What are the warning signs of sepsis. How is sepsis diagnosed and treated. When does sepsis require emergency care or intensive care unit treatment. What antibiotics are used for sepsis.

Understanding Sepsis: The Silent Killer

Sepsis is a life-threatening condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction. It can progress rapidly, making early detection and treatment crucial for survival. This article explores the symptoms, diagnosis, and treatment of sepsis, providing valuable information for patients and healthcare professionals alike.

The TIME Acronym: Key Symptoms of Sepsis

Healthcare professionals use the TIME acronym to identify potential sepsis cases:

• T – Temperature higher or lower than normal
• I – Infection signs and symptoms
• M – Mental decline
• E – Extremely ill

Is fever always present in sepsis cases? Interestingly, while fever is common, some patients may experience hypothermia (low body temperature) instead. Any significant change in body temperature, whether high or low, can be a warning sign of sepsis.

Infection: The Root Cause of Sepsis

Can sepsis occur without an obvious infection? Yes, it’s possible to have an infection without noticeable symptoms. This is particularly important to remember after surgery, invasive medical procedures, or exposure to someone who is ill. Common infection sites that can lead to sepsis include:

• Urinary tract infections
• Pneumonia
• Infected wounds or cuts

Mental Status Changes: A Critical Warning Sign

How does sepsis affect mental status? Sepsis can cause confusion, sleepiness, and difficulty rousing. In elderly patients, it may manifest as a sudden worsening of dementia or confusion. These mental status changes are often overlooked but can be crucial indicators of sepsis progression.

Diagnostic Criteria for Sepsis

Healthcare professionals use various indicators to diagnose sepsis, including:

Inflammatory Markers

• Elevated white blood cell count
• Presence of immature white blood cells in circulation
• High levels of C-reactive protein and procalcitonin

Hemodynamic Changes

• Low blood pressure
• Reduced oxygen saturation in central or mixed venous blood
• Elevated cardiac index

Organ Dysfunction Indicators

• Low oxygen levels
• Decreased urine output
• Elevated blood creatinine
• Coagulation abnormalities
• Absent bowel sounds
• Low platelet count
• High bilirubin levels

Tissue Perfusion Markers

• Elevated blood lactate levels
• Decreased capillary filling or skin mottling

Emergency Treatment for Sepsis

When is emergency treatment or intensive care necessary for sepsis patients? Emergency care or admission to an intensive care unit (ICU) is required in cases of severe sepsis or septic shock. Septic shock occurs when blood pressure drops to dangerously low levels, compromising organ function.

ICUs provide crucial support for vital functions like breathing, allowing medical staff to focus on treating the underlying infection. With prompt identification and treatment, most sepsis cases lead to full recovery without lasting complications.

Antibiotic Therapy: The Cornerstone of Sepsis Treatment

Why is rapid antibiotic administration critical in sepsis treatment? Timely antibiotic therapy is the mainstay of sepsis treatment. Ideally, intravenous antibiotics should be administered within an hour of diagnosis to maximize the chances of a positive outcome.

Broad-Spectrum Antibiotics

Initially, broad-spectrum antibiotics are used to cover a wide range of potential pathogens. These antibiotics are effective against most common infections and are administered before the specific causative organism is identified.

Targeted Antibiotic Therapy

Once the specific bacterium responsible for the infection is identified, treatment can be tailored using more focused antibiotics. This approach helps to minimize the risk of antibiotic resistance and potential side effects.

Duration of Antibiotic Treatment

How long does antibiotic treatment for sepsis typically last? Intravenous antibiotics are usually replaced by oral medications after 2 to 4 days. The total duration of antibiotic therapy can range from 7 to 10 days or longer, depending on the severity of the infection and the patient’s response to treatment.

Viral Sepsis: A Unique Challenge

Can sepsis be caused by viral infections? Yes, viral infections can also lead to sepsis. In these cases, antibiotics are not effective, but they are often administered initially due to the urgency of treatment and the difficulty in quickly distinguishing between bacterial and viral causes.

