What are the warning signs of sepsis. How does sepsis affect body temperature. Can sepsis cause mental confusion. What are the inflammatory markers of sepsis. How is sepsis treated in emergency situations.

Understanding Sepsis: A Life-Threatening Condition

Sepsis is a severe and potentially life-threatening condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction. Recognizing the early signs of sepsis is crucial for timely intervention and improved outcomes. The Sepsis Alliance has developed a helpful acronym, TIME, to help identify the key symptoms of sepsis.

The TIME Acronym for Sepsis Recognition

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

Let’s delve deeper into each of these components to better understand how sepsis manifests in the body.

Temperature Changes: A Key Indicator of Sepsis

One of the most striking symptoms of sepsis is an abnormal body temperature. While many people associate infections with fever, sepsis can actually cause both high and low body temperatures.

Hyperthermia in Sepsis

A temperature of 100 degrees Fahrenheit (37.7 degrees Celsius) or higher is considered hyperthermia or fever. This is often the body’s initial response to infection as it attempts to create an environment less hospitable to pathogens.

Hypothermia in Sepsis

Interestingly, some individuals with sepsis experience hypothermia, or a drop in body temperature, instead of fever. This unexpected response can sometimes delay diagnosis if healthcare providers are solely focused on detecting fever.

Why does sepsis sometimes cause low body temperature? In severe cases of sepsis, the body’s ability to regulate temperature can be compromised, leading to a drop in core temperature. This hypothermic response is often associated with a poorer prognosis and requires immediate medical attention.

Identifying Infection: The Root Cause of Sepsis

Sepsis always stems from an underlying infection, though the signs and symptoms can vary depending on the infection’s location and severity.

Localized Infection Symptoms

For localized infections, symptoms are typically confined to the affected area. For example:

• Urinary tract infection: Frequent urination, burning sensation while urinating
• Pneumonia: Coughing, chest pain, difficulty breathing
• Infected wound: Redness, swelling, pus formation

Systemic Infection Symptoms

As an infection spreads or becomes more severe, systemic symptoms may develop, including:

• Fever or low body temperature
• Fatigue and weakness
• Generalized pain or discomfort
• Loss of appetite

It’s important to note that some infections, particularly in elderly individuals or those with compromised immune systems, may not present with obvious symptoms. This underscores the importance of vigilance and regular health check-ups, especially following surgeries, invasive procedures, or exposure to ill individuals.

Mental Status Changes: A Critical Sepsis Warning Sign

Sepsis can have a profound impact on cognitive function and mental status. These changes are often one of the earliest and most noticeable signs of sepsis, particularly in older adults.

Common Mental Status Changes in Sepsis

• Confusion or disorientation
• Difficulty staying awake or being roused
• Sudden worsening of pre-existing dementia
• Agitation or restlessness
• Hallucinations

Why does sepsis affect mental status? The exact mechanisms are complex, but they likely involve a combination of factors including inflammation, changes in blood flow to the brain, and metabolic disturbances caused by organ dysfunction.

How quickly can mental status changes occur in sepsis? Mental status changes can develop rapidly in sepsis, sometimes within hours of the onset of infection. This rapid decline is one reason why prompt medical attention is crucial when sepsis is suspected.

Extreme Illness: When Sepsis Becomes Life-Threatening

As sepsis progresses, patients often report feeling extremely ill – perhaps the worst they’ve ever felt. This severe discomfort is a critical warning sign that should never be ignored.

Symptoms of Extreme Illness in Sepsis

• Severe pain or discomfort
• Shortness of breath or rapid breathing
• Feeling of impending doom
• Pale or mottled skin
• Cold and clammy extremities

How does sepsis cause such extreme symptoms? Sepsis triggers a cascade of inflammatory responses throughout the body, affecting multiple organ systems simultaneously. This widespread dysfunction leads to the severe symptoms experienced by patients.

Inflammatory Markers: The Hidden Signs of Sepsis

While not visible to the naked eye, certain inflammatory markers in the blood can provide crucial information about the presence and severity of sepsis. Healthcare professionals often rely on these markers for diagnosis and monitoring.

Key Inflammatory Markers in Sepsis

• Elevated white blood cell count
• Presence of immature white blood cells in circulation
• Increased levels of C-reactive protein (CRP)
• Elevated procalcitonin (PCT)

What do these inflammatory markers indicate? These markers suggest an active and severe inflammatory response in the body, which is characteristic of sepsis. Elevated levels often correlate with the severity of the condition and can help guide treatment decisions.

Hemodynamic Changes: The Cardiovascular Impact of Sepsis

Sepsis can dramatically affect the cardiovascular system, leading to significant hemodynamic changes. These alterations in blood flow and pressure can have far-reaching consequences throughout the body.

