Sepsis differential diagnosis: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M. | | style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Sepsis resident survival guide]] | ||
| style="vertical-align: middle; padding: 5px;" align=center | [[Sepsis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
|} | |||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Sepsis]] | |||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org] | |||
==Overview== | ==Overview== | ||
Sepsis must be differentiated from other syndromes such as the acute bacterial endocarditis, myocardial ring [[abscess]], [[subacute bacterial endocarditis]] | Sepsis must be differentiated from other syndromes such as the [[acute bacterial endocarditis]], myocardial ring [[abscess]], [[subacute bacterial endocarditis]] and [[bacterial meningitis]].<ref name="pmid28477737">{{cite journal |vauthors=Machowicz R, Janka G, Wiktor-Jedrzejczak W |title=Similar but not the same: Differential diagnosis of HLH and sepsis |journal=Crit. Rev. Oncol. Hematol. |volume=114 |issue= |pages=1–12 |year=2017 |pmid=28477737 |doi=10.1016/j.critrevonc.2017.03.023 |url=}}</ref> | ||
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==Differential Diagnosis== | |||
Sepsis must be differentiated from other causes of shock and fever based on clinical and hemodynamic findings. | |||
{| style="border: 4px solid #A8A8A8; font-size: 100%;" align="center" | |||
|+align="center" style="background:#4479BA; color: #FFFFFF;" | '''Classification of shock based on hemodynamic parameters.''' <ref name="isbn0-683-06754-0">{{Cite book | last1 = Parrillo | first1 = Joseph E. | last2 = Ayres | first2 = Stephen M. | title = Major issues in critical care medicine | date = 1984 | publisher = William Wilkins | location = Baltimore | isbn = 0-683-06754-0 | pages = }}</ref><ref name="isbn9781405179263">{{cite book | author = Judith S. Hochman, E. Magnus Ohman | authorlink = | editor = | others = | title = Cardiogenic Shock | edition = | language = | publisher = Wiley-Blackwell | location = | year = 2009 | origyear = | pages = | quote = | isbn = 9781405179263 | oclc = | doi = | url = | accessdate = }}</ref> | |||
| align="center" style="background: #A8A8A8; width: 100px;"| '''Type of Shock''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''Etiology''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''CO''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''SVR''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''PCWP''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''CVP''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''SVO2''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''RVS''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''RVD''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''PAS''' | |||
| align="center" style="background: #A8A8A8; width: 70px;" | '''PAD''' | |||
|- | |- | ||
|- | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 100px;" align=center rowspan=4 | '''Cardiogenic''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" | '''[[Ventricular septal defect|Acute Ventricular Septal Defect]]''' | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" align=center |↓↓ | ||
|- | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | ||
|- | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
|- | |- | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" | '''[[Mitral regurgitation|Acute Mitral Regurgitation]]''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
|- | |- | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" | '''[[Myocardium|Myocardial Dysfunction]]''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
|- | |- | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" | '''[[RV infarction|Right Ventricular Infarction]]''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↑ | |||
|- | |- | ||
|- | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" rowspan=2 align=center | '''Obstructive''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" | '''[[Pulmonary embolism|Pulmonary Embolism]]''' | ||
| | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓ | ||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↑ | |||
|- | |- | ||
| | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" |'''[[Cardiac tamponade|Cardiac Tamponade]]''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↓↓ | ||
| | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↑ | |||
|- | |- | ||
|- | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" rowspan=2 align=center | '''Distributive''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" | '''[[Septic shock|Septic Shock]]''' | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↓↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
|- | |- | ||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" | '''[[Anaphylactic shock|Anaphylactic Shock]]''' | ||
| ''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑↑ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↓↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ | |||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | |||
| | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | ||
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| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" rowspan=1 align=center | '''Hypovolemic''' | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" | '''[[Volume depletion|Volume Depletion]]''' | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ | |||
|} | |} | ||
<span style="font-size:85%">'''Abbreviations:''' | |||
'''CO:''' cardiac output, '''CVP:''' central venous pressure, '''PAD:''' pulmonary artery diastolic pressure. '''PAS:''' pulmonary artery systolic pressure, '''RVD:''' right ventricular diastolic pressure.'''RVS:''' right ventricular systolic pressure. '''SVO2:''' systemic venous oxygen saturation, '''SVR:''' systemic vascular resistance. | |||
</span> | |||
Other non-infectious causes of systemic inflammatory response syndrome (SIRS) that must be considered include: | |||
* Postoperative recovery | |||
* Penetrating trauma | |||
* [[Burns]] | |||
* [[Transplant rejection]] | |||
* [[Hyperthyroidism]] | |||
* [[Addisonian crisis]] | |||
* Blood product transfusion reactions | |||
* [[Serum sickness]] | |||
* [[Immunization|Immunizations]] | |||
* CNS infarction or [[hemorrhages]] | |||
* [[Leukemia]] | |||
* [[Malignant hyperthermia]] | |||
* [[Neuroleptic malignant syndrome]] | |||
* Serotonergic syndrome | |||
* [[Delirium tremens]] | |||
* [[Lactic acidosis|Metformin lactic acidosis]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Latest revision as of 00:07, 30 July 2020
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]
Overview
Sepsis must be differentiated from other syndromes such as the acute bacterial endocarditis, myocardial ring abscess, subacute bacterial endocarditis and bacterial meningitis.[1]
Differential Diagnosis
Sepsis must be differentiated from other causes of shock and fever based on clinical and hemodynamic findings.
