Sepsis causes an enormous number of deaths worldwide and is far less recognised by the public than heart attack or stroke. It begins as an ordinary infection and becomes life threatening within hours.
Survival depends heavily on how quickly treatment starts, which makes public recognition genuinely important.
What Sepsis Is
Sepsis is not an infection itself. It is the body's own response to infection going wrong.
Normally the immune system contains an infection locally. In sepsis the response becomes generalised, causing widespread inflammation, blood vessels to leak and dilate, clotting abnormalities, and reduced blood flow to organs.
Organs then begin to fail: kidneys stop producing urine, lungs fail to oxygenate, the liver and clotting system fail, and blood pressure drops. Septic shock is the stage at which blood pressure cannot be maintained despite fluids.
Any infection can trigger it: pneumonia, urinary infection, abdominal infection, skin infection, or an infected wound.
Recognising It
Early sepsis looks like a bad infection, which is why it is missed. These features suggest the response has become systemic.
- Slurred speech or confusion, or unusual drowsiness
- Extreme shivering, or muscle pain
- Passing no urine for most of a day
- Severe breathlessness
- A feeling that something is seriously wrong, often described as feeling like they might die
- Skin that is mottled, discoloured, very pale or blue tinged
- Very fast heart rate and breathing
- Fever, or in some cases an abnormally low temperature
Confusion is the most useful single sign in adults, particularly in older people, and it is frequently attributed to age rather than recognised as a sign of infection.
Sepsis in Children
Children compensate well and then deteriorate rapidly, which makes early recognition harder and more important.
- Very fast breathing, or grunting with each breath
- A fit or convulsion
- Mottled, bluish or very pale skin
- A rash that does not fade when pressed with a glass
- Abnormally cold hands and feet
- Unusual sleepiness, or difficulty waking
- A weak, high pitched or continuous cry
- Not feeding, or repeated vomiting
- No wet nappy for twelve hours
In a baby under three months, any fever should be assessed urgently regardless of how well they otherwise appear. Our paediatric emergency service assesses these immediately.
Who Is at Higher Risk
Anyone can develop sepsis, but some groups are considerably more vulnerable.
- Babies under one and adults over sixty five
- People with diabetes
- People on chemotherapy or immunosuppressive drugs
- People on long term steroids
- Those with chronic kidney or liver disease
- People without a functioning spleen
- Pregnant and recently pregnant women
- People with indwelling catheters, lines or recent surgery
- Malnourished people
Postpartum sepsis deserves specific mention. Fever with abdominal pain or foul discharge in the weeks after delivery requires urgent assessment rather than waiting for the postnatal appointment.
The First Hour Matters
Mortality in septic shock increases measurably with each hour that appropriate treatment is delayed. Hospitals therefore work to a bundle of actions in the first hour.
- Blood cultures taken before antibiotics
- Broad spectrum antibiotics given intravenously
- Intravenous fluids for low blood pressure
- Blood lactate measured, which indicates tissue oxygen debt
- Oxygen given
- Urine output monitored
Finding and controlling the source is equally important. That may mean draining an abscess, removing an infected line, or surgery for a perforated bowel. Antibiotics alone rarely resolve an undrained collection.
Our sepsis management protocol in critical care is built around these time targets.
What to Say at the Hospital
Advocating clearly makes a difference in a busy department.
Say plainly: I am worried this might be sepsis. That phrase prompts a specific assessment pathway in most hospitals.
Provide the timeline of the illness, mention any recent infection, surgery, catheter or wound, list current medications particularly steroids and chemotherapy, and describe any confusion or reduced urine output, which are the features clinicians most want to know.
If the person is deteriorating while waiting, say so rather than waiting to be called.
Recovery Afterwards
Surviving sepsis is followed by a long recovery that is frequently underestimated.
- Profound fatigue lasting months
- Muscle weakness and difficulty with previously easy activities
- Poor appetite and weight loss
- Memory and concentration problems
- Anxiety, depression and post traumatic stress
- Increased vulnerability to further infections for a period
- In severe cases, amputation of fingers or toes where circulation failed
Recovery is gradual and frequently takes six to twelve months. Physiotherapy, nutrition and psychological support all help, and families should expect a slower return than after most illnesses.
Prevention
Reducing infections reduces sepsis, and some measures are specific.
- Vaccination, particularly influenza and pneumococcal in older adults and those with chronic conditions
- Prompt treatment of infections rather than waiting them out, particularly in high risk groups
- Good wound care, keeping wounds clean and watching for spreading redness
- Careful diabetic foot care
- Hand hygiene
- Completing prescribed antibiotic courses
- Removing catheters and lines as soon as they are no longer needed
People without a spleen, or with significant immunosuppression, should have a clear written plan for what to do if they develop a fever, since their illness can progress extremely fast.
Sepsis is an infection that has become an emergency. Confusion, not passing urine, mottled skin, severe breathlessness and a sense that something is badly wrong are the features to act on. Say the word sepsis at the hospital, and do not wait until morning.
Our emergency department and critical care unit at T. Nagar manage sepsis around the clock.
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