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Chapter 26. Sepsis Syndromes

Select the definition that describes a patient with septic shock.

a. GH has the presence of bacteria within the blood.

b. HH has a systemic inflammatory response to a clinical insult.

c. JA has an infection associated with organ dysfunction.

d. KS has an infection with persistent hypotension despite fluid resuscitation.

Answer d is correct. Adult patients with septic shock can be identified using the clinical criteria of hypotension requiring use of vasopressors to maintain mean blood pressure of 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L persisting after adequate fluid resuscitation.

Answer a is incorrect. Bacteremia (or fungemia) is the presence of viable bacteria (or fungi) within the bloodstream.

Answer b is incorrect. Systemic inflammatory responses to a variety of clinical insults can be either infectious or non-infectious.

Answer c is incorrect. This fits more with the definition of sepsis as outlined in the 2016 guideline update.

XJ is a 33-year-old woman (weight 70 kg) who presents with sepsis (hypotension and decreased urine output). Past medical history is significant for diabetes, hypertension, hypothyroidism, and gastroesophageal reflux. Medications include metformin, lisinopril, levothyroxine, and omeprazole. Select the appropriate initial regimen for fluid resuscitation in XJ.

a. 5% dextrose 500 mL

b. 5% albumin 1000 mL

c. 0.9% sodium chloride 2000 mL

d. 0.45% sodium chloride 2000 mL

Answer c is correct. It is appropriate to use 0.9% sodium chloride (normal saline) 1000 mL for fluid resuscitation in sepsis. Infusion of 1 L of 0.9% sodium chloride (isotonic saline) adds 275 mL to the plasma volume and 825 mL to the interstitial volume. Note that the total volume expansion (1100 mL) is slightly greater than the infused volume. This is the result of a fluid shift from the intracellular to extracellular space, which occurs because isotonic saline is actually hypertonic to the extracellular fluids.

Answer a is incorrect. Five percent dextrose is not an appropriate resuscitation fluid because only 8% of the administered volume stays intravascular. 5% glucose (dextrose) is widely used as a maintenance fluid (a substitute for patients unable to drink water) or to correct a free water deficit when oral fluids cannot be given. It has no place in the restoration of circulating volume because it is rapidly distributed throughout the entire body water compartment of about 40 liters.

Answer b is incorrect. Colloids, like albumin, can ...

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