Sepsis (Septic Shock) Clinical Manifestation Complications with Laboratory Findings

SepsisSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... » (Septic ShockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ») CLINICALHow to take good medical history & examination. Read more ... » MANIFESTATIONS

• There is some primary infection or diseaseHow to take good medical history & examination. Read more ... ».
• Mild sepsis chan,ges to severe, and to septic shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ». Patient may be hormo, hypo or hyper thermic i.e. feverThyrotoxic crisis or Thyroid storm. Read more ... » normal, low or high Fever is absent in neonates, elderly, alcoholics and in uremia.
•   Hyperventilation is early sign.
• Then there is disorientation, confusion, encephalopathy.
• No focal neurological signsHow to take good medical history & examination. Read more ... » are seen. There is hypotensionDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... ».
• Disseminated intravascular coagulation leading to acrocyanosis, ischemia and necrosis of tissues of fin­gers and toes is seen.
• Cellulitis, pustules, bullae, hemorrhagic lesions, dif­fuse cutaneous lesions occur.
• In Neisseria meningitides, Hemophilus influenzaInfluenza SARS and Whooping Cough Signs and Symptoms with Diagnosis and Treatment. Read more ... », Rocky Mountain Spotted Fever (tickbite) infection ­Cutaneous Petechiae/Purpura seen.
• PseudomonasInfections Caused by Gram-Negative PSEUDOMONAS SPECIES diagnosis Treatment Signs and symptom. Read more ... » aeroginosa-Ecthyma gangrenosum is seen i.e. central bullous lesion with haemorrhage and necrosis surrounded by edema.
• It is also seen in neutropenic patients. Gastrointestinal Manifestations - NauseaNausea and Vomiting. Read more ... », vomitingNausea and Vomiting. Read more ... », diarrhoeaInfections CHOLERA Caused by Vibrio cholerae with diagnosis Treatment Signs and symptoms. Read more ... », ileus.
• Stress ulcers, Upper GI bleeding, cholestatic jaun­dice with increased serum bilirubin, increased alka­line phosphatase, hepatic dysfunction.
• It may be reversible. -
• Severe hypotension may lead to hepatic injury or is­chemic bowel necrosis.
• There is lactic acidosis, hyperglycemiaSome Facts about Glucocorticoid & Major side effects. Read more ... » (in diabetics), hypoglycemia.

Sepsis (Septic Shock) Clinical Manifestation Complications with Laboratory Findings

MAJOR COMPLICATIONS of Sepsis (Septic Shock)

Cardiopulmonary -

• Ventricular perfusion mismatch leading to fall in arterial P0₂
• Pulmonary oedema due to increased pulmonary wa­ter content.
• Pa0₂ / Fi0₂ < 200 mmHg indicates development of acuteHow to take good medical history & examination. Read more ... » respiratory distress syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... » – ARDSAcute Respiratory Distress Syndrome (ARDS) Causes Clinical feature Treatment. Read more ... ».
• Respiratory muscle failure results in hypoxaemia and hypercapnia.
• In ARDS pulmonary wedge pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... » less than 18 mmHg.
• If PWP is more than 18 mm then it suggests fluid volume overload or cardiacCOMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU). Read more ... » failure.
• Viral pneumonia or pneumonia due to Pneumocystis
• carinii is just like ARDS. •

Septic hypotension -

• is due to diffuse capillary leak­age of intravascular fluid, dehydration, insensible fluid losses, vomiting, diarrhoea, polyuria.
• After fluid administration in septic shock, cardiac out­put increases and systemic vascular resistance de­creases.
• In cardiogenic shock this does not occur. There is decreased cardiac output and increased systemic vas­cular resistance.
• In anaphylaxis, beri-beri, cirrhosis, nitroprusside or narcotic overdose there is like septic shock increased cardiac output and decreased systemic vascular re­sistance with administration of fluids.
• In severe sepsis there is depressed myocardial func­tion, increase in end-diastolic volume, increased end­systolic volume, decreased ejection fraction within 24 , hours. Cardiac output is maintained but ejection frac­tion decreased due to ventricular dilatation.
• There is low systemic vascular resistance – hypoten­sion.
• Multi-organ failure leads to decreased systemic vas­cular resistance.

Renal complications of Sepsis (Septic Shock)

• · Oliguria
• · Azotemia (increased blood urea)
• · Proteinuria
• · Non-specific urinary casts
• · Polyuria
• · Hyperglycemia.
• Acute tubular necrosis leads to renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » failure due to hypotension and ischemia.
• Some “patients may have glomerulonephritis, renal cortical necrosis, interstitial nephritisAcute Renal Failure (ARF) Causes Clinical Features TREATMENT of ARF. Read more ... » or drugHow to take good medical history & examination. Read more ... »-induced as with aminoglycosides.

Coagulation abnormalities -

• Thrombocytopenia in 10 to 30% patients.
• Platelets less than 50,000jml in disseminated intra­vascular coagulation due to diffuse endothelial injury or microvascularChronic Long-term Complications Of Diabetes Mellitus. Read more ... » thrombi.

Neurological complications -

• Critical polyneuropa­thy occurs when weeks to months pass with sepsis preventing weaning from ventilatory support.
• There is distal motor weakness.

LABORATORY FINDINGS in Sepsis (Septic Shock)

• · Leucocytosis
• · Thrombocytopenia
• · HyperbilirubinemiaHyperbilirubinemia Classification Types Symptoms Examination. Read more ... »
• · Proteinuria
• · Leucopenia
• · Toxic granulation in neutrophils
• · Increased prothrombin time
• · Decreased fibrinogen
• · Presence of D-dimers (DIe-Disseminated Intra-
• vascular Coagulation)
• · Azotemia ,
• · Increased SGPT
• · Increased SGOT
• · Hemolysis suggests Clostridial bacteremia, ma­laria, drug reaction, DIe.

ARTERIAL BLOOD GAS ANALYSIS

• Hyperventilation results in respiratory alkalosisAcidosis & Alkalosis physiology with signs and symptoms. Read more ... », later lactic acidosis, metabolic acidosis, increased anion.­gap, hypoxaemia corrected with 100% oxygen. Later, due to right to left shunting there is refractory hypoxaemia.

CHEST X-RAY

• Normal or shows pneumonia, volume overload, or ARDS.

ECG

• Sinus tachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... », ST-T changes

DIAGNOSIS of Sepsis (Septic Shock)

• Fever or hypothermia, tachypnea, tachycardia, leu­kocytosis, leukopenia, altered mental state, thromb­ocytopenia, hypotension are all features of septic shock.
• Indications of infection seen.
• SIRSSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... » – noninfectious etiology in burns, pancreatitis, adrenalCushing's Syndrome Symptoms Causes and Treatment. Read more ... » insufficiency, pulmonary embolism, dissect­ing or ruptured aortic aneurysmAORTIC ANEURYSM THORACIC AORTIC ANEURYSM and ABDOMINAL AORTIC ANEURYSM Etiology Symptoms with Treatment. Read more ... », myocardial infarc­tion, occult haemorrhage, cardiac tamponadeCARDIAC TAMPONADE Causes with Physical findings and Treatment. Read more ... », post cardio-pulmonary bypass syndrome, anaphylaxis, drug overdose.
• 2 blood samples 10 ml each from 2 different sites at 2 different times are sent for culture.
• Staphylococcus aureus seen in 48 hours.
• Gram negative infection yield is low.
• Gram’s staining and culture of material from primary site of infection or skin may reveal the microbial eti­ology.
• Detection of endotoxin in blood is by Limulus Lysate test.
• Blood level of IL-6 and cytokine assays are of limited value.