Type of Shock | Etiology | CO | SVR | PCWP | CVP | SVO2 | RVS | RVD | PAS | PAD |
Cardiogenic | Acute Ventricular Septal Defect | ↓↓ | ↑ | N — ↑ | ↑↑ | ↑ — ↑↑ | N — ↑ | ↑ | N — ↑ | N — ↑ |
Acute Mitral Regurgitation | ↓↓ | ↑ | ↑↑ | ↑ — ↑↑ | ↓ | ↑ | N — ↑ | ↑ | ↑ | |
Myocardial Dysfunction | ↓↓ | ↑ | ↑↑ | ↑↑ | ↓ | N — ↑ | N — ↑ | N — ↑ | ↑ | |
Right Ventricular Infarction | ↓↓ | ↑ | N — ↓ | ↑↑ | ↓ | ↓ — ↑ | ↑ | ↓ — ↑ | ↓ — ↑ | |
Obstructive | Pulmonary Embolism | ↓↓ | ↑ | N — ↓ | ↑↑ | ↓ | ↓ — ↑ | ↑ | ↓ — ↑ | ↓ — ↑ |
Cardiac Tamponade | ↓ — ↓↓ | ↑ | ↑↑ | ↑↑ | ↓ | N — ↑ | ↑ | N — ↑ | N — ↑ | |
Distributive | Septic Shock | N — ↑↑ | ↓ — ↓↓ | N — ↓ | N — ↓ | ↑ — ↑↑ | N — ↓ | N — ↓ | ↓ | ↓ |
Anaphylactic Shock | N — ↑↑ | ↓ — ↓↓ | N — ↓ | N — ↓ | ↑ — ↑↑ | N — ↓ | N — ↓ | ↓ | ↓ | |
Hypovolemic | Volume Depletion | ↓↓ | ↑ | ↓↓ | ↓↓ | ↓ | N — ↓ | N — ↓ | ↓ | ↓ |
Abbreviations: CO: cardiac output, CVP: central venous pressure, PAD: pulmonary artery diastolic pressure. PAS: pulmonary artery systolic pressure, RVD: right ventricular diastolic pressure.RVS: right ventricular systolic pressure. SVO2: systemic venous oxygen saturation, SVR: systemic vascular resistance.
Other non-infectious causes of systemic inflammatory response syndrome (SIRS) that must be considered include:
- Postoperative recovery
- Penetrating trauma
- Burns
- Transplant rejection
- Hyperthyroidism
- Addisonian crisis
- Blood product transfusion reactions
- Serum sickness
- Immunizations
- CNS infarction or hemorrhages
- Leukemia
- Malignant hyperthermia
- Neuroleptic malignant syndrome
- Serotonergic syndrome
- Delirium tremens
- Metformin lactic acidosis
References
- ↑ Machowicz R, Janka G, Wiktor-Jedrzejczak W (2017). "Similar but not the same: Differential diagnosis of HLH and sepsis". Crit. Rev. Oncol. Hematol. 114: 1–12. doi:10.1016/j.critrevonc.2017.03.023. PMID 28477737.
- ↑ Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicine. Baltimore: William Wilkins. ISBN 0-683-06754-0.
- ↑ Judith S. Hochman, E. Magnus Ohman (2009). Cardiogenic Shock. Wiley-Blackwell. ISBN 9781405179263.