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Klinisk Biokemi i Norden · 4 2013
Sepsis
As the clinical picture of presepsis can be discrete in
the single patient, changing rapidly into the life-thre-
atening septic shock, the early detection and therapy
of potential sepsis is crucial. It has been shown that
survival in septic patients is directly correlated to
early identification, early antibiotics and adequate
fluid therapy. Sepsis should be suspected and treated
by the clinical picture, however, sampling can help the
clinician in finding the right patients for aggressive
antibiotic therapy. Elevated - or in very severe sepsis
low leucocytes, mostly neutrophils – elevated CRP
and in severe bacterial infection PCT (in neonates
IL6), metabolic acidosis and elevated lactate (50% of
septic patients in early sepsis), spontaneous elevated
INR, blood, leucocytes, proteins and nitrite on the
urinary dipstick, leucocytes, low glucose and elevated
lactate in CFS, pleural effusion, ascites or articular
fluid (and the exclusion of the latter revealing alter-
nate diagnoses as crystals and urat) are common
samples requested in the potentially septic patient.
Due to secondary pathophysiologic effects in the
septic patient causing multiple organ dysfunction
BNP, troponins, a full blood count and electrolytes
will be asked for by the clinician confronted to a sep-
tic patient. The analysis of liquor regarding leukocyte
count, lactate and direct staining for infectious agents
might be necessary in the case of suspected menin-
gitis. PCR-methods allowing early identification of
infectious agents, and in cases of risk Elisa-testing
or direct microscopy for malaria can be life-saving
in the single patient. Due to the alternate diagnosis
of vasculitis and autoimmune processes, a BSR and
the screening for autoantibodies (cold and warm), and
in the patient with fever, tachycardia and high blood
pressure the TSH, T3, T4 and rT4 might be helpful
in detecting alternate causes of a clinical sepsis-alike
presentation.
Is there a need of rapid laboratory analysis at the
ED?
Of course, there is always the option of therapy before
analysis of any samples as practiced in the emergency
department based on the patient’s clinical status and
vital parameters. However, there are several general
rules to be followed at the ED, one of which is: Do
no further harm! Here, the life-saving samples are
key-players helping to adopt the optimum therapy.
So why is the analysis even of blood-glucose
important? The clinical picture of hypoglycemia
Island (Foto: Ingunn Þorsteinsdóttir).
