Test Result

blood, urine and sputum positive for organism

cultures
Other fluids to consider
culturing are wounds, central
venous catheter tip and
aspirate specimens, pleural
fluid and ascites.
Pathogen growth is
dependent on the use of
appropriate culture mediums
(e.g., aerobic, anaerobic,
fungal).
Negative cultures common.
ABG hypoxemia,
hypercapnia
Blood gas evaluation
facilitates optimization of
oxygenation.

Differentiation of respiratory
from metabolic acidosis
allows metabolic demands to
be identified and treated.
Repeat blood gases are
indicated depending on the
clinical state of the patient.
CBC WBC count greater
than 12,000/microliter
WBC count is sensitive but
or less than
not specific for the diagnosis
4000/microliter, low
of sepsis.
platelets
Noninfectious injury (e.g.,
crush injury), cancer and
immunosuppressive agents
can also cause either
increased or decreased
WBC counts.
Thrombocytopenia of
nonhemorrhagic origin is a
sign of severe sepsis.
lactate levels hyperlactatemia: 2 to
5 mmol/L; shock: 4
Venous and/or arterial blood
mmol/L or greater
may be sampled.
Lactate levels are an index
of global inadequate tissue
perfusion.
Increasing levels of lactate
are associated with
increasing levels of
anaerobic metabolism.
Persistently elevated lactate
levels may parallel the
degree of malperfusion or
organ failure.
coagulation studies prolonged INR, PTT
and PT
Baseline test, especially
before central line
placement.
renal function tests creatinine 2-fold
normal
Elevated creatinine is a sign
of severe sepsis.
LFT raised ALT, AST, alk
phos, gamma-GT and
Baseline test.
bilirubin
Sepsis can originate from
hepatic or perihepatic
infections.
Comorbidity of underlying
hepatic disease can affect
drug metabolism and
outcome in sepsis.
Septic shock can
compromise hepatic blood
flow and metabolism,
including lactate.
serum glucose target: 80 to 120
mg/dL
Tight glycemic control is
recommended for patients in
the ICU, as hyperglycemia is
associated with increased
morbidity and mortality.
Spontaneous or iatrogenic
hypoglycemia also poses
significant dangers. [33] [34]
CXR may show pleural
effusion,
Required to look for cause of
consolidation, cardiac
sepsis.
abnormalities or a
A CXR is always indicated pneumothorax
after CVP/pulmonary artery
catheter and endotracheal
tube placement to rule out
malposition and
complications.