Suspect sepsis

If you, a relative, or a patient feels "severely sick", "that something is wrong", or "are not yourself", and shows any of the following symptoms, you should suspect sepsis:

• Weakness
• Loss of appetite
• Fever and chills
• Confusion and lethargy
• Thirst
• Signs of worsening organ function such as:
  - Difficult or rapid breathing
  - Rapid heart rate
  - Low blood pressure
  - Low urine output

or has a suspected or diagnosed infection (like pneumonia, abdominal infection, urinary tract infection, or wound infection),
sepsis is the most common cause.

Sepsis is diagnosed if the following criteria are present:
Infection (documented or suspected) and some of the following;

General variables

• Fever (core temperature > 38.3°C/100.9°F)
• Hypothermia (core temperature < 36°C/96.8°F)
• Heart rate >90 min-1 or >2 SD above the normal value for age
• Rapid breathing
• Altered mental state
• Significant edema (accumulation of fluid) or positive fluid balance (>20 mL/kg over 24 hrs)
• Hyperglycemia (blood sugar >120 mg/dL or 7.7 mmol/L) in the absence of diabetes

Inflammatory variables

• Leukocytosis (high white blood cell count > 12,000 µL-1)
• Leukopenia (low white blood cell count > 4000 µL-1)
• Normal white blood cell count with > 10% immature forms
• Plasma C-reactive protein > 2 SD above the normal value
• Plasma procalcitonin > 2 SD above the normal value

Hemodynamic (blood circulation) variables

• Arterial hypotension (SBP < 90 mm Hg, MAP < >70, or an SBP decrease > 40 mm Hg in adults or > 2 SD below normal for age)
• SvO2 <70%
• Cardiac index > 3.5 L/min per square meter

Organ dysfunction variables

• Arterial hypoxemia (blood oxygen deficiency) (PaO2/FIO2 <300)
• Acute oliguria (low urine output) (urine output <0.5 mL×kg-1×hr-1 or 45 mmol/L for at least 2 hrs)
• Creatinine increase > 0.5 mg/dL
• Coagulation abnormalities (INR > 1.5 or aPTT > 60 secs)
• Ileus (absent bowel sounds)
• Thrombocytopenia (low blood platelet count) (platelet count < 100,000 µL-1)
• Hyperbilirubinemia (plasma total bilirubin > 4 mg/dL or 70 mmol/L)

Tissue perfusion variables

• Hyperlactataemia (low pH) (>1 mmol/L)
• Decreased capillary refill or mottling

Please keep in mind: Laboratory signs are unspecific and common. Normal white blood count and lack of fever do not rule out sepsis. Hypothermia and leucopenia (low white blood cell count) are signs of unfavorable prognosis.
Some national and international guidelines recommend procalcitonin to guide antibiotic therapy and to confirm the diagnosis of sepsis.

Or as Carl Flatley, founder of the Sepsis Alliance put it in this mnemonic:
"U C the bugs running home"
U = low urine output
C = chills, confusion, consciousness
T = temperature  above 100°F/38°C or below 97°F/36°C
B = blood pressure, high or low
R = respirations, more than 20 breaths per minute
H = heart rate over 90 per minute

The International Sepsis Guidelines were developed between 2004 and 2008; an updated version will be available soon. These guidelines give you, as a healthcare professional, the knowledge you need to act when you suspect sepsis.