Sepsis And Septic Shock | Cleveland Clinic
Overview Diagnosis and Tests Management and Treatment Sepsis, also known as systemic inflammatory response syndrome (SIRS), is a serious medical condition caused by the bodys response to an infection. Sepsis can lead to widespread inflammation and blood clotting. Inflammation may result in redness, heat, swelling, pain, and organ dysfunction or failure. Blood clotting during sepsis causes reduced blood flow to limbs and vital organs, and can lead to organ failure or gangrene (damage to tissues). Sepsis can strike anyone, but those at particular risk include: People with pre-existing infections or medical conditions People with severe injuries, such as large burns or bullet wounds People with a genetic tendency for sepsis Bacterial infections are the most common cause of sepsis. Sepsis can also be caused by fungal, parasitic, or viral infections. The source of the infection can be any of a number of places throughout the body. Common sites and types of infection that can lead to sepsis include: The abdomen: An inflammation of the appendix (appendicitis), bowel problems, infection of the abdominal cavity (peritonitis), and gallbladder or liver infections The central nervous system: Inflammation or infections of the brain or the spinal cord The skin: Bacteria can enter skin through wounds or skin inflammations, or through the openings made with intravenous (IV) catheters (tubes inserted into the body to administer or drain fluids). Conditions such as cellulitis (inflammation of the skins connective tissue) can cause sepsis. The urinary tract (kidneys or bladder): Urinary tract infections are especially likely if the patient has a urinary catheter to drain urine Because of the many sites on the body from which sepsis can originate, there is a wide variety of symptoms. The Continue reading >>
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Sepsis - Wikipedia
For the genus of flies of this name, see Sepsis (genus) . Blood culture bottles: orange label for anaerobes , green label for aerobes , and yellow label for blood samples from children Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.  Common signs and symptoms include fever , increased heart rate , increased breathing rate , and confusion .  There also may be symptoms related to a specific infection, such as a cough with pneumonia , or painful urination with a kidney infection .  In the very young, old, and people with a weakened immune system , there may be no symptoms of a specific infection and the body temperature may be low or normal, rather than high .  Severe sepsis is sepsis causing poor organ function or insufficient blood flow.  Insufficient blood flow may be evident by low blood pressure , high blood lactate , or low urine output .  Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids are given.  Sepsis is caused by an immune response triggered by an infection.   Most commonly, the infection is bacterial , but it may also be from fungi , viruses , or parasites .  Common locations for the primary infection include lungs, brain, urinary tract , skin, and abdominal organs .  Risk factors include young or old age, a weakened immune system from conditions such as cancer or diabetes , major trauma , or burns .  An older method of diagnosis was based on meeting at least two systemic inflammatory response syndrome (SIRS) criteria due to a presumed infection.  In 2016, SIRS was replaced with qSOFA which is two of the following three: increased breathing rate, change in level of con Continue reading >>
Lactic Acidosis: Background, Etiology, Epidemiology
Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... In basic terms, lactic acid is the normal endpoint of the anaerobic breakdown of glucose in the tissues. The lactate exits the cells and is transported to the liver, where it is oxidized back to pyruvate and ultimately converted to glucose via the Cori cycle. In the setting of decreased tissue oxygenation, lactic acid is produced as the anaerobic cycle is utilized for energy production. With a persistent oxygen debt and overwhelming of the body's buffering abilities (whether from chronic dysfunction or excessive production), lactic acidosis ensues. [ 1 , 2 ] (See Etiology.) Lactic acid exists in 2 optical isomeric forms, L-lactate and D-lactate. L-lactate is the most commonly measured level, as it is the only form produced in human metabolism. Its excess represents increased anaerobic metabolism due to tissue hypoperfusion. (See Workup.) D-lactate is a byproduct of bacterial metabolism and may accumulate in patients with short-gut syndrome or in those with a history of gastric bypass or small-bowel resection. [ 3 ] By the turn of the 20th century, many physicians recognized that patients who are critically ill could exhibit metabolic acidosis unaccompanied by elevation of ketones or other measurable anions. In 1925, Clausen identified the accumulation of lactic acid in blood as a cause of acid-base disorder. Several decades later, Huckabee's seminal work firmly established that lactic acidosis frequently accompanies severe illnesses and that tissue hypoperfusion underlies the pathogenesis. In their classic 1976 monograph, Cohen and Woods classified the causes of lactic acidosis according to the presence or absence of adequate tissue oxygenation. (See Presentationand Differe Continue reading >>
Sepsis And Septic Shock
