Sepsis

• you have severe difficulty breathing, for example, you struggle to speak without pausing, or you are 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 that 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 the way they normally do (they may find it hard to focus on you, or be harder to wake than usual)
• has severe difficulty breathing (they may make grunting noises, or suck their stomach in under the ribcage)
• is breathing fast, or stops or pauses
• is pulling in at the 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" for meningitis)
• 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 a doctor urgently if you or your child:

• are feeling confused, dizzy or lightheaded
• have difficulty breathing (you may be more short of breath than usual)
• have pain when breathing in or coughing
• are peeing less than usual, which can be a sign of dehydration
• have had a dry nappy for 12 hours or more, or are showing other signs of dehydration
• have a high temperature that has lasted for more than 5 days
• have severe muscle pain
• feel sick or are being sick, for example if you can't keep food or fluids down
• have pain or swelling in the arms or legs
• have other signs of illness, such as a rash, as well as a high temperature, for example if you feel either hot or cold to touch or you're shivering

If your doctor's chamber is closed, call a doctor or the 16263 health line.

Trust your instincts. If your child's symptoms are getting worse, or they seem sicker than you'd expect, call a doctor or the 16263 health line (even if their temperature falls).

Sepsis is a serious complication of an infection. If it isn't treated quickly, it can lead to failure of several organs at once, and it can lead to death.

Normally, your immune system keeps an infection in one place. This is called a localised infection. To do this, your body makes white blood cells.

These white blood cells travel to the site of the infection and destroy the germs causing it. That sets off swelling in the tissue, which is known as inflammation. The swelling helps fight the infection and stops it from spreading.

But an infection can spread to other parts of the body if your immune system is weak or the infection is severe.

When inflammation becomes widespread, it can damage tissue and interfere with blood flow. If blood flow is interrupted, blood pressure can fall dangerously low. Oxygen then can't reach the organs and tissues.

Sepsis can be triggered by an infection in any part of the body. The most common sites of infection that lead to sepsis are the:

• lungs
• urinary tract
• tummy (abdomen)
• pelvis

But sometimes the specific infection and source of sepsis can't be identified.

• appendicitis: infection in the appendix
• cellulitis: a skin infection that can be caused by an intravenous catheter that's been inserted through the skin to give fluids or medicine
• cholangitis: an infection of the bile duct
• cholecystitis: an infection of the gallbladder
• encephalitis: an infection of the brain and nervous system
• endocarditis: a heart infection
• flu: only in some cases
• meningitis: an infection of the brain and nervous system
• peritonitis: an infection of the thin layer of tissue that lines the abdomen
• pneumonia: a lung infection
• post-surgery infections
• osteomyelitis: a bone infection
• urinary tract infection: an infection of the bladder, urethra or kidneys

Doctors often diagnose sepsis by checking your:

• temperature
• heart rate
• breathing rate
• blood

Other tests can help show what type of infection you have, where it is and which parts of the body it has 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 and tested
• respiratory secretion testing, which means taking a sample of saliva, phlegm or mucus
• blood pressure tests
• imaging studies, like an X-ray, ultrasound scan or computerised tomography (CT) scan

Anyone can develop sepsis after an injury or a minor infection. Some people are more vulnerable than others, though, 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

Some people recover fully from sepsis fairly quickly. How long it takes depends on:

• how severe the sepsis was
• the person's overall health
• how much time they spent in hospital
• whether they needed treatment in an intensive care unit (ICU)

Some people who have had sepsis go on to have physical and psychological problems that last a long time. This is called post-sepsis syndrome.

The symptoms of post-sepsis syndrome include:

• feeling lethargic or excessively tired
• muscle weakness
• swollen limbs
• joint pain
• chest pain
• breathlessness

Sepsis can cause many different symptoms.

• a temperature over 38C in babies under 3 months
• a temperature over 39C in babies aged 3 to 6 months
• a temperature below 36C, checked 3 times in a 10-minute period
• a high temperature in a child who can't be encouraged to show interest in anything

• difficulty breathing, which looks like hard work
• grunting with every breath
• struggling to speak more than a few words at once (for older children who normally talk)
• breathing that obviously "pauses"

• no interest in feeding (child under 1 month)
• not drinking for more than 8 hours (when awake)
• black, green or bloody vomit

• a soft spot on a baby's head that bulges
• "sunken" eyes
• a baby that's floppy
• a child that can't be encouraged to show interest in anything
• weak, whining or continuous crying in a younger child
• confusion in an older child
• irritableness
• unresponsive
• stiffness in the neck, especially when trying to look up or down
• not had a wee or wet nappy for 12 hours

Sepsis can start with a few early symptoms, which may include:

• a high temperature (fever) or low body temperature
• chills and shivering
• a fast heartbeat
• fast breathing

Sometimes sepsis becomes more severe, or turns into septic shock, which is when your blood pressure drops to a dangerously low level. If this happens, you may notice symptoms such as:

• feeling dizzy or faint
• a change in mental state, like confusion or disorientation
• diarrhoea
• nausea and vomiting
• slurred speech
• severe muscle pain
• severe breathlessness
• less urine production than normal (for example, not urinating for a day)
• cold, clammy and pale or mottled skin
• loss of consciousness

How sepsis is treated depends on a few things:

• the area affected
• the cause of the infection
• the organs affected
• the extent of any damage

If you have the early signs of sepsis, you'll usually be sent to hospital, where you'll be given a diagnosis and treatment.

You'll need emergency treatment, or treatment in an intensive care unit (ICU), if:

• the sepsis is severe
• you develop septic shock, which is when your blood pressure drops to a dangerously low level

An ICU can support body functions that sepsis affects, such as breathing. This lets the medical staff 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.

Antibiotics are the main treatment for sepsis, severe sepsis and septic shock. You get them straight into a vein (this is called giving them intravenously).

Ideally, the antibiotics should start within an hour of the diagnosis.

After 2 to 4 days, the intravenous antibiotics are usually replaced by tablets. You may need to take them for 7 to 10 days or longer, depending on how severe your condition is.

When doctors suspect sepsis, they start with broad-spectrum antibiotics. There simply isn't time to wait until the exact type of infection has been identified.

Broad-spectrum antibiotics work against a wide range of known infectious bacteria, and they usually cure most common infections.

Once a specific bacterium has been identified, the doctor can switch to a more focused antibiotic.

Antibiotics won't work if a virus is behind the sepsis. But waiting to find out the exact cause would be too dangerous, so antibiotics are usually given anyway.

With a viral infection, you'll have to wait until your immune system starts to tackle it. Antiviral medicine may be given in some cases.

When you have sepsis, your body needs extra fluid to guard against dehydration and kidney failure.

If you have severe sepsis or septic shock, you'll usually get fluids through a drip into a vein (intravenously) for the first 24 to 48 hours.

Doctors need to know how much urine your kidneys are making while you have sepsis, because this helps them spot the signs of kidney failure early. So if you're admitted to hospital with severe sepsis or septic shock, you'll usually have a catheter put in. This is a thin tube placed in your bladder, and it lets the team keep track of your urine output.

If you have sepsis, your body needs more oxygen than usual. So if you're admitted to hospital with sepsis and the level of oxygen in your blood is low, you'll usually be given oxygen. It's given through a mask or through small tubes placed in your nostrils.

If doctors can find where the sepsis infection started, such as an abscess or an infected wound, that source will need treatment too. Any pus may have to be drained away, for example. In more serious cases, you may need surgery to remove the infected tissue and repair any damage.

If sepsis has made your blood pressure drop too low, you'll be given medicines called vasopressors. These are normally given through a drip into a vein while you're in an intensive care unit (ICU). You may also get extra fluids through a vein, which help raise your blood pressure.

With sepsis, you may need some other treatments as well, such as:

• corticosteroids
• insulin medication
• a blood transfusion
• mechanical ventilation, where a machine is used to help you breathe
• dialysis, where a machine filters your blood to copy the function of your kidneys

These treatments are mostly used in ICUs.