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Septicemia

Multiplication of highly virulent micro-organisms or their toxins in the blood stream overwhelming the immune system there by producing septic shock and  widespread metastatic deposits leading to multi-organ failure and death

Clinical features

  • Fever, tachypnea, tachycardia
  • Encephalopathy (Confusion, disorientation)
  • Hypotension
  • DIC
  • Skin lesions (rash, petechae)
  • Nausea, vomiting & diarrhea
  • Signs of primary site (Infective)

Major complications

  1. Cardio-pulmonary complications
  2. ARDS/Shock lung  – severe hypoxemia
  3. Renal complications
  4. Oliguria, Azotemia, proteinuria, renal cortical necrosis
  5. Coagulation
  6. DIC
  7. Neurological complication
  8. Encephalopathy, coma

Laboratory findings

  • Leukocytosis with left shift
  • Deranged coagulation profile
  • Deranged liver function test
  • Deranged renal functions
  • Metabolic acidosis nX-ray chest — Bilateral infiltrates (ARDS)
  • ECG abnormalities

Diagnosis

  • No specific test
  • History important
  • Knowledge of likely organism involved
  • Clinical examination very important
  • Identification of infected areas
  • Blood cultures…. Multiple sites

Treatment

Effective antimicrobial agents

  • Bacterial Culture
  • Based on likely organism involved

Removal of source of infection

Infected sites, IV catheters, Foleys or drainage catheters

Haemodynamic

Organ perfusion- ionotropes, IV fluids

Respiratory

Ventilatory support

Metabolic support

Sodium bicarbonates

Treatment of DIC

Platelet and FFP transfusion

Prognosis

Severe sepsis              25-35% die

Septic shock                40-55% die

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