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