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| ==Definition==
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| Sepsis is a systemic, deleterious host response to infection, manifested as multi system organ dysfunction plus hypotension, that is not readily reversible with fluid resuscitation.
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| ==Diagnostic Criteria For Sepsis (Documented/Suspected Infection Plus Inflammatory variables Plus One of The Organ Dysfunction)==
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| :'''General variables'''
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| :*Fever > 38.3°C
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| :*Hypothermia ( core temperature < 36°C )
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| :*Heart rate > 90/min–1 or > 2 SD above the normal value for age
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| :*Tachypnea
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| :*Altered mental status
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| :*Edema
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| :*Positive fluid balance ( > 20 mL/kg over 24 hr)
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| :*Hyperglycemia ( plasma glucose > 140 mg/dL or 7.7 mmol/L ) in the absence of diabetes
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| :'''Inflammatory variables'''
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| :*Leukocytosis ( WBC count > 12,000 µL–1 )
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| :*Leukopenia ( WBC count < 4000 µL–1 )
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| :*Immature WBCs forms are > 10% with normal count
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| :*Plasma C-reactive protein > 2 SD above the normal value
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| :*Plasma procalcitonin > 2 SD above the normal value
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| :'''Hemodynamic variables'''
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| :*Arterial hypotension after 30 ml/kg fluid bolus ( SBP < 90 mm Hg, MAP < 70 mm Hg, or an SBP decrease > 40 mm Hg in adults or < 2 SD below normal for age )
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| :'''Organ dysfunction variables'''
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| :*Arterial hypoxemia ( Pao2/Fio2 < 300 )
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| :*Acute oliguria ( urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation )
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| :*Creatinine increase > 0.5 mg/dL or 44.2 µmol/L
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| :*Coagulation abnormalities ( INR > 1.5 or aPTT > 60 Sec )
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| :*Ileus ( absent bowel sounds )
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| :*Thrombocytopenia ( platelet count < 100,000 µL–1 )
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| :*Hyperbilirubinemia ( plasma total bilirubin > 4 mg/dL or 70 µmol/L )
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| :'''Tissue perfusion variables'''
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| :*Hyperlactatemia > 1 mmol/L
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| :*Decreased capillary refill or mottling
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| ==Diagnostic Criteria for Severe Sepsis (sepsis induced hypoperfusion or organ dysfunction)==
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| Includes any one of the following caused due to the infection:
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| :* Sepsis-induced hypotension
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| :* Lactate above upper limits laboratory normal
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| :* Urine output < 0.5 mL/kg/hr for more than 2 hrs despite adequate fluid resuscitation
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| :* Acute lung injury with Pao2/Fio2 < 250 in the absence of pneumonia as infection source
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| :* Acute lung injury with Pao2/Fio2 < 200 in the presence of pneumonia as infection source
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| :* Creatinine > 2.0 mg/dL (176.8 μmol/L)
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| :* Bilirubin > 2 mg/dL (34.2 μmol/L)
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| :* Platelet count < 100,000 μL
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| :* Coagulopathy (international normalized ratio > 1.5)
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| ==Management==
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| {{familytree/start}}
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| {{familytree | | | | | | | | A01 | | | | | | | | | | |A01= Characterize the symptoms: <br> Fever <br> Hypothermia <br> Altered mental status <br> Mottling <br> Ileus <br> oliguria }}
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| {{familytree | | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | | B01 | | | | | | | | | | |B01= Examine the patient: <br> Tachycardia <br> Tachypnea <br> Edema <br> Hyperglycemia <br> Hypotension after an initial 30 ml/Kg bolus <br> Decreased capillary refill }}
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| {{familytree | | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | | C01 | | | | | | | | | | |Order labs: <br> Random blood sugar (RBS) <br> Complete blood count (CBC) <br> Plasma C reactie protein (CRP) <br> Plasma procalcitonin <br> Pulse oximetry <br> Urinalysis/Renal function tests <br> PT/INR <br> Liver function tests <br> Serum lactate <br> Central venous pressure (CVP) }}
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| {{familytree | | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | | D01 | | | | | | | | | | |D01=Consider alternative diagnosis: <br> Infections <br> Acute pancreatitis <br> Diabetic ketoacidosis <br> Lower gastrointestinal bleeding <br> Myocardial infarction }}
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| {{familytree | | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | | E01 | | | | | | | | | | |E01=Initial resuscitation: Goals to achieve in first 6 hours <br> CVP 8-12 mm Hg <br> Mean arterial pressure (MAP) ≥ 65 mm Hg <br> Urine output ≥ 0/5 mL/Kg/hr <br> Central venous O<sub>2</sub> sat. 70% }}
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| {{familytree | | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | | F01 | | | | | | | | | | |F01=Diangosis: <br> 2 sets of blood cultures (aerobic and anaerobic) atleast, before starting antibiotics <br>
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| :# Drawn percutaneously <br>
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| :# Drawn through each vascular access device present for > 48 hours <br>
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| 1,3 beta-D_glucan assay, mannan, anti-mannan antibody assay if available <br> Imaging studies as appropriate to locate a source }}
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| {{familytree/end}}
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