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Case 53: Fever and jaundice

A 56 year old woman is admitted with jaundice for investigation. After 3 days on the ward she spikes a fever.

1. What features on this observation chart would concern you?

The patient is febrile and tachycardic.

2. How would you diagnose sepsis and its related syndromes?

There is now worldwide consensus on the clinical definition of sepsis.

The systemic inflammatory response syndrome (SIRS) is defined clinically by the presence of two or more of:
- Heart rate >90 bpm
- Respiratory rate > 20 bpm or PaCO2 <32 mmHg
- Temperature >38C or <36C
- WBC >12,000 cells/mm3, <4000 cells/mm3, or >10 percent immature (band) forms

Sepsis is then defined as the presence of SIRS with a documented source of infection.

Severe sepsis is sepsis with evidence of hypoperfusion or hypotension (systolic BP <90 mmHg or > 40 mmHg drop from the patients usual BP) resulting in organ dysfunction such as lactic acidosis, oliguria or altered mental state.

Septic shock is the state where severe sepsis is no longer responding to simple fluid resuscitation and more invasive supports are required such as inotropes or vasopressors.

Multiple organ dysfunction syndrome (MODS) refers to the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. MODS may then be classified as either primary or secondary.