For viral sepsis, treatment primarily involves supportive care and allowing the immune system to combat the infection. In some cases, antiviral medications may be prescribed if a specific viral cause is identified.

Fluid Resuscitation in Sepsis Management

Why is intravenous fluid administration crucial in sepsis treatment? Sepsis often leads to significant fluid loss and decreased blood volume, which can compromise organ function. Intravenous fluid therapy helps to:

• Maintain adequate blood pressure
• Improve tissue perfusion
• Support organ function
• Facilitate the delivery of antibiotics and other medications

The type and amount of fluids administered are carefully monitored and adjusted based on the patient’s response and overall clinical picture.

Sepsis in Special Populations

Pediatric Sepsis

How does sepsis present differently in children? Children with sepsis may exhibit symptoms that differ from those seen in adults. These can include:

• High fever or hypothermia
• Rapid breathing or difficulty breathing
• Rapid heart rate
• Lethargy or difficulty waking
• Reduced urine output
• Mottled or cold skin

Early recognition and treatment are particularly crucial in pediatric sepsis cases, as children can deteriorate rapidly.

Sepsis in the Elderly

Why is sepsis often more challenging to diagnose in older adults? Elderly patients may not display typical sepsis symptoms, making diagnosis more difficult. Key considerations in this population include:

• Subtle changes in mental status or behavior
• Worsening of pre-existing conditions
• Decreased mobility or falls
• Reduced appetite or fluid intake

Healthcare providers must maintain a high index of suspicion for sepsis in elderly patients, especially those with multiple comorbidities or a history of recurrent infections.

Long-Term Consequences of Sepsis

Does sepsis have lasting effects on survivors? While many patients recover fully from sepsis, some may experience long-term complications, collectively known as post-sepsis syndrome. These can include:

• Chronic fatigue
• Muscle weakness
• Cognitive impairment
• Anxiety and depression
• Increased susceptibility to infections
• Organ dysfunction

Recognizing and addressing these potential long-term effects is crucial for improving the quality of life for sepsis survivors.

Sepsis Prevention Strategies

How can the risk of developing sepsis be reduced? While it’s not always possible to prevent sepsis, several strategies can help minimize the risk:

• Practicing good hygiene, including regular handwashing
• Staying up to date with vaccinations
• Promptly treating infections and wounds
• Managing chronic health conditions effectively
• Seeking medical attention early when symptoms of infection arise

Healthcare providers play a crucial role in sepsis prevention by implementing evidence-based protocols for infection control and early sepsis recognition.

Advances in Sepsis Research and Treatment

What new developments are on the horizon for sepsis management? Ongoing research in sepsis is focused on several promising areas:

• Biomarker discovery for earlier and more accurate diagnosis
• Targeted immunomodulatory therapies
• Personalized treatment approaches based on genetic profiles
• Novel antibiotic development to combat resistant pathogens
• Machine learning algorithms for early sepsis prediction and management

These advancements hold the potential to significantly improve sepsis outcomes and reduce mortality rates in the coming years.

The Role of Public Awareness in Sepsis Prevention

Why is public education crucial in combating sepsis? Increasing public awareness about sepsis is essential for several reasons:

• Early recognition of symptoms can lead to prompt medical intervention
• Understanding risk factors can help individuals take preventive measures
• Awareness can drive policy changes and increased funding for sepsis research
• Education can reduce the stigma associated with sepsis and improve support for survivors

Organizations like the Sepsis Alliance play a vital role in disseminating information and resources to both healthcare professionals and the general public.

Sepsis in the Context of Global Health

How does sepsis impact global health systems? Sepsis is a significant global health challenge, with an estimated 48.9 million cases and 11 million deaths worldwide annually. The impact of sepsis extends beyond individual patient outcomes, affecting:

• Healthcare resource utilization and costs
• Antibiotic stewardship efforts
• Health disparities in low- and middle-income countries
• Global initiatives for infection control and antimicrobial resistance

Addressing sepsis on a global scale requires coordinated efforts from healthcare systems, policymakers, and international organizations.

