Septicemia
Septicemia is a life-threatening illness resulting from the body’s over-response to an infection. The immune system goes into overdrive, triggering whole-body inflammation and malfunction of vital organs.
Sepsis, the body’s response to septicemia, may progress to septic shock. Blood pressure dramatically drops leading to multisystem organ failure and death. Appropriate treatment involves identifying the source of infection, broad-spectrum intravenous antibiotics, surgical drainage of abscess, fluid resuscitation, vasopressors, and close monitoring in the intensive care unit.
The prompt administration of antibiotics, fluid resuscitation, and vasopressors are interventions that can increase the survival of septic patients.
Symptoms
Signs and symptoms of septicemia
Septicemia is likely if you have an infection with the following signs and symptoms:
- Fever, confusion or disorientation, shortness of breath
- Systolic blood pressure lower than 90 mm Hg., or hypertensive patient with a significant drop in blood pressure
- A respiratory rate equal to or higher than 20 breaths per minute.
Signs and symptoms of septic shock
Septic shock occurs when your blood pressure significantly drops leading to multisystem organ failure. Progressive exacerbation of septic shock can lead to death.
When to see a doctor
Septicemia usually occurs from uncontrolled infection of patients with underlying medical conditions for example elderly patients, immunocompromised patients, and uncontrolled diabetes. If the patient becomes drowsy, or confused, with poor appetite, low blood pressure, and urine output, immediate medical care is necessary. Elderly patients with severe septicemia may have subnormal temperatures lower than 36 degrees Celsius.
Causes
Septicemia is commonly caused by bacterial infection, less commonly by fungal infection in various organ systems including:
- Respiratory system infection: pneumonia
- Urinary tract infection: renal pelvis infection
- Digestive system infection: gastroenteritis
- Catheter-associated infection: hemodialysis catheter, Foley catheter.
- Spreading wound infection
Patients at increased risk of septicemia
- Newborns or the elderly
- Immunocompromised patients: on steroid/immunosuppressive drugs,
- Organ transplant recipients, cancer patients under active therapy, and patients with low white blood cell count
- Diabetes (uncontrolled)
- Chronic kidney, cirrhotic liver disease
- Prolonged hospitalization, or ICU admission
- Patients requiring endotracheal tube or indwelling venous catheter
Complications
Severe septicemia with low blood pressure leads to inadequate blood supply to the body’s organs, small blood clots in capillaries causing multisystem organ failure such as acute renal failure, respiratory failure, and severe acidosis from buildup of lactic acid. Most septicemic patients without shock can recover from the illness. In severe cases requiring ICU admission, recovery will be longer.
Diagnosis
The doctor will assess from history and physical examination to locate the suspected site of infection. Additional investigations are:
- Blood tests including complete blood count, kidney/liver function test, electrolytes, acid-base balance, and urinalysis to provide additional clue and information for diagnosis
- Specific cultures including blood cultures, urine/sputum/wound/pus cultures, depending on the source of infection
Imaging tests
If the infection source is not obvious or easily found, imaging tests are required.
- Chest X-ray
- Ultrasound, a sound wave technology displaying images on video screens, is used to diagnose intraabdominal infections including liver, biliary tract, gallbladder, kidney, or subcutaneous infections.
- Computerized tomography (CT) technology, which combines X-ray images from multiple angles and displays cross-sectional images of internal structures to diagnose intraabdominal infection, for example, ruptured intestine, intestinal obstruction, or deep-seated abdominal or muscle abscess
- Magnetic resonance imaging (MRI), uses radio waves and a strong magnet field to produce detailed soft tissue and bone images helpful for diagnosing infection.
Treatment
Prompt diagnosis and treatment as well as close ICU care and monitoring leads to a higher chance of recovery.
Medications
- Broad-spectrum intravenous antibiotics to cover suspected infectious agents
- Intravenous fluid resuscitation to maintain blood pressure and electrolytes
- Vasopressor for low blood pressure despite fluid resuscitation
- Miscellaneous: insulin to control blood sugar, sedatives for patients on breathing tube
- Treatment for comorbid conditions
Surgery
Surgery is often needed in patients with intraabdominal/deep-seated abscesses, perforated intestine, or soft tissue infection with dead tissue; insertion of drainage tube or removal of infected catheter may also be required because these infections will not respond to treatment with broad-spectrum antibiotics alone.
Other treatment and care
- Mechanical ventilation through an endotracheal tube with oxygen supplementation is required in case of respiratory failure.
- Hemodialysis for acute kidney injury with low urine output, acidosis, and electrolyte imbalances.
- Blood transfusion for severe anemia or plasma transfusion for coagulopathy
