Hey all, I'm a relatively new ICU nurse and had a few questions regarding sepsis as I see these patients often. I know the SIRS criteria are low/high temp, low/high WBCs, tachycardia and tachypnea but what would cause the low temps/low WBCs vs. high temps/high WBCs? Also, what causes the ionized calcium to be so low in these patients? Finally, our sepsis protocol includes drawing a baseline cortisol level and starting IV steroids - how exactly does adrenal insufficiency play in? I have looked into my critical care texts but haven't found any straightforward answers. Thanks to all in advance!
Jun 3, '13
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Jun 5, '13
Low white count can occur early on in an infection because the leukocytes will extravasate at first making it seem as though absolute counts are low when in fact the circulating levels of WBCs are only transiently low. You can also see a left shift develop. The overwhelming endotoxins and circulating inflammatory cytokines/interleukins can reset the hypothalamus and, dependent on the patient, make them hypothermic or hyperthermia. If you do see a low body temp, it will generally be in the elderly and children. The etiology of hypocalcemia in sepsis is poorly understood at this point and probably multifactorial. Do a lit search on pubmed and you'll find plenty to read on this topic. And again, sepsis induced adrenal insufficiency can be explained pretty well by any number of papers published and easily accessible on sites such as pubmed.
Jun 5, '13
Renal function may be compromised in sepsis which affects half life of circulating cortisol. Overall assumption, lactic acid increase, reduces calcium transport out of the cell because lactic acid raises the acidity in the muscle, making it weak. Plus the high lactate levels show tissue hypoxia which increases the cell death increasing lactic acid even higher.
Simple terms, but it's how I can understand sepsis better.
In my patient experiences those with low temps had worse outcomes, but that is my own survey over 8 years in ICU.
Jun 5, '13
I was also going to note that hypothermia seems to be a bad sign. I'm not sure if it is a "cause" or an "effect", though. (Probably both!)
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