Sharma_Aditi_Case study of an acute life-threatening health condition-1
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Western Sydney University *
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Date
Feb 20, 2024
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ADITI SHARMA 20351856
Search Engines Used: Pubmed, SpringerLink, ScienceDirect, ProQuest Central,
National Library of Medicine, WSU Library, BioMed Central
Keywords: Sepsis, Urosepsis, pathogenesis of sepsis, Ceftriaxone, normal saline,
tachycardia, hypotension related to sepsis, procalcitonin.
Question 1:
According to the case study provided, Mrs. Smith exhibits a range of clinical
symptoms that are all explained by the pathophysiology of her illness, sepsis. Sepsis,
which carries a significant risk of death, this condition occurs when the body harms
it’s own tissue and organs in response to an infection (Australian Commision on
Safety and Quality in Healthcare, 2022). Multiple organ dysfunction syndrome can
result from sepsis, which can range from infection to septic shock and
mortality (Neviere, 2023). Endogenous pyrogens and cryogens, which are created
when the innate immune system recognises an infectious pathogen, are the mediators
of fever. Hepatic and pulmonary macrophages (and later brain endothelial cells) begin
to secrete cytokines and lipid mediators, with prostaglandin (PG) E2 playing a major
role. Fevers are brought on by blood PGE2 entering the brain (Garami et al., 2018).
This caused Mrs. Smith fever, with a temperature of 38.9 .
℃
Urerosepsis can be
brought on by a urinary tract infection, such as cystitis, which affects the lower
urinary tract and bladder, or pyelonephritis, which impact on the upper urinary system
and kidneys (Porat et al., 2023). Mrs. Smith was found to have a fever, bilateral flank
discomfort (R>L), bowel noises, and nausea upon abdominal examination. The
symptoms listed above suggest she has acquired polynephritis. She also has dysuria,
frank hematuria and suprapubic pain which are the signs and symptoms for cystisis
(Porat et al., 2023). According to Mankowski et al. (2022), the host organ systems
affected by sepsis include the skeletal muscle system. Sepsis-induced myopathy is
ADITI SHARMA 20351856
defined by the ensuing neuromuscular dysfunction and decreased ability for
regeneration, which manifests as atrophy, loss of strength, and delayed regeneration
following injury and Mrs. Smith complained about myalgia at the time of admission.
She was tachycardic at the time of admission, her heart rate recorded was 124/mt
and according to Aseri (2021), tachycardia is a common sign of septic shock and
signifies a bad outcome for the patient. It is brought on by increased venodilatation-
induced activation of α- and β -adrenergic receptors, and it may also be associated to
excessive temperature. Moreover, sepsis causes hypotension and distributive shock
due to arterial and venous dilatation (induced by inflammatory mediators) and
consequent decreased venous return, as Mrs. Smith’s was presented with BP of 90/58
mmHg (Gyawali et al., 2019). Other than this, according to the case study of Mrs.
Smith, her WBC count was remarkably increased that is 26.3x10^9/L, which shows
that blood WBC count greater than 14x 10^9/L can be used as an early warning sign
for urosepsis in individuals with urinary tract infection (Wu et al., 2023). Her elevated
neutrophil count that is 13.0x10^9/L is due to the union between neutrophils and
endothelial cells and slow down normal neutrophil death, that cause increase in
peripheral blood neutrophil levels and as a result sepsis develops (Wu et al., 2023).
Additionally, her laboratory results showed that when inflammation, infection, or
tissue damage occurs in the body, C- reactive protein (CRP) rises within 12–24 hours,
peaks within 2-3 days, and increases to 1000–fold normal levels. The increase in
CRP, measuring 116 mg/L, and the elevated procalcitonin, at 37.18 ug/L, were two
additional indicators of this (Wu et al., 2023).
The blood gas analysis of Mrs. Smith revealed a high lactate level of 5.2 mmol/L and
a pH of 7.12, indicating the presence of acidosis, low bicarbonate of 16 mmol/L, and
ADITI SHARMA 20351856
low SpO2 of 82% levels indicate metabolic acidosis and tissue hypoxia. Her blood pH
was 7.12 and PaCO
2
was 28 mmHg so, it is evident
that if PaCO2 < 40 and pH > 7.4
that signifies
a respiratory alkalosis
(Castro et al., 2022). Evidence shows that
individuals with severe sepsis or septic shock frequently experience hyperlactatemia
and lactic acidosis, which has been commonly thought of as a biomarker for elevated
lactate, highlighting the severity of Mrs. Smith’s condition (Yang et al., 2020). It is
reasonable to conclude from the case study of Mrs. Smith that urosepsis, which
resulted from a urinary tract infection, is the cause of both her diagnostic findings and
her clinical manifestations. Due to this diagnosis, Mrs. Smith was given the following
interventions immediately.
Question 2:
The broad-spectrum cephalosporin β-lactam antibiotic ceftriaxone is therapeutically
significant and can be used indiscriminately against organisms like Escherichia coli
(E. coli) (Heffernan et al., 2020). In contrast to other types of sepsis, E. coli is the
bacterium that is most frequently isolated in urosepsis (Bonkat et al., 2019). So, these
antibiotics work by inhibiting penicillin-binding proteins, which are the enzymes
responsible for bacterial cell wall formation (Sethuvel et al., 2023). Effective
treatment for individuals with sepsis requires prompt and appropriate antibiotic
medication, which has a direct impact on mortality. In cases where sepsis is likely,
empirical antibiotic therapy should start as soon as possible and no later than 1 hour
after the possibility of sepsis has been recognised (Roy, 2023). Patients with sepsis or
septic shock have a higher 28-day death rate when infection therapy is delayed.
Patients with and without septic shock had a higher risk of death when given
antibiotics later than they should have, and their chances of going from sepsis to
septic shock were also higher (Ruddel et al., 2022). That is why, Mrs. Smith needs a
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ADITI SHARMA 20351856
timely administration of appropriate antibiotic therapy. One of the cornerstones of
therapy to avoid deaths and life-threatening consequences in this situation is the use
of suitable and timely antibiotic treatment (Martinez et al., 2020).
Normal Saline is a crystalloid fluid administered via an intravenous route. It is the
most widely used crystalloid in the world which is used to manage and treat moderate
sodium depletion, and dehydration for example hypovolemia, shock. In Mrs. Smith’s
case study, normal saline is the most appropriate fluid for hydration and electrolyte
disturbances which ultimately increase the blood pressure. The optimal sodium
chloride solution for parenteral replacement of chloride losses that are greater than or
equal to sodium losses is at an isotonic concentration (Tonog and Lakhar, 2022). The
major sign of septic shock is systemic vasodilation, which produces hypovolemia,
decreased tissue perfusion, and decreased oxygen supply.The main goal of fluid
resuscitation in this situation is to improve tissue perfusion and, ultimately, increase
the supply of oxygen to tissues by restoring normal hemodynamics (Wallace and
Regunath, 2023).
A continuous pulse oximetry analysis of arterial oxygen saturation is recommended.
Mrs. Smith’s creatinine level was elevated, recorded 127 µmol/L, so it is important to
assess urine output, which is a reliable sign of renal perfusion because increased
creatinine may be an indication of approaching renal failure (Forrester, 2023).
ADITI SHARMA 20351856
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ADITI SHARMA 20351856
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