The Future of Sepsis Care: Integrating Technology and Personalized Medicine

How will technological advancements shape the future of sepsis management? The integration of technology and personalized medicine approaches holds great promise for improving sepsis care:

• Artificial intelligence for real-time sepsis risk assessment
• Wearable devices for continuous patient monitoring
• Genomic profiling to guide individualized treatment strategies
• Telemedicine platforms for remote sepsis management and follow-up care
• Big data analytics to identify patterns and predict outcomes

These innovations have the potential to revolutionize sepsis diagnosis, treatment, and long-term management, ultimately leading to better patient outcomes and reduced healthcare costs.

Symptoms | Sepsis Alliance

Click here to download this symptoms card.

It’s important to look for a combination of the warning signs of sepsis. Spotting these symptoms early could prevent the body from entering septic shock, and could save a life.

T – Temperature higher or lower.

Your body’s temperature should stay fairly constant, around 98.6 degrees Fahrenheit (37 degrees Celsius), moving up or down a bit depending on your activity, the environment, and time of day. A temperature of 100 degrees Fahrenheit (37.7 degrees Celsius) is considered to be hyperthermia, a fever. When you have an infection, your body’s temperature usually rises as it tries to fight off the bug causing the infection. Interestingly, some people see their body temperature go down (hypothermia) instead of up. This is why any change, high or low, can be a sign of sepsis.

I – Infection – may have signs and symptoms of an infection.

If you have a local infection, like a urinary tract infection, pneumonia, or an infected cut, the signs and symptoms are localized according to the area affected (needing to urinate or burning on urination for a UTI, coughing and chest pain for pneumonia, redness and pus for an infected cut, for example). If the infection has spread or you have a generalized infection, you may develop other signs and symptoms, such as fever, fatigue, pain, etc.

Sometimes however, you may have an infection and not know it, and not have any symptoms. Keep this in mind especially if you have recently had surgery or an invasive medical procedure, a break in your skin, or you have been exposed to someone who is ill.

M – Mental decline – confused, sleepy, difficult to rouse.

Sepsis can affect your mental status. Some people, especially the elderly, may not show typical signs of infection. Instead, they may show a sudden change in mental status, becoming confused, or a worsening of dementia and confusion. Sleepiness, often severe, is also a common complaint.

E – Extremely ill –  severe pain or discomfort, shortness of breath.

Many sepsis survivors have said that when they were ill, it was the worst they ever felt. It was the worst sore throat, worst abdominal pain, or they felt that they were going to die.

Children developing sepsis may exhibit different symptoms, as seen below.

Healthcare professionals look for the following signs and symptoms, as well as those listed above, to determine a diagnosis. They include:

Inflammatory

• High white blood cell count
• Immature white blood cells in the circulation
• Elevated plasma C-reactive protein
• Elevated procalcitonin (PCT)

Hemodynamic

• Low blood pressure
• Low central venous or mixed venous oxygen saturation
• High cardiac index

Organ Dysfunction

• Low oxygen level
• Low urine output
• High creatinine in the blood
• Coagulation (clotting) abnormalities
• Absent bowel sounds
• Low platelets in the blood
• High bilirubin levels

Tissue Perfusion

• High lactate in the blood
• Decreased capillary filling or mottling

Sepsis | NHS inform

Treatment for sepsis varies, depending on the:

• area affected
• cause of the infection
• organs affected
• extent of any damage

If you have the early signs of sepsis, you’ll usually be referred to hospital. You’ll then be given a diagnosis and treatment.

Emergency treatment

You’ll need emergency treatment, or treatment in an intensive care unit (ICU), if:

• the sepsis is severe
• you develop septic shock – when your blood pressure drops to a dangerously low level

ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection.

Sepsis is treatable if it’s identified and treated quickly. In most cases it leads to full recovery with no lasting problems.