(Video) How to do Cardiopulmonary Resuscitation (CPR) in Adults By Paul M. Maggio, MD, MBA, Associate Professor of Surgery, Associate Chief Medical Officer, and Co-Director, Critical Care Medicine, Stanford University Medical Center Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver, can occur. Common causes in immunocompetent patients include many different species of gram-positive and gram-negative bacteria. Immunocompromised patients may have uncommon bacterial or fungal species as a cause. Signs include fever, hypotension, oliguria, and confusion. Diagnosis is primarily clinical combined with culture results showing infection; early recognition and treatment is critical. Treatment is aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissue and drainage of pus, and supportive care. Sepsis represents a spectrum of disease with mortality risk ranging from moderate (eg, 10%) to substantial (eg, > 40%) depending on various pathogen and host factors along with the timeliness of recognition and provision of appropriate treatment. Septic shock is a subset of sepsis with significantly increased mortality due to severe abnormalities of circulation and/or cellular metabolism. Septic shock involves persistent hypotension (defined as the need for vasopressors to maintain mean arterial pressure 65 mm Hg, and a serum lactate level > 18 mg/dL [2 mmol/L] despite adequate volume resuscitation  ). The concept of the systemic inflammatory response syndrome (SIRS), defined by certain abnormalities of vital signs and laboratory results, has long Continue reading >>
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Sepsis From New To Icu
In my medical ICU, the vast majority of patients are in septic shock because of some type of infection. Have you ever had a patient's family ask you about sepsis? "Why is my family member's blood pressure so low?" Is there any easy way to explain this to them or do you just say, "their body is reacting abnormally to a widespread infection?" So this is how I like to explain it. Say that you have a splinter in your finger--what happens to it? It becomes red, hot and infected. Why is it red and hot? The body has opened up the veins around the splinter to let white blood cells out and fight the infection. Just like this, when someone is septic, all of the patient's vessels open up (decreasing the blood pressure) to try and fight the infection. The only problem is that the body is fighting the infection systemically. So what causes this widespread response? The Mayo Clinic states that "sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail." Common causes are pneumonia, urinary tract infections, cellulitis, and abdominal infections. Sepsis can be caused by bacteria, viruses, or fungal infections. The usual presentation for sepsis is tachypnea, tachycardia, fever, and hypotension. Patients can also exhibit organ dysfunction if the sepsis becomes severe. Symptoms would show decreased urine output, lactic acidosis, hypoxemia, elevated liver enzymes, and an increased white blood cell count. Renal failure causes the decreased urine output as well as electrolyte imbalances. Respiratory failure causes the hypoxemia and lactic acidosis. Lactic acid forms when the body breaks down carbohydrates Continue reading >>
Sepsis Is Not Caused By Bacterial Infection?
Sometimes I come across something so bizarre, so utterly wrong, that my mind reels in confusion and amazement, not to mention horror, that anyone can actually think or write something something like it. In fact, for a moment I considered offering up this one bit of horrifically inspired craziness up as an installment of Your Friday Dose of Woo , but I decided against it. The reason, Im afraid, is the same reason that Ive considered some bits of woo previously for this honor but then ultimately declined and covered them as normal posts, dripping with my usual brand of Respectful and not-so-Respectful Insolence. Do you remember Robert O. Young excuse me Dr. Robert O. Young or Robert O. Young, Ph.D., D.Sc., both titles that he seems to be especially enamored with? You dont? Perhaps you remember that he is the guy who thinks that all disease is due to excess acid (due to diet, of course!), that cancer is a liquid acid , and that viruses are molecular acids , among other complete and total woo. His one-size-fits-all treatment for all disease follows logically from his central thesis, namely that the treatment for all disease is to alkalinize the blood through diet and various other means. I say logical not because Young is right but because his conclusion does logically flow from his premise. Of course, his premise is utterly wrong, which makes his conclusions wrong. In fact, the pH of the blood is very important for cellular function and health; so not suprisingly, the body has evolved numerous homeostatic mechanisms to keep the pH pretty rigidly controlled between around 7.35 and 7.45. Indeed, its very hard to change the blood pH very much. The body is very good at compensating. Moreover, there are relatively few indications for alkalinizing the blood, which, when its ind Continue reading >>
Metabolic Acidosis In Sepsis
