Sepsis

Question 1

Vasopressors of choice

Answer 1

1. Norepinephrine
2. Vasopressin
   3, epinephrine

Question 2

Septic shock

Answer 2

Hydrocortisone 200-300 mg/day
Fludrocortisone 0.1 mg/day

Question 3

AKI in sepsis

Answer 3

Due to dysregulated thromboinflammatory response
JTH Haemost 2024;22:1530-1540

Question 4

Sepsis AKI
Acute tubular damage is due to:

Answer 4

1. Hypotension
2. Increased nitric oxide synthase
3. Mediators of oxidative stress
4. Hypoxia due to microvascular inflammation and coagulopathy
   (Mitochondrial damage)

Question 5

Sepsis AKI

Answer 5

1. Diminished glomerular blood flow
2. Loss of glycocalyx components results in increased microvascular permeability

Question 6

Sepsis AKI

Answer 6

1. Ischemia leads to cortical necrosis
2. Microthombosis
3. Suppressed fibrinolysis

Question 7

Sepsis AKI PREDICTORS

Answer 7

1. Platelet count, INR, DIC markers predict AKI, thrombomodulin

Question 8

Sepsis AKI THROMBOMODULIN is

Answer 8

Thrombin receptor on endothelial cells.
Thrombomodulin activates protein C

Question 9

Sepsis AKI

Answer 9

Oxygen diffusion impaired on organ edema. “Aggressive fluid therapy may not prevent progression of AKI in sepsis.”
A randomized study reported restricting volume reduces AKI

Question 10

Sepsis AKI
FLUID RESUSUSCITATIVE
J Thr Haemost 2024;22:1530-1540

Answer 10

Hjortrup, et al Intensive care medicine 2016;42:1695-705
Xiao, et al Am J Emergency Medicine 2023;74:146-51
Montomoli, et al Nephron 2019;143:170-3

Question 11

Severe pneumonia

Answer 11

Add hydrocortisone 200 mg/day 5-7 days

Question 12

Lung abscess, cavitations, empyema

Answer 12

Anaerobic coverage