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According to Schouten et al (2008), sepsis involves the activation of the coagulation cascade coupled with down-regulation of anticoagulation and fibrinolysis. An intricate link between inflammation and coagulation exists within the body (Neligan, 2006). When a pathogen is present in the bloodstream or when tissue injury occurs, an inflammatory response occurs. The response causes a stimulation of the immune system to produce interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα) (Neligan, 2006). These cytokines are the main catalysts of the inflammatory response and cause the release of several agents including, interleukin-8, histamine, kinins, serotonin, selectins, and neutrophils. When the above compounds are activated, local vasodilation occurs, cytotoxic chemicals are released and the invading pathogen is destroyed (Neligan, 2006). The inflammatory response can be excessive at times and causes local cellular destruction (Neligan, 2006). In septic patients, damage to their own tissues occurs throughout the body in the vasculature
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Her cultures on September 21st showed moderate growth of gram positive bacilli and gram positive cocci with some gram negative bacilli and yeast cells. Therefore, throughout her ICU stay, her body was continuing to fight infection, and so her white blood cell count was often elevated. The two biggest laboratory indicators of acute and chronic renal failure are elevated urea and creatinine levels.14 Mrs. E’s urea levels were high 100 percent of the time she was in the ICU.
Normal urea concentration is 2.9 to 7.5 mmol/L, according to CVH accepted normal values. Mrs. E’s lowest urea value was 10.1 mmol/L on September 19th and her highest concentration was 66.5 mmol/L on October 3rd. Similarly, Mrs. E’s creatinine values were elevated for 95 percent of her stay in hospital. Her lowest creatinine concentration was 94 µmol/L on September 20th and the highest concentration recorded was 348 µmol/L on September 14th. Normal concentration of creatinine in the blood is 58 – 110 µmol/L. A third indicator of kidney function is hypoalbuminemia, as it can be a feature of
Running Head: Sepsis
11
nephrotic syndrome (Finkle, 2004). Mrs. E’s albumin level was low for 100 percent
Her cultures on September 21st showed moderate growth of gram positive bacilli and gram positive cocci with some gram negative bacilli and yeast cells. Therefore, throughout her ICU stay, her body was continuing to fight infection, and so her white blood cell count was often elevated. The two biggest laboