Case Report:
This is a 56-year-old white female with a history of cirrhosis secondary to alcoholism and NASH, history of portal hypertension and ascites, and hepatic encephalopathy, who was brought to the ED by her mother and daughter due to concerns about confusion. The patient is confused and unable to answer questions; therefore this information has been obtained by family members. According to the family members, the patient has been confused for 2-3 days and has had a few episodes of emesis for the last few days and was drinking an excess amount of lactulose for the last 3 days due to constipation; however, she did have a loose bowel movement yesterday. The patient has been complaining of diffuse body pain including her abdomen, but she …show more content…
It may lead to organ dysfunction. Sepsis should be suspected when certain diagnostic criteria are met. In order to meet systemic inflammatory response syndrome (SIRS), two of the four are needing: fever (100.4°F) or low temperature (96.8°F), tachycardia (>90), respiratory rate greater than 20, or a PaCO2 < 32 mm Hg, a white blood cell count > 12,000/mm>3 or < 4,000/mm>3, or > 10% bands. The definition of sepsis is two out of the preceding four criteria, plus a present or suspected source of infection. Severe sepsis is diagnosed when the aforementioned are combined with end organ damage, as found by the presence of lactic acidosis, a systolic blood pressure less than 90, or a drop in blood pressure more than 40 mmHg from normal. Septic shock is the last and most severe category, defined as severe sepsis, with continuing hypotension despite an adequate level of fluid resuscitation.
Spontaneous bacterial peritonitis (SBP) is generally suspected in cases when a patient has ascites as well as a history of cirrhosis. In addition, the symptoms of altered mental status, fever, diarrhea, abdominal inflammation, and hypotension are usually present. When contrasted with cases in which patients do not have ascites, those with spontaneous bacterial peritonitis cases have symptoms more readily masked or subtle. In fact, approximately 13% of patients with …show more content…
Cefotaxime or a similar third-generation cephalosporin provides suitable bacterial coverage. A fluoroquinolone (eg, levofloxacin) is a substitute in those who are allergic to penicillin. The treatment period should be simply five days. A longer regimen may be sensible in those who are infected with an atypical organism such as pseudomonas. It is recommended to reassess a patient after five days of therapy. Treatment is stopped if there is a marked improvement, but if symptoms of fever and abdominal pain linger, then one either searches surgically for a source of infection, or antibiotics can be continued for 48 hours. A tenet of treatment is to treat empirically, rather than waiting for the results of cultures from ascitic fluids. In fact, prophylactic treatment is even recommended in those at high risk for SBP, and this is greatly associated with a diminished risk of morbidity and
This is a 56-year-old white female with a history of cirrhosis secondary to alcoholism and NASH, history of portal hypertension and ascites, and hepatic encephalopathy, who was brought to the ED by her mother and daughter due to concerns about confusion. The patient is confused and unable to answer questions; therefore this information has been obtained by family members. According to the family members, the patient has been confused for 2-3 days and has had a few episodes of emesis for the last few days and was drinking an excess amount of lactulose for the last 3 days due to constipation; however, she did have a loose bowel movement yesterday. The patient has been complaining of diffuse body pain including her abdomen, but she …show more content…
It may lead to organ dysfunction. Sepsis should be suspected when certain diagnostic criteria are met. In order to meet systemic inflammatory response syndrome (SIRS), two of the four are needing: fever (100.4°F) or low temperature (96.8°F), tachycardia (>90), respiratory rate greater than 20, or a PaCO2 < 32 mm Hg, a white blood cell count > 12,000/mm>3 or < 4,000/mm>3, or > 10% bands. The definition of sepsis is two out of the preceding four criteria, plus a present or suspected source of infection. Severe sepsis is diagnosed when the aforementioned are combined with end organ damage, as found by the presence of lactic acidosis, a systolic blood pressure less than 90, or a drop in blood pressure more than 40 mmHg from normal. Septic shock is the last and most severe category, defined as severe sepsis, with continuing hypotension despite an adequate level of fluid resuscitation.
Spontaneous bacterial peritonitis (SBP) is generally suspected in cases when a patient has ascites as well as a history of cirrhosis. In addition, the symptoms of altered mental status, fever, diarrhea, abdominal inflammation, and hypotension are usually present. When contrasted with cases in which patients do not have ascites, those with spontaneous bacterial peritonitis cases have symptoms more readily masked or subtle. In fact, approximately 13% of patients with …show more content…
Cefotaxime or a similar third-generation cephalosporin provides suitable bacterial coverage. A fluoroquinolone (eg, levofloxacin) is a substitute in those who are allergic to penicillin. The treatment period should be simply five days. A longer regimen may be sensible in those who are infected with an atypical organism such as pseudomonas. It is recommended to reassess a patient after five days of therapy. Treatment is stopped if there is a marked improvement, but if symptoms of fever and abdominal pain linger, then one either searches surgically for a source of infection, or antibiotics can be continued for 48 hours. A tenet of treatment is to treat empirically, rather than waiting for the results of cultures from ascitic fluids. In fact, prophylactic treatment is even recommended in those at high risk for SBP, and this is greatly associated with a diminished risk of morbidity and