever is most often due to a systemic infection such as pneumonia or to bacterial meningitis or viral encephalitis. An excessively high body temperature (42 or 43 C) associated with dry skin should arouse suspicion of heat stroke or intoxication by a drug with anticholinergic activity. Fever should not be ascribed to a brain lesion that has disturbed the temperature-regulating center so-called central fever, which is a rare occurrence. Hypothermia is observed in patients with alcoholic or barbiturate intoxication, drowning, exposure to cold, peripheral circulatory failure, and myxedema. Slow breathing points to opiate or barbiturate intoxication and occasionally to hypothyroidism, whereas deep, rapid breathing (Kussmaul respiration) should suggest the presence of pneumonia, diabetic or uremic acidosis, pulmonary edema, or the less common occurrence of an intracranial disease that causes central neurogenic
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