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Sepsis

Posted by Margaret Donohue on April 17, 2017 at 9:10 AM

A female patient of mine with chronic pain had a new symptom.  Severe abdominal pain.  "It's like I'm being stabbed with a hot knife."  That's a very specific description.  One that will prompt an emergency room doctor to start poking around in the abdomen or taking an x-ray of the abdomen or doing an ultrasound of the abdomen.  But the symptom has nothing to do with the abdomen.  The gastrointestinal tract is where the immune system is going into overdrive.  On a scale of 1 to 10 the pain ranges from an 8 to a 10.  Although the person may have a fever, they tend to complain of feeling cold.  The temperature drops in the morning and rises in the afternoon or evening.  There are night sweats.  These are the beginning signs of the development of a septic infection.  


It's important to find out the actual location of the infection.  In the case of my patient she had a vaginal discharge.  So the infection wasn't in her GI tract, it was in her vagina.  When caught this early, these infections can be treated with antibiotics.  If she had waited for the next symptoms of sepsis to develop, the one's that may still get missed by an emergency room physician, the prognosis becomes grim.  25% of early sepsis patients die after an initial misdiagnosis.


I've had patients with the abdominal pain have a simple infected pimple or cut, or even a sinus or lung infection progress to sepsis.  All present with the strange severe abdominal pain.  If it's a lung infection, the cough may prompt a physician to prescribe a steroid.  That will help the cough, and slightly stop the pain, but the infection will get a huge boost.  The rate of infection spread can be alarmingly fast.  The next two stages can progress in as little as 6 to 12 hours.


The next stage of sepsis is a strange confusional state where thinking becomes difficult.  Blood pressure rises or drops, heart rate elevates, blood sugar elevates.  The body is going into massive overdrive as it tries to fight off the infection and is loosing.  This is where many physicians may make the diagnosis of sepsis or at least an infection.  The abdominal pain will have returned.  This pain seems to confuse physicians.  If they missed the infection initially, they may not realize how severe it is.  At this point the infection must be treated aggressively because the next stage has a mortality rate nearing 85%.


The last stage of sepis is recognizable to emergency room physicians.  The person is in severe pain, the blood counts are severely depressed or severely elevated.  The blood itself is infected and can be cultured.  The temperature is very high or very low.  The blood pressure is very high or very low and the blood volume is depleted.  The heart rate is elevated and the lungs are starting to gain fluid.  The kidneys are shutting down and no longer producing urine.  The person may be vomiting from the pain or pacing from the pain.  This stage is treated with intravenous antibiotics and may require surgery to remove the infected tissue.


If you have unusually severe abdominal pain, keep going back to see your physician and report all signs of infection, no matter how small or how far away from the abdomen the apparant infection may be located.  If your temperature is over 101 degrees or below 96.8 degrees and your heart is beating too fast go see your doctor or go to a hospital emergency room.  It may save your life.



Categories: Diagnosis

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