107.1!

My sister ran a temp of 106-106.5 over the course of a week with a mouth infection. She was hallucinating and thrashing in her sleep. My parents took her to the doc several times that week and he refused to admit her on the grounds that she was still taking fluids and they would do nothing else for her in the hospital. It was a viral infection, but still, she was 6 years old and we lived 30 minutes from the nearest doctor.

I've seen a few greater than 106F, always in patients with head injuries that have the "hypothalamic storm," as well call it. They often shake, shudder, and appear to be seizing, as well as become extremely tachypnic and tachycardic. We do the cooling blanket, ice them down, alternate tylenol and motrin (if they don't have a bleed). We also pan culture every few days to rule out infectious process.

The families almost always totally freak out, and I've found it's really difficult to explain the pathphysiology behind it as well as why we can't "fix" the problem.