2.4. Clinical Manifestations of Sepsis Flashcards
What is the Clinical Features of Sepsis dependent on?
- Host
- Organism (type)
- Environment
What Respiratory Dysfunction can occur in Sepsis?
- Tachypnoea (not just associated with chest infection)
- PaO2 less than 70mmHg (normal is > 80mHg)
- O2 Saturation less than 90%
What Cardiovascular Dysfunction can occur in Sepsis?
- Tachycardia
- Hypotension
What Liver Dysfunction can occur in Sepsis?
- Increase in Liver Enzyme production (deranged LFT’s)
- Decrease in Albumin
- Increase in Prothrombin Time (PT)
Note - Jaundice can occur due to this
What Psychological / Neurological Dysfunction can occur in Sepsis?
- Altered consciousness (common in the elderly and very young, but can be present in normal individuals)
- Confusion
- Psychosis
What Renal Dysfunction can occur in Sepsis?
- Oliguria
- Anuria
- Increase in Creatinine
What Coagulation Dysfunction can occur in Sepsis?
- Decrease in Platelets
- Increase in Prothrombin Time (PT and Activated Partial Thromboplastin Time (APTT)
- Decreased Protein C
- Increased D-Dimer
What are the generic features of Sepsis?
- Fever (>38 degrees) / Hypothermia (<36 degrees)
- Tachycardia (>90bpm)
- Tachypnoea (>20 breaths/min)
- Altered Mental Status (especially in the elderly)
- Hyperglycaemia in the absence of Diabetes
Note - Hypothermia is common in the elderly and the very young
Why might Hyperglycaemia, in the absence of Diabetes, occur in Sepsis?
Due to the Catabolic State of the body
What are the Inflammatory Variables in Sepsis?
- Leucocytosis (WCC > 12,000/ml)
- Leucopenia (WCC < 4,000/ml)
- Normal WCC with greater than 10% immature forms
- High CRP (not specific)
- High Procalcitonin (only elevated in bacterial infection)
Note - Leucopenia is a bad sign body is unable to produce White Cells (too many anti-inflammatory (Th2) mediators)
What are the Haemodynamic Variables in Sepsis?
- Arterial Hypotension (Systolic < 90mmHg, or MAP < 70mmHg)
- SvO2 > 70%
What are the Organ Dysfunction Variables in Sepsis?
- Arterial Hypoxaemia
- Oliguria
- Creatinine increase (compared to baseline)
- Coagulation abnormalities (PT>1.5 or APTT>60s)
- Ileus (Abdominal distention)
- Thrombocytopenia (<150,000/ml)
- Hyperbilirubinaemia
In Sepsis, when does Arterial Hypoxaemia occur?
When the PaO2 / FiO2 is less than 50mmHg (Normal is > 80mmHg)
What is the definition of Oliguria?
Not able to produce much urine (<0.5ml/kg/hr)
Note - on a normal person this is about 35-40mls/hr
What is the Tissue Perfusion Variables in Sepsis?
- High Lactate
- Skin mottling and reduced Capillary Perfusion
What is the most important blood test when it comes to Sepsis?
Serum Lactate
What does Serum Lactate tell us?
Whether the patient has tissue hypoperfusion or not
If Serum Lactate is high, there is reduced perfusion
What are the Effects of the Host on Sepsis presentation?
- Age
- Co-morbidities
- Immunosuppression
- Previous Surgery (Splenectomy)
What are some common Co-morbidities which would effect Sepsis?
- Chronic Obstructive Pulmonary Disease
- Diabetes Mellitus
- Congestive Cardiac Failure
- Disseminated Malignancy
What are the different types of immunosuppression?
- Acquired - HIV / AIDS
- Drug-induced - Steroids, Chemotheraputic agents, biologics
- Congenital - Alpha-Gamma-Globulinaemia, Phagocytic defects, defects in terminal complement component
What are the Effect of the Organism on the presentation of Sepsis?
- Gram Positive usually causes infection from above the diaphragm
- Gram negative usually causes infection from below the diaphragm
Note - the treatment differs fro Gram Positive and Gram Negative, due to the different pathophysiologies - Virulence factors (e.g. MRSA, Toxin secretion etc.)
- Bioburden
What are the Effects of the Environment on the presentation of Sepsis?
- Occupation
- Travel
- Hospitalization