Antibiotics

The main treatment for sepsis, severe sepsis or septic shock is antibiotics. These will be given directly into a vein (intravenously).

Ideally, antibiotic treatment should start within an hour of diagnosis.

Intravenous antibiotics are usually replaced by tablets after 2 to 4 days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition.

Types of antibiotics

If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there won’t be time to wait until a specific type of infection has been identified.

Broad-spectrum antibiotics work against a wide range of known infectious bacteria. They usually cure most common infections.

Once a specific bacterium has been identified, a more focused antibiotic can be used.

Viral infections

If the sepsis is caused by a virus, antibiotics won’t work. However, it would be too dangerous to delay treatment to find out the specific cause. This means antibiotics are usually given anyway.

With a viral infection, you’ll need to wait until your immune system starts to tackle it. However, antiviral medication may be given in some cases.

Intravenous fluids

If you have sepsis, your body needs more fluid to prevent dehydration and kidney failure.

If you have severe sepsis or septic shock, you’ll usually be given fluids intravenously for the first 24 to 48 hours.

It’s important that the doctors know how much urine your kidneys are making when you have sepsis. This helps them spot signs of kidney failure.

If you’re admitted with severe sepsis or septic shock, you’ll usually be given a catheter. This is inserted into your bladder to monitor your urine output.

Oxygen

Your body’s oxygen demand goes up if you have sepsis.

If you’re admitted to hospital with sepsis and the level of oxygen in your blood is low, you’ll usually be given oxygen. This is given through a mask or tubes in your nostrils.

Treating the source of infection

If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated.

For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage.

Increasing blood pressure

Medications called vasopressors are used if you have low blood pressure caused by sepsis.

Vasopressors are normally given intravenously while you’re in an ICU. Extra fluids may also be given intravenously to help increase blood pressure.

Other treatments

You may require additional treatments like:

• corticosteroids
• insulin medication
• a blood transfusion
• mechanical ventilation – where a machine is used to help you breathe
• dialysis – where a machine filters your blood to copy the function of your kidneys

These treatments are mostly used in ICUs.

Viral gastroenteritis – Humanitas

Viral gastroenteritis – is an infection of the intestines that is characterized by watery stools, abdominal cramps, nausea or vomiting, and sometimes fever.

The most common viral gastroenteritis (sometimes called “stomach flu”) is transmitted through contact with a sick person or ingestion of contaminated food or water. If the state of health is otherwise normal, recovery will probably not be accompanied by complications. However, in infants, the elderly, and people with suppressed immune systems, viral gastroenteritis can be fatal.

There is no effective treatment for viral gastroenteritis, so prevention is becoming more important. In addition to avoiding food and water that may be contaminated, the best defense is thorough and frequent handwashing.

Symptoms

Despite the common name “stomach flu”, gastroenteritis is different from the flu. The true flu only affects the respiratory system: nose, throat and lungs. Gastroenteritis affects the intestines, causing the following signs and symptoms:

• Watery stools, usually without blood – bloody diarrhea often indicates another, more severe infection.
• Abdominal cramps and pain
• Nausea, vomiting or both
• Periodic muscle pain and headaches
• Low temperature

Depending on the cause, symptoms of viral gastroenteritis may appear within one to three days after infection and may be mild or severe. Symptoms usually persist for one to two days, but can sometimes persist for up to 10 days.

Because the symptoms are similar, viral diarrhea can easily be mistaken for diarrhea caused by bacteria, such as salmonella and E. coli, or parasites, such as giardia.

Conditions requiring medical attention

An adult should seek medical attention in the following cases:

• Fluid is not retained within 24 hours
• Vomiting for more than two days
• Hematemesis
• Dehydration: Signs of dehydration include extreme thirst, dry mouth, deep yellow urine, infrequent or no urination, severe weakness, dizziness, or lightheadedness.
• Detection of blood impurities in feces
• Temperature above 40°C (104°F)
• In infants and young children

If your child has any of the following symptoms, see a doctor immediately:

• Temperature 38.9C (102 F) and above
• Drowsiness or irritability
• Feeling that the child is in severe discomfort or pain
• Bloody diarrhea
• Child feels dehydrated: monitor for signs of dehydration in sick infants and young children by comparing fluid intake and urine output with the child’s normal intake

If you have a small child, remember that if daily spitting up is not a cause for concern, then vomiting is not the norm. Vomiting in children appears for various reasons, many of which require medical intervention.

