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Patient case: Sepsis and Sepsis Syndrome

Patient case: Sepsis and Sepsis Syndrome

Discussion

A 65-year-old woman with a history of type 2 diabetes and hypertension is brought to the emergency department by her family due to confusion, fever, and weakness for the past 24 hours. She had been complaining of a burning sensation while urinating for the last few days but did not seek medical attention. Today, she became increasingly drowsy and difficult to wake.

On arrival, her temperature was 39.1°C (102.4°F), blood pressure was 85/50 mmHg, heart rate was 118 beats per minute, and respiratory rate was 26 breaths per minute. She appears lethargic and disoriented. Examination reveals cool, clammy skin and tenderness over the suprapubic area.

Laboratory tests show an elevated white blood cell count, high lactate levels, and impaired kidney function. Blood cultures and a urine sample are sent for analysis, revealing a urinary tract infection (UTI) caused by Escherichia coli. A diagnosis of sepsis secondary to a UTI is made.

The patient is immediately started on intravenous fluids, broad-spectrum antibiotics, and oxygen therapy. Despite initial resuscitation, her condition worsens, requiring admission to the intensive care unit (ICU) for vasopressor support. Over the next several days, with aggressive treatment, she gradually stabilizes and is eventually discharged with close follow-up.

Questions
1. What is the most likely diagnosis in this patient?

a) Severe dehydration

b) Sepsis secondary to a urinary tract infection

c) Stroke

d) Myocardial infarction

2. Which clinical finding suggests that the patient is in septic shock?

a) Fever of 39.1°C (102.4°F)

b) Hypotension (BP 85/50 mmHg) despite infection

c) Burning sensation while urinating

d) High white blood cell count

3. What is the most important initial treatment for this patient?

a) High-dose corticosteroids

b) Immediate intravenous fluid resuscitation and broad-spectrum antibiotics

c) Oral antibiotics and discharge home

d) Antipyretics only

4. Which laboratory marker is most useful in assessing sepsis severity?

a) Blood glucose

b) Serum lactate

c) Total cholesterol

d) Uric acid

Reveal answers

Answers

1. Answer: b) Sepsis secondary to a urinary tract infection

The patient presents with fever, confusion, low blood pressure, and a confirmed UTI, indicating sepsis due to an underlying bacterial infection. Other conditions like stroke or myocardial infarction do not explain her full presentation.

2. Answer: b) Hypotension (BP 85/50 mmHg) despite infection

Septic shock is defined by persistent hypotension despite adequate fluid resuscitation, indicating circulatory failure. Fever alone does not indicate shock, and a burning sensation while urinating suggests a UTI but not sepsis severity.

3. Answer: b) Immediate intravenous fluid resuscitation and broad-spectrum antibiotics

Early administration of IV fluids and broad-spectrum antibiotics is the cornerstone of sepsis treatment. Delaying treatment increases the risk of multi-organ failure and death.

4. Answer: b) Serum lactate

Elevated lactate levels indicate tissue hypoperfusion and are used to assess sepsis severity. Persistent high lactate suggests worsening shock and organ dysfunction.