How does sepsis feel?
Blood poisoning (Sepsis): life-threatening infection of the whole body. Blood poisoning is probably more common than previously assumed - more recent estimates assume around 150,000 sick people per year in Germany, of which ~ 35% die. Patients with weakened immune systems are particularly at risk, but blood poisoning can also develop in previously healthy people.
The starting point of blood poisoning is a focus of infection that spreads to the rest of the body. This causes an excessive immune reaction that is no longer in proportion to the local infection. The decisive factor for the severity of blood poisoning is not the extent of the inflammation at the local focus of infection, but the extent of the loss of control in the mechanisms of the immune system. Accordingly, even supposedly minor injuries and minor infections can lead to severe blood poisoning. The classic symptoms of blood poisoning include:
- Fever above 38 ° C or under temperature below 36 ° C. Typical are fever spikes with a rapid rise in fever, often with chills, then a fall in fever within a day, followed by a renewed rise in the fever
- Pulse over 90 beats / minute
- Systolic blood pressure ≤ 100 mmHg
- Changes in consciousness (restlessness, disorientation) or impaired consciousness
- More than 20 breaths per minute or evidence of pulmonary dysfunction
- Significantly too few or too many white blood cells in the blood
- Increased blood sugar level
The sepsis definition was therefore revised in 2016: A life-threatening functional disorder (organ dysfunction) of the kidneys, lungs, heart or brain is binding for the presence of sepsis. It usually develops due to insufficient blood supply to the corresponding organ: The excessive immune system reacts to the infection with increased blood clotting. As a result, blood clots form in the vessels of the organs and close them. Due to the massive consumption of the coagulation factors, a bleeding tendency then develops. For the definition of sepsis, however, it is irrelevant whether the underlying infection is caused by bacteria, viruses, fungi or parasites. However, around 95% of the cases are bacteria.
When to the doctor
Today if an infection gives the impression that it is getting worse rather than better.
Call the ambulance immediately, if
- The sick person becomes increasingly restless, sleepy or confused as part of an infection
- The skin turns bluish (signs of lack of oxygen) or red spots appear on the skin (signs of clotting disorders)
- The affected person hardly or no more urine in the event of an infection (“limit” in adults about 500 ml or 2-3 visits to the toilet daily).
The most common cause of blood poisoning is a severe bacterial infection in which bacteria repeatedly flood the organism. The starting point is often infections of the respiratory or urinary tract.
The immune system is still trying to master the situation, but it often fails to do so. After all, it is not only the bacteria themselves that damage the organism, but also the actually meaningful defense reactions and messenger substances intended to combat infection. The circulation and blood clotting collapse, and the heart, lungs and kidneys are increasingly affected.
In contrast to tropical countries, mushrooms are rare in Central Europe, which can be seriously dangerous for a healthy organism. In people with a significantly weakened immune system, however, harmless fungi such as Candida albicans can also trigger the most serious diseases, including blood poisoning. At risk are z. B. premature babies, leukemia sufferers and people with congenital or acquired immunodeficiency.
Variable picture. Bacterial sepsis usually develops quickly, sometimes within a few hours, from an infection that initially often looks harmless. It is a misconception that a high fever is absolutely necessary - especially in older people it is often lacking. The patient's appearance is also not a reliable indicator: although many of those affected look “bad” and increasing deterioration is always an alarm sign, especially at the beginning of blood poisoning, the patient often looks “good” and rosy, because the heart and circulation are running out Full speed.
Fungal sepsis usually begins very slowly: The patient feels exhausted, tired and sweats at night. In contrast to temporary lighter infections, the symptoms do not go away, but get worse and worse.
Severe blood poisoning and septic shock. Failure to quickly control the blood poisoning results in impaired circulation with low blood pressure and damage to organs, especially the lungs (warning signs: bluish discoloration of the skin), the brain (warning signs: restlessness, drowsiness, confusion), the kidneys (warning signs: decreased urine production) and coagulation (recognizable e.g. by red patches of skin). Serious blood poisoning has developed. There is then an immediate threat of life-threatening septic shock with circulatory collapse.
It is not uncommon for Multiple organ failure. At least two vital organs fail here, e.g. B. Lungs and kidneys or liver and brain.
Multiple organ failure occurs not only in blood poisoning, but also in the course of multiple injuries, e.g. B. in traffic accidents, or in liver failure as the end stage of liver cirrhosis.
That's what the doctor does
If blood poisoning is suspected, the patient is immediately admitted to an intensive care unit. Blood, urine, ultrasound and X-ray examinations and, if necessary, a CSF examination (examination of cerebral fluid) should clarify the type and severity of the infection as quickly as possible, because a few hours can be decisive for survival. Immediately after the various samples have been taken, the anti-infective, usually antibiotic, treatment begins. Often the condition of those affected is so serious that they have to be artificially fed and possibly even ventilated in the intensive care unit.
Nevertheless, the treatment is often unsuccessful, which is also due to the fact that blood poisoning often affects elderly and immunocompromised patients who no longer have much to "counter" the pathogen.
- www.sepsis-gesellschaft.de - German Sepsis Society e. V., Jena: Under the heading What is Sepsis there is good information for lay people as well as for people with previous knowledge.
AuthorsDr. med. Nicole Menche, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:30
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