Common Hemodynamic Changes in Sepsis

• Low blood pressure (hypotension)
• Decreased oxygen saturation in venous blood
• Elevated cardiac index

Why does sepsis cause low blood pressure? In sepsis, blood vessels dilate and become leaky, leading to a drop in blood pressure. This can reduce blood flow to vital organs, potentially causing organ dysfunction or failure if not addressed promptly.

How does the body try to compensate for these hemodynamic changes? Initially, the heart may try to compensate by beating faster and more forcefully, leading to an elevated cardiac index. However, this compensation can eventually fail if sepsis progresses to septic shock.

Organ Dysfunction: The Devastating Effects of Sepsis

As sepsis progresses, it can lead to widespread organ dysfunction. This multisystem impact is what makes sepsis so dangerous and potentially lethal.

Signs of Organ Dysfunction in Sepsis

• Respiratory: Low oxygen levels, rapid breathing
• Renal: Decreased urine output, elevated creatinine levels
• Hepatic: Elevated bilirubin levels
• Hematologic: Low platelet count, coagulation abnormalities
• Gastrointestinal: Absent bowel sounds, ileus

How quickly can organ dysfunction develop in sepsis? Organ dysfunction can develop rapidly in sepsis, sometimes within hours of the onset of infection. This is why early recognition and treatment are crucial for preventing long-term complications or death.

Can organ dysfunction from sepsis be reversed? With prompt and appropriate treatment, many cases of sepsis-induced organ dysfunction can be reversed. However, the longer sepsis goes untreated, the higher the risk of permanent organ damage or failure.

Emergency Treatment: Combating Sepsis in Critical Care

When sepsis is suspected or diagnosed, immediate medical intervention is crucial. Treatment often takes place in an intensive care unit (ICU) where close monitoring and support of vital functions can be provided.

Key Components of Sepsis Treatment

1. Antibiotic Therapy: Broad-spectrum antibiotics are typically administered intravenously within an hour of diagnosis. These may be adjusted later based on blood culture results.
2. Fluid Resuscitation: Large volumes of intravenous fluids are given to support blood pressure and organ function.
3. Vasopressors: If fluids alone don’t restore blood pressure, medications to constrict blood vessels may be used.
4. Oxygen Therapy: Supplemental oxygen or mechanical ventilation may be necessary to support breathing.
5. Organ Support: Depending on the affected organs, additional treatments like dialysis for kidney failure may be required.

How long does sepsis treatment typically last? The duration of treatment can vary widely depending on the severity of sepsis and the patient’s response. Intravenous antibiotics are usually given for 7-10 days, but hospitalization may last longer if organ support is needed.

What is the goal of sepsis treatment? The primary goals are to eliminate the underlying infection, support failing organs, and prevent further complications. Early, aggressive treatment significantly improves the chances of survival and full recovery.

Special Considerations in Sepsis Treatment

While antibiotics are the mainstay of sepsis treatment, there are some important considerations:

• Viral Sepsis: In cases where sepsis is caused by a viral infection, antibiotics won’t be effective. However, they’re often given initially while waiting for test results, as delaying treatment could be dangerous.
• Antiviral Medications: In confirmed cases of viral sepsis, antiviral drugs may be administered if appropriate for the specific virus.
• Supportive Care: Regardless of the cause, supportive care to maintain organ function is crucial in all cases of sepsis.

Can sepsis be prevented? While not all cases of sepsis can be prevented, many can be avoided through proper hygiene, prompt treatment of infections, and appropriate wound care. Vaccination against common infectious diseases can also reduce the risk of sepsis.

Recovery and Long-Term Effects of Sepsis

While sepsis is a severe condition, many people recover fully with prompt and appropriate treatment. However, some survivors may experience long-term effects, a condition known as post-sepsis syndrome.

Common Long-Term Effects of Sepsis

• Fatigue and weakness
• Cognitive difficulties or “brain fog”
• Anxiety and depression
• Muscle and joint pain
• Increased susceptibility to infections
• Organ dysfunction

How long can post-sepsis syndrome last? The duration of post-sepsis syndrome can vary greatly. Some people recover within a few weeks, while others may have symptoms that persist for months or even years.

What support is available for sepsis survivors? Many hospitals and healthcare systems offer post-sepsis care programs to support recovery. These may include physical therapy, cognitive rehabilitation, and psychological support. Support groups can also be valuable resources for sepsis survivors and their families.

In conclusion, sepsis is a serious medical condition that requires immediate attention and treatment. By understanding the signs and symptoms, particularly the TIME criteria (Temperature, Infection, Mental decline, Extremely ill), individuals can seek prompt medical care when needed. With early intervention and appropriate treatment, many people with sepsis can recover fully and return to their normal lives.

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.