Sepsis

Sepsis is a life-threatening condition caused by processes surrounding an infection. Sepsis occurs when the body's defenses go into overdrive while fighting an invading disease, causing the immune system to attack organs and other healthy parts of the body.

This causes systemic inflammation, fever, pain, and can progress further, into coma and death. If caught early enough, treatment with intravenous fluids and antibiotics can usually reverse and cure sepsis, once the underlying infection is dealt with. Still, proper identification and handling of the condition is crucial to survival.

Definition & Facts

Sepsis is the name of the condition caused by a runaway immune response to an infection. It is often mistaken for an infection itself, but it is a secondary condition with its own symptoms, particularly at least two of these symptoms:

• Abnormal body temperature
• Abnormal heart rate (typically racing)
• Low blood pressure
• Abnormal arterial blood gas
• Extremely high white blood cell count or low white blood cell count
• Abnormal respiratory rate - typically hyperventilation

Sepsis itself is a catchall term for a handful of conditions that describe the severity of the immune response. Systemic inflammatory response syndrome (SIRS) which is the earliest stage causes the previously mentioned systemic problems, and can often be easily reversed with antibiotics and fluids.

Severe sepsis is the next stage, typified by organ dysfunction and fluid retention. The final stage is septic shock, which has the symptoms of the previous two categories along with persistent and dangerously low blood pressure despite the administration of IV fluids. Septic shock can end with organ failure, delirium, and death.

Symptoms & Complaints

As the sepsis progresses, different systems are affected, with the progression to severe sepsis marked by confusion and mood swings, need for a respirator, decreased urine output, jaundice, and blood clotting dysfunction.

All of these symptoms depend on which organ systems are suffering the most damage and they may not all be present, but neurological symptoms and difficulty breathing are very common in severe sepsis. Once the condition progresses to septic shock, markedly decreased functioning across the board is common, as blood pressure continues to drop lower despite efforts to counteract this process.

Causes

When the body fights an infection, it releases various types of white blood cells to kill and remove the invader. Sometimes this creates a reaction in the immune system that causes it to go haywire, attacking healthy tissue and organs in addition to the infection.

The essential cause is an infection, and primarily those that take longer to resolve. Sepsis from simple infections like those that cause sinusitis or a cut on the hand are not as common as those arising from abdominal infections, kidney infections, or lung infections. As the body attacks itself, cells rupture which causes inflammation and causes blood pressure to drop, increasing heart and respiratory rate, fever, and eventually organ damage on a much larger scale.

Incidentally, the occurrence of sepsis in America is on the rise, owed partially at least to drug-resistant bacteria, and an increasing number of people in the at risk zone (those over 65), and those with weakened immune systems, like people with HIV, cancer, or organ transplant recipients.

Diagnosis & Tests

Diagnosis of sepsis is difficult; often the symptoms mimic those caused by the disease creating the septic condition itself. Because the primary complaints are fever and increased heart and breathing rates, a doctor will need to thoroughly examine the patient and run a barrage of tests to determine if there is sepsis. From two distinct blood samples (drawn from different locations on the body), tests need to be run for blood clotting problems, decreased blood oxygen, electrolyte imbalance, and of course signs of any disease-causing agent.

A doctor may also run body scans to determine the location of the infection, as certain diseases like pneumonia might not be immediately visible. MRIs are useful for infections in the spine or bones which do not have an external surface wound.

Treatment & Therapy

The treatment protocols for sepsis depend heavily on what stage of sepsis the patient is in and the severity of the symptoms. For early-stage sepsis, antibiotics are the first line of medication, to treat the underlying infection and the cause of the system-wide immune response. At the same time, fluids are administered to keep organs working correctly and blood pressure stable.

For severe sepsis and septic shock, the key is ensuring the patient is stable before administering antibiotics. This is done with IVs, respirators, and vasopressors to keep the heart rate even and blood pressure up. Insulin can be used to regulate blood sugar as well as small doses of corticosteroids to help with inflammation. Sedatives and ibuprofen may also be prescribed. For extreme cases, extra oxygen provided by a machine as well as dialysis to help the kidneys function better may also be administered. If the infection is due to a deep abscess, surgery may be necessary to completely remove it at the source.

Prevention & Prophylaxis

Being aware of risk factors - the age of the patient, weakened immune systems, or long-lasting infection - can be the difference between not getting sepsis or keeping it treatable, and having it progress into septic shock that threatens lives.