If a child has any of the following, see a doctor immediately:

• Vomiting for several hours
• Diaper dry for six hours
• Bloody stools or severe diarrhea
• Sunken fontanel – soft spot on top of child
• The child has a dry mouth or no tears when crying
• Unusual drowsiness, no response

Complications

The main complication of viral gastroenteritis is severe loss of water and important salts and minerals. If the body is healthy and the person is drinking enough fluid to replace the fluid excreted through vomiting or diarrhea, dehydration is not dangerous.

Young children, the elderly, or people with a suppressed immune system can become severely dehydrated if the amount of fluid they take in cannot replace the amount of fluid lost. In this case, hospitalization may be required, where the lost fluid will be restored intravenously. In rare cases, dehydration can lead to death.

description of the disease, causes, symptoms, diagnosis and treatment

Hypothermia is a violation of heat transfer, which is manifested by a significant decrease in body temperature (less than 35.5°C). Occurs with prolonged exposure to low ambient temperatures or a decrease in heat production and an increase in its return. Hypothermia often becomes a sign of certain diseases.

Mechanism of heat production

Mandatory heat production is the heat that is produced during the body’s metabolic processes. It is enough to maintain normal body temperature, but only if the ambient temperature is comfortable. For an adult, the range from 18 to 23 ° C is considered comfortable, but with minimal physical activity and light clothing. When the body is hypothermic, muscle tone increases, so muscle tremors appear.

However, there is the concept of additional heat production. It becomes active if the air temperature becomes too low. Additional heat production includes contractile thermogenesis, which is based on involuntary muscle contraction, as well as non-contractile thermogenesis, carried out by splitting brown fat. It is practically absent in adults, since it regresses with growing up. Brown adipose tissue is located in the area of ​​​​the kidneys, shoulder blades, on the neck. Young children have more of it, and it is metabolically very active, because it protects them from severe hypothermia.

The metabolic rate is influenced by thyroid and adrenal hormones. The thermoregulatory center is located in the hypothalamus. The central body temperature is measured in the oral cavity, rectum, ear canal, and in a medical institution – in the bladder, nasopharynx and esophagus. In the central vessels and most internal organs, it is maintained at a level of 36–38°C.

Peripheral body temperature is measured in the armpits or on the forehead. Normally, it is slightly below the center.

Temperature readings are individual for each person and differ depending on the part of the body. There is a certain norm, which changes slightly during the day.

Causes of hypothermia

Possible causes of decreased body temperature include:

• CNS pathology;
• low muscle mass;
• alcohol or other intoxication;
• prolonged physical activity;
• decreased metabolic rate;
• period of pregnancy;
• drug exposure;
• recovery period after a long illness.

Hypothermia is also caused by prolonged exposure to ice-cold water, wet clothing, and low ambient temperatures. These factors often lead to disruption of thermal exchange and heat loss.

Types of low temperature

Hypothermia is endogenous, when pathologies of internal organs are observed, or exogenous, when body temperature depends on external factors.

Medical hypothermia is also classified as exogenous. It is used when a temporary slowdown in blood circulation is required. That is, its task is to reduce metabolism and activity in organs and tissues. This is necessary to increase resistance to lack of oxygen. Medical hypothermia is indicated during open surgical interventions on the heart and blood vessels, with injuries of the brain and spinal cord, ischemic stroke, neonatal hypoxia.

The following types of low temperature are noted:

1. Mild degree – observed at body temperature from 32.2 to 35 ° C, characterized by drowsiness, chills, increased heart rate and respiration.
2. Medium degree – noted at a temperature of 27 to 32.1 ° C, it is characterized by a decrease in reflexes, bradycardia and slow breathing.
3. Severe degree – observed at temperatures below 27 ° C, when a person is in a depressed state, and he completely lacks reflexes.

The degree of severity is assessed by the doctor not only by the level of decrease in the central temperature, but also by some clinical signs.

Pathologies causing hypothermia

The most rare causes include:

• spinal cord injury;
• terminal liver failure;
• septic condition;
• uremia;
• certain types of diabetes.

Common causes of hypothermia include heart attack and stroke, Addison’s disease, hypothyroidism, anemia, hypoglycemia, as well as VSD and depression.

Body temperature may decrease during shock conditions, with a sharp expansion of blood vessels. Heat transfer increases many times, and the body temperature drops by 4-5 ° C below the accepted norm. If this is combined with chest pain and low blood pressure, then myocardial infarction is possible.

Occasionally, hypothermia is caused by ischemic stroke. The patient feels drowsiness, some stupor, a short-term loss of consciousness is possible. As a rule, neurological symptoms and temperature decrease increase gradually.

A decrease in temperature below 32°C is noted with hemorrhages or inflammatory processes in the hypothalamus. When the posterior hypothalamus is affected, temperature fluctuations associated with the environment (poikilothermia) are observed. In cold conditions, a hypothermic coma is possible with irreversible consequences for some parts of the brain.

Addison’s disease is also often the cause of a decrease in temperature. Corticosteroids, which are synthesized by the adrenal glands, maintain the metabolism at the proper level, including the temperature. However, with their insufficient production, a number of disorders appear, against their background, the body temperature drops. A sudden decrease in blood pressure, muscle weakness, loss of consciousness, combined with a temperature below 33 ° C, indicate an Addisonian crisis.

Hypothyroidism slows down metabolism, and the brain center responsible for proper thermoregulation reduces its activity. Such conditions negatively affect the skin: pallor, waxiness are the main signs. Due to microcirculation disorders, hair can fall out. The patient complains of loss of strength, constant drowsiness.

Initially, with hypoglycemia, there is a slight decrease in temperature, but if the causes are not eliminated, the condition rapidly worsens, and the temperature continues to decrease. Deep syncope is possible, because with hypoglycemia, energy starvation of the brain occurs.

Hypothermia in anemia is caused by low levels of red blood cells and hemoglobin. Among the clinical signs are headache, darkening in the eyes, fatigue. The condition of nails, hair, skin worsens.

In VVD, hypothermia is caused by impaired blood circulation and autonomic regulation. Such conditions are characterized by weakness, dizziness, trembling in the limbs. Such attacks occur periodically, they are provoked by prolonged stress, physical activity, prolonged stay in a stuffy room.

It is not uncommon to have a low body temperature after a viral infection. This is due to the sluggish activity of the immune system and the depletion of the body. Among the symptoms of asthenia are fatigue, weakness, drowsiness. The condition persists for 2-3 weeks.

In some cases, hypothermia is noted in depression, as associations change and the limbic system is disturbed, which causes malfunctions in the thermoregulatory center. However, temperatures are rarely set below 34.5°C, although hypothermia in depressive disorders is prolonged. Along with a low temperature, patients experience depression, sleep problems, they have cold extremities with a marbled pattern on the skin.

Hypothermia is possible with various intoxications of the body. Toxins, accumulating in the blood, penetrate into the parts of the brain, disrupting the transmission of impulses. Under the influence of toxic compounds, the body temperature decreases, the general condition of the body worsens.

Which doctor should I contact if my body temperature drops?

If a slight decrease in temperature, which is not associated with hypothermia, persists for a long time, then it is necessary to consult a general practitioner, neurologist, endocrinologist.

In case of a sharp drop in temperature, which is accompanied by other life-threatening symptoms, severe hypothermia, an ambulance will be required.

Diagnosis of hypothermia

The volume of diagnostic measures depends on the degree of temperature decrease and the general condition of the body.