Sepsis laboratory tests

Identify patient symptoms as early or late sepsis and evaluate diagnostic and laboratory tests for patient treatment and monitoring. 

Laboratory tests to evaluate infection or complications of sepsis ... 

A 65-year-old man with acute leukemia recently underwent induction chemotherapy and subsequently developed neutropenia and fever (with no source of fever identihed). Fever persisted despite the use of empirical antibacterial therapy, and amphotericin B has been prescribed for possible fungal sepsis. Which laboratory test is LEAST helpful in monitoring for toxicities associated with amphotericin B ... 

Systemic infection induced by the Trichosporon species (s. tab. 26.2) may lead to sepsis and, in the liver, to marked hepatitis-like findings, granulomas and micro-absesses. Laboratory tests revealed an increase in transaminases, alkaline phosphatase and bilirubin. Diagnosis was confirmed by liver biopsy and fungal culture. (41,42)... 

Disorders of the intestinal tract in the neonatal period usually present with abdominal distension and dilatation of the bowel. However, not all intestinal dilatations represent obstruction. Infants with medical disorders such as sepsis, electrolyte imbalance or necrotizing enterocolitis may present ileus characterized by uniform dilatation of the bowel to the level of the rectum. Also, infants on continuous positive airways pressure may swallow an excessive amount of air and exhibit important intestinal dilatation. This dilatation must be distinguished from mechanical obstruction, because the treatment is completely different. The differentiation between these two categories can usually be made on the basis of clinical history, laboratory tests, and appropriate radiographs (Hernanz-SCHULMAN 1999). 

A 70-year-old woman with a 2-year history of primary biliary cirrhosis confirmed by histological and immunological criteria took colestyramine sachets twice daily for 2 months and developed lethargy, confusion, and drowsiness (3). She had signs of chronic liver disease, portal hypertension, and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis, and a urinary pH of 4.85 together with tests of renal acidification excluded renal tubular acidosis. No other cause was found and she responded to 600 mmol of sodium bicarbonate intravenously over 36 hours. 

The major concern of the emergency department physicians was the lethargy, hypotonia, and seizure activity. Initial laboratory studies revealed that the child had a normal complete blood count and smear. Other blood tests revealed metabolic acidosis with a bicarbonate concentration of 11 mEq/L (normal is 20-25 mEq/L) and an anion gap of 22 mEq/L (normal is < 15 mEq/L). His serum glucose, calcium, and magnesium concentrations were normal. To exclude the diagnosis of meningitis, a spinal tap was performed. The cell counts and chemistries of the cerebrospinal fluid were normal. The physicians considered that the child might have sepsis and administered antibiotics and intravenous fluids. Prior to administration of antibiotics, blood, urine, and cerebrospinal fluid were sent for bacterial culture. 

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