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Chapter 82. Sepsis and Septic Shock

Student Questions

Use this case for the following two questions.

AB is a 75-year-old man who presents from his nursing home with a urinary tract infection. He is febrile with a temperature of 39.1oC (102.4°F), a heart rate of 102 beats/min, respiratory rate of 12 breaths/min, and a blood pressure of 135/75 mm Hg. His laboratory values are notable for SCr 2.3 mg/dL (203.3 μmol/L), WBC 14,200/mm3 (14.2 × 109/L), and lactate 1.2 mEq/L (1.2 mmol/L).

Which of the following does AB meet criteria for?

A. Bacteremia

B. Sepsis

C. Severe sepsis

D. Septic shock

Answer: B

Option A: Incorrect. The patient has sepsis, but does not necessarily have bacteremia, which would be diagnosed by a positive blood culture.

Option B: Correct. Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection." The patient has a urinary tract infection, has aberrant vital signs and laboratory values indicating a dysregulated host response, and is experiencing acute kidney injury indicating organ dysfunction.

Option C: Incorrect. The Sepsis-3 definitions have eliminated the classification of "severe sepsis."

Option D: Incorrect. The patient is not hypotensive and does not have an elevated lactate.

AB's blood pressure begins to decline. His current blood pressure is 101/50 mm Hg and you wish to administer a fluid challenge. What type of fluid do you recommend?

A. 0.9% sodium chloride

B. 25% albumin

C. Hydroxyethyl starch

D. 5% dextrose

Answer: A

Option A: Correct. Crystalloids (such as normal saline) are the first-line option for fluids resuscitation.

Option B: Incorrect. Colloids (such as concentrated albumin) are recommended for select patients in whom hypervolemia is a concern (eg, congestive heart failure).

Option C: Incorrect. Synthetic colloids (such as hydroxyethyl starch) are not recommended in sepsis due to increased morbidity and mortality.

Option D: Incorrect. Dextrose 5% is not a balanced resuscitation fluid.

MS is a 42-year-old woman with ulcerative colitis who is on home parenteral nutrition secondary to short bowel syndrome from multiple small bowel resections. She was febrile to 39.4°C (103°F) at home and presented to the ED for evaluation. In the ED, her vital signs and laboratory values were as follows: HR 118 beats/min, ...

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