Author(s): Alexandre Toledo Maciel , Danilo Teixeira Noritomi , Marcelo Park . Rua Francisco Preto, 46, bloco 3, apto 64 Sao PauloBrazil, ZIP 05623010., Brazil Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets (Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders) Metabolic acidosis is very common in critically ill septic patients. Acidosis may be a result of the underlying pathophysiology, but it also may be the result of the way in which those patients are managed. Chloride-associated acidosis is frequent and is potentially aggravated during fluid resuscitation. The severity of metabolic acidosis is associated with poor clinical outcomes; however, it remains uncertain whether or not there is a causal relationship between acidosis and the pathophysiology of septic syndromes. Several experimental findings have demonstrated the impact of acidosis modulation on the release of inflammatory mediators and cardiovascular function. Treatment of metabolic acidosis is based on control of the underlying process and support of organ dysfunction, although the use of intravenous chloridepoor balanced solutions seems an attractive option to prevent the worsening of metabolic acidosis during fluid resuscitation. Keywords: Metabolic acidosis, sepsis, septic shock Endocrine, Metabolic & Immune Disorders - Drug Targets Author(s):Alexandre Toledo Maciel, Danilo Teixeira Noritomi and Marcelo Park Affiliation:Rua Francisco Preto, 46, bloco 3, apto 64 Sao PauloBrazil, ZIP 05623010. Keywords:Metabolic acidosis, sepsis, septic shock Abstract: Metabolic acidosis is very common in critically ill septic patients. Acidosis may be a result of the underlying pathophysiology, but it also may be the result of the way in which those patients are managed. Chloride- Continue reading >>
Lactic Acidosis In Sepsis: Its Not All Anaerobic: Implications For Diagnosis And Management - Sciencedirect
Volume 149, Issue 1 , January 2016, Pages 252-261 Contemporary Reviews in Critical Care Medicine Lactic Acidosis in Sepsis: Its Not All Anaerobic: Implications for Diagnosis and Management Author links open overlay panel BandarnSuetrongMD Keith R.WalleyMD Get rights and content Increased blood lactate concentration (hyperlactatemia) and lactic acidosis (hyperlactatemia and serum pH< 7.35) arecommon in patients with severe sepsis orseptic shock and are associated with significant morbidity and mortality. In some patients, most of the lactate that is produced in shock states is due to inadequate oxygen delivery resulting in tissue hypoxia and causing anaerobic glycolysis. However, lactate formation during sepsis is not entirely related to tissue hypoxia or reversible by increasing oxygen delivery. In this review, weinitially outline the metabolism of lactateand etiology of lactic acidosis; we thenaddress the pathophysiology of lacticacidosis in sepsis. We discuss the clinical implications of serum lactate measurement in diagnosis, monitoring, and prognostication in acute and intensive care settings. Finally, we explore treatment of lactic acidosis and its impact on clinical outcome. Continue reading >>
Sepsis (blood Poisoning)
Why are there so many diseases with "sepsis," "septic," "septicemia," or "blood poisoning" in their name? Sepsis (blood poisoning) facts Sepsis is a potentially life-threatening medical condition that's associated with an infection. Blood poisoning is a nonmedical term that usually refers to the medical condition known as sepsis. There are three described clinical stages of sepsis. The major diagnostic criteria for sepsis are altered mental status, increased respiratory rate, and low blood pressure. The majority of cases of sepsis are due to bacterial infection. Sepsis is treated with hospitalization, intravenous antibiotics, and therapy to support any organ dysfunction. Although the first health care professionals to treat a patient with sepsis may be a primary care, pediatric, or emergency-medicine specialist, critical care specialists, hospitalists, infectious disease, and lung (pulmonologists) specialists are usually consulted to help treat sepsis; infrequently, a toxicologist or surgeon may also be consulted. Prevention of infections and early diagnosis and treatment of sepsis are the best ways to prevent sepsis or reduce the problems sepsis causes. The prognosis depends on the severity of sepsis as well as the underlying health status of the patient; in general, the elderly have the worst prognosis. What Is a Staph Infection? Symptoms, Pictures The newest definition of sepsis has recently been published. In 2016, the Third International Consensus Definitions Task Force (Sepsis-3) defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The new criteria are based on just three symptoms: Patients who meet the above criteria likely have sepsis and are also termed septic. Blood tests are no longer required for the diagno Continue reading >>
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Lactic Acidosis: What You Need To Know
Lactic acidosis is a form of metabolic acidosis that begins in the kidneys. People with lactic acidosis have kidneys that are unable to remove excess acid from their body. If lactic acid builds up in the body more quickly than it can be removed, acidity levels in bodily fluids — such as blood — spike. This buildup of acid causes an imbalance in the body’s pH level, which should always be slightly alkaline instead of acidic. There are a few different types of acidosis. Lactic acid buildup occurs when there’s not enough oxygen in the muscles to break down glucose and glycogen. This is called anaerobic metabolism. There are two types of lactic acid: L-lactate and D-lactate. Most forms of lactic acidosis are caused by too much L-lactate. Lactic acidosis has many causes and can often be treated. But if left untreated, it may be life-threatening. The symptoms of lactic acidosis are typical of many health issues. If you experience any of these symptoms, you should contact your doctor immediately. Your doctor can help determine the root cause. Several symptoms of lactic acidosis represent a medical emergency: fruity-smelling breath (a possible indication of a serious complication of diabetes, called ketoacidosis) confusion jaundice (yellowing of the skin or the whites of the eyes) trouble breathing or shallow, rapid breathing If you know or suspect that you have lactic acidosis and have any of these symptoms, call 911 or go to an emergency room right away. Other lactic acidosis symptoms include: exhaustion or extreme fatigue muscle cramps or pain body weakness overall feelings of physical discomfort abdominal pain or discomfort diarrhea decrease in appetite headache rapid heart rate Lactic acidosis has a wide range of underlying causes, including carbon monoxide poisoni Continue reading >>
Causes Of Lactic Acidosis In Sepsis - Deranged Physiology
This topic is for some reason the subject of one frequently repeated question. Notable duplicates include the following: Question 6.4 from the first paper of 2013 (a detailed discussion is carried out here) Question 22.2 from the second paper of 2011 Question 6.4 from the first paper of 2011 Mechanisms responsible for lactic acidosis in sepsis Endogenous catecholamine release and use of catecholamine inotropes Circulatory failure due to hypoxia and hypotension Inhibition of pyruvate dehydrogenase (PDH) by endotoxin Slowed hepatic blood flow, impairing clearance So the lactate in sepsis is raised. What of it? The college seems to favour this concept as an exam topic. It has come up repeatedly in the past papers. It seems important for the trainees to understand that in septic shock the lactate elevation is not purely a feature of tissue hypoperfusion, but rather the outcome of complex metabolic changes. The mechanism of lactate elevation in sepsis is discussed in greater detail in a chapter dedicated to these metabolic changes . Instead of revisiting that elaborate explanation, I will instead produce some references, and this confusing flowchart diagram: Jones, Alan E., and Michael A. Puskarich. "Sepsis-induced tissue hypoperfusion." Critical care clinics25.4 (2009): 769. Continue reading >>
Metabolic Acidosis In Sepsis.
Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. Endocr Metab Immune Disord Drug Targets. 2010 Sep;10(3):252-7. Metabolic acidosis is very common in critically ill septic patients. Acidosis may be a result of the underlying pathophysiology, but it also may be the result of the way in which those patients are managed. Chloride-associated acidosis is frequent and is potentially aggravated during fluid resuscitation. The severity of metabolic acidosis is associated with poor clinical outcomes; however, it remains uncertain whether or not there is a causal relationship between acidosis and the pathophysiology of septic syndromes. Several experimental findings have demonstrated the impact of acidosis modulation on the release of inflammatory mediators and cardiovascular function. Treatment of metabolic acidosis is based on control of the underlying process and support of organ dysfunction, although the use of intravenous chloride-poor balanced solutions seems an attractive option to prevent the worsening of metabolic acidosis during fluid resuscitation. Continue reading >>
Lactic Acidosis, Hyperlactatemia And Sepsis | Montagnani | Italian Journal Of Medicine
Montagnani and Nardi: Lactic Acidosis, Hyperlactatemia and Sepsis Lactic Acidosis, Hyperlactatemia and Sepsis  Division of Internal Medicine, Misericordia Hospital, Grosseto  Division of Internal Medicine, Maggiore Hospital, Bologna, Italy Correspondence to: Ospedale Misericordia di Grosseto, via Senese, 58100 Grosseto, Italy. +39.0564.485330. [email protected] Among hospitalized patients, lactic acidosis represents the most common cause of metabolic acidosis. Lactate is not just a metabolic product of anaerobic glycolysis but is triggered by a variety of metabolites even before the onset of anaerobic metabolism as part of an adaptive response to a hypermetabolic state. On the basis of such considerations, lactic acidosis is divided into two classes: inadequate tissue oxygenation (type A) and absence of tissue hypoxia (type B). Lactic acidosis is characterized by non-specific symptoms but it should be suspected in all critical patients who show hypovolemic, hypoxic, in septic or cardiogenic shock or if in the presence of an unexplained high anion gap metabolic acidosis. Lactic acidosis in sepsis and septic shock has traditionally been explained as a result of tissue hypoxia when whole-body oxygen delivery fails to meet whole body oxygen requirements. In sepsis lactate levels correlate with increased mortality with a poor prognostic threshold of 4 mmol/L. In hemodynamically stable patients with sepsis, hyperlactatemia might be the result of impaired lactate clearance rather than overproduction. In critically ill patients the speed at which hyperlactatemia resolves with appropriate therapy may be considered a useful prognostic indicator. The measure of blood lactate should be performed within 3 h of presentation in acute care setting. The presence of lactic a Continue reading >>
Metabolic Acidosis In Patients With Sepsis: Epiphenomenon Or Part Of The Pathophysiology?
Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology? Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 1526, USA. To review the mechanisms of metabolic acidosis in sepsis. Articles and published reviews on metabolic acidosis in sepsis. Sepsis affects millions of patients each year and efforts to limit mortality have been limited. It is associated with many features one of which is acidosis which may be a result of the underlying pathophysiology (e.g. respiratory failure, shock, renal failure) or may also result from the way in which we manage critically ill patients. Lactic acidosis identifies septic patients at risk and aggressive fluid resuscitation (along with inotropes and blood in some patients) to reverse acidosis and improve venous oxygen saturation will improve mortality. However, most patients with severe sepsis or septic shock receive 0.9% saline and therefore may develop hyperchloraemic acidosis as a consequence of their resuscitation. Therefore alterations in acid-base balance are almost always in the background in the management of patients with sepsis. What is unknown is whether acidosis is in the causal pathway for organ dysfunction or whether it is simply an epiphenomenon. Changes in acid-base balance, of the type and magnitude commonly encountered in patients with sepsis, significantly alter the release of inflammatory mediators. Less significant changes in the immune response have already been implicated in influencing outcome for patients with sepsis and a reduction in acidosis in septic patients may have the same effect. Understanding the effects of acid-base on the inflammatory response is relevant as all forms of metabolic acidosis appear to be associated with pro Continue reading >>
Metabolic Acidosis: Pathophysiology, Diagnosis And Management: Management Of Metabolic Acidosis
Recommendations for the treatment of acute metabolic acidosis Gunnerson, K. J., Saul, M., He, S. & Kellum, J. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit. Care Med. 10, R22-R32 (2006). Eustace, J. A., Astor, B., Muntner, P M., Ikizler, T. A. & Coresh, J. Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease. Kidney Int. 65, 1031-1040 (2004). Kraut, J. A. & Kurtz, I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. Am. J. Kidney Dis. 45, 978-993 (2005). Kalantar-Zadeh, K., Mehrotra, R., Fouque, D. & Kopple, J. D. Metabolic acidosis and malnutrition-inflammation complex syndrome in chronic renal failure. Semin. Dial. 17, 455-465 (2004). Kraut, J. A. & Kurtz, I. Controversies in the treatment of acute metabolic acidosis. NephSAP 5, 1-9 (2006). Cohen, R. M., Feldman, G. M. & Fernandez, P C. The balance of acid base and charge in health and disease. Kidney Int. 52, 287-293 (1997). Rodriguez-Soriano, J. & Vallo, A. Renal tubular acidosis. Pediatr. Nephrol. 4, 268-275 (1990). Wagner, C. A., Devuyst, O., Bourgeois, S. & Mohebbi, N. Regulated acid-base transport in the collecting duct. Pflugers Arch. 458, 137-156 (2009). Boron, W. F. Acid base transport by the renal proximal tubule. J. Am. Soc. Nephrol. 17, 2368-2382 (2006). Igarashi, T., Sekine, T. & Watanabe, H. Molecular basis of proximal renal tubular acidosis. J. Nephrol. 15, S135-S141 (2002). Sly, W. S., Sato, S. & Zhu, X. L. Evaluation of carbonic anhydrase isozymes in disorders involving osteopetrosis and/or renal tubular acidosis. Clin. Biochem. 24, 311-318 (1991). Dinour, D. et al. A novel missense mutation in the sodium bicarbonate cotransporter (NBCe1/ SLC4A4) Continue reading >>