Sepsis
Sepsis
Overview
- About sepsis
- Symptoms of sepsis
- Treating sepsis
About sepsis
What is sepsis?
Sepsis is a serious complication of an infection.
Without quick treatment, sepsis can lead to multiple organ failure and death.
Common Symptoms
Emergency Warning Signs
Phone 999 or go to A&E if:
- you have severe difficulty breathing – for example, you struggle to speak without pausing, gasping or choking
- your lips or skin are turning very pale, blue or grey – on brown or black skin this is easier to see on the palms of your hands
- you feel more drowsy than usual or find it more difficult to wake up
- you have cold, clammy and pale or mottled skin – on brown or black skin this is easier to see on the palms of your hands
- you have a rash that does not fade when a glass is rolled over it, or looks like bruising or bleeding under the skin
Always trust your instincts and phone 999 if you think there’s an emergency.
Your child:
- is limp, floppy or not responding like they normally do – they may find it difficult to focus on you or are more difficult to wake up than usual
- has severe difficulty breathing – they may make grunting noises or suck their stomach in under their ribcage
- is breathing fast or stops or pauses
- is pulling in at their throat area (tracheal tug) or their windpipe is more prominent
- has a fit (febrile seizure) for the first time (they cannot stop shaking
- has lips or skin that are turning pale, blue or grey – on brown or black skin this is easier to see on the palms of their hands
- has a weak, high-pitched cry that’s not like their normal cry
- has cold, clammy and pale or mottled skin – on brown or black skin this is easier to see on the palms of your hands
- has a rash that does not fade when you press a glass against it (use the ‘glass test‘ from Meningitis Now)
- is less than 3 months old and has a temperature of 38°C (101°F) or above and has not had a vaccination in the past 2 days
- is less than 3 months old and has a temperature of 36°C (97°F) or less and has not had a vaccination in the past 2 days
Contact your GP practice urgently if:
You or your child:
- are feeling confused, dizzy, or lightheaded
- has difficulty breathing – you may be more short of breath than usual
- has pain when breathing in or coughing
- are peeing less than usual – this can be a sign of dehydration
- has had a dry nappy for 12 hours or more, or is showing other signs of dehydration
- has a high temperature that has lasted for more than 5 days
- has severe muscle pain
- feel sick or are being sick – for example, you can’t keep food or fluids down
- has pain or swelling in the arms or legs
- has other signs of illness, such as a rash, as well as a high temperature – for example, you feel either hot or cold to touch or you’re shivering
Phone 111 if your GP practice is closed.
Trust your instincts
Trust your instincts and phone 111 if your child’s symptoms are getting worse or they are sicker than you’d expect (even if their temperature falls).
Emergency treatment
You’ll need emergency treatment, or treatment in an intensive care unit (ICU), if:
- the sepsis is severe
- you develop septic shock – when your blood pressure drops to a dangerously low level
ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection.
Sepsis is treatable if it’s identified and treated quickly. In most cases it leads to full recovery with no lasting problems.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Phone 999 or go straight to A&E if you or your child show any of these warning signs:
- Severe difficulty breathing, such as struggling to speak without pausing, gasping, or choking
- Lips or skin turning very pale, blue, or grey (on brown or black skin, this often shows up more clearly on the palms)
- Feeling unusually drowsy, or finding it hard to wake up or stay awake
- Cold, clammy skin that looks pale or mottled (again, check the palms on brown or black skin)
- A rash that does not fade when a glass is rolled over it, or one that looks like bruising or bleeding under the skin
Trust your instincts. If something feels seriously wrong, phone 999 without hesitation.
For a child, also watch for:
- Limpness or floppiness, or not responding as they normally would, including trouble focusing on you or being harder than usual to wake
- Grunting noises or the stomach sucking in under the ribcage when breathing
- Fast breathing, or breathing that stops or pauses
- Pulling in at the throat area (tracheal tug), or a windpipe that looks more prominent than usual
- A first-time fit or febrile seizure, where shaking will not stop
- A weak, high-pitched cry unlike their usual one
- A rash that does not fade under the glass test (Meningitis Now explains how to do this)
- Being under 3 months old with a temperature of 38°C (101°F) or higher, without a vaccination in the past 2 days
- Being under 3 months old with a temperature of 36°C (97°F) or lower, without a vaccination in the past 2 days
Contact your GP practice urgently, or phone 111 if the practice is closed, when you or your child:
- Feel confused, dizzy, or lightheaded
- Are more short of breath than usual
- Feel pain when breathing in or coughing
- Are peeing less than usual, which can signal dehydration
- Have had a dry nappy for 12 hours or more, or show other signs of dehydration
- Have had a high temperature lasting more than 5 days
- Have severe muscle pain
- Cannot keep food or fluids down
- Have pain or swelling in the arms or legs
- Show other signs of illness alongside a high temperature, such as a rash, or feeling unusually hot or cold to the touch, or shivering
If your child's symptoms seem to be worsening, or they seem sicker than expected, even if the fever eases, phone 111 and trust what your gut is telling you.
When sepsis becomes severe, or septic shock sets in and blood pressure falls to a dangerously low level, emergency care or treatment in an intensive care unit (ICU) becomes necessary. ICUs can support vital functions like breathing while sepsis affects the body, giving medical staff room to focus on treating the underlying infection.
The encouraging news is that sepsis responds well to treatment when it is caught early. Most people recover fully, with no lasting effects.
Causes
What causes sepsis?
Normally, the immune system keeps an infection contained to one part of the body. This is called a localised infection. To do this, the body sends out white blood cells.
These white blood cells travel to the site of the infection to destroy the germs responsible. This causes the tissue to swell, a process known as inflammation, which helps fight the infection and stop it from spreading further.
But if the immune system is weak, or the infection is severe, it can spread to other parts of the body.
When inflammation becomes widespread, it can damage tissue and disrupt normal blood flow. Once blood flow is interrupted, blood pressure can fall to dangerously low levels, and this stops oxygen from reaching the organs and tissues that need it.
Where the infection starts
Sepsis can develop from an infection almost anywhere in the body. The parts most commonly involved are the lungs, the urinary tract, the abdomen (tummy), and the pelvis.
That said, in some cases doctors are unable to pin down exactly which infection or site triggered the sepsis.
Some of the infections known to lead to sepsis include:
appendicitis, an infection of the appendix; cellulitis, a skin infection that can occur when an intravenous catheter has been placed through the skin to give fluids or medication; cholangitis, an infection of the bile duct; cholecystitis, an infection of the gallbladder; encephalitis, an infection of the brain and nervous system; endocarditis, an infection of the heart; flu, though only in some cases; meningitis, another infection affecting the brain and nervous system; peritonitis, an infection of the thin lining inside the abdomen; pneumonia, an infection of the lungs; infections that develop after surgery; osteomyelitis, an infection of the bone; and urinary tract infection, affecting the bladder, urethra, or kidneys.
Diagnosis
Tests to diagnose sepsis
Sepsis is often diagnosed by testing your:
- temperature
- heart rate
- breathing rate
- blood
Other tests can help determine the type of infection, where it’s located and which parts of the body have been affected. These include:
- urine or stool samples
- a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
- respiratory secretion testing – taking a sample of saliva, phlegm or mucus
- blood pressure tests
- imaging studies – like an X-ray, ultrasound scan or computerised tomography (CT) scan
Who’s at risk of sepsis?
Anyone can develop sepsis after an injury or minor infection. However, some people are more vulnerable, including people who:
- are very young
- are very old
- are pregnant
- have had a urinary catheter fitted
- have a long term health condition like diabetes
- have recently had surgery
- are genetically prone to infections
- are already in hospital with a serious illness
- have to stay in hospital for a long time
- have wounds or injuries as a result of an accident
- have a medical condition that weakens the immune system – like HIV or leukaemia
- are receiving medical treatment that weakens the immune system – like chemotherapy or long-term steroids
- are on mechanical ventilation – where a machine is used to help you breathe
Treatment
Sepsis treatment depends on which part of the body is affected, what caused the infection, which organs are involved and how much damage has occurred.
If you show early signs of sepsis, you will usually be referred to hospital, where you'll be assessed and given a diagnosis and treatment plan.
Antibiotics
The main treatment for sepsis, severe sepsis or septic shock is antibiotics, given directly into a vein.
Antibiotic treatment should ideally start within an hour of diagnosis.
Antibiotics given into the vein are usually switched to tablets after 2 to 4 days. You may need to keep taking them for 7 to 10 days or longer, depending on how severe your condition is.
Types of antibiotics
If sepsis is suspected, broad-spectrum antibiotics are given first, since there isn't time to wait until the exact infection has been identified.
Broad-spectrum antibiotics work against a wide range of known infectious bacteria and usually cure most common infections.
Once a specific bacterium has been identified, a more focused antibiotic can be used instead.
Viral infections
If a virus is behind the sepsis, antibiotics won't work against it. Even so, it would be too risky to wait for the exact cause to be confirmed before starting treatment, so antibiotics are usually given anyway.
With a viral infection, your immune system needs time to fight it off. In some cases, though, antiviral medication may be given as well.
Intravenous fluids
When you have sepsis, your body needs extra fluid to prevent dehydration and kidney failure.
If you have severe sepsis or septic shock, you'll usually be given fluids through a vein for the first 24 to 48 hours.
It's important for doctors to know how much urine your kidneys are producing when you have sepsis, as this helps them pick up early signs of kidney failure.
If you're admitted with severe sepsis or septic shock, you'll usually be given a catheter, inserted into your bladder to keep track of your urine output.
Oxygen
Your body needs more oxygen when you have sepsis.
If you're admitted to hospital with sepsis and the oxygen level in your blood is low, you'll usually be given oxygen, through a mask or through small tubes placed in your nostrils.
Treating the source of infection
If a specific source of infection can be found, such as an abscess or an infected wound, this will need to be treated as well.
For example, any pus may need to be drained. In more serious cases, surgery may be needed to remove infected tissue and repair any damage it has caused.
Increasing blood pressure
Medications called vasopressors are used if sepsis has caused your blood pressure to drop.
Vasopressors are normally given through a vein while you're being cared for in an ICU. Extra fluids may also be given into the vein to help raise your blood pressure.
Other treatments
You may also need additional treatments such as:
- corticosteroids
- insulin medication
- a blood transfusion
- mechanical ventilation, where a machine helps you breathe
- dialysis, where a machine filters your blood to do the work your kidneys normally would
These treatments are mostly given in ICUs.
Complications
Recovery from sepsis can be quick for some people, while others take longer. How long it takes depends on things like how severe the sepsis was, the person's general health, how long they stayed in hospital, and whether they needed ICU treatment.
Long-term effects of sepsis
Some people are left with lasting physical and psychological problems after sepsis, known as post-sepsis syndrome. It can show up as constant tiredness or lethargy, weak muscles, swelling in the arms or legs, joint pain, chest pain, and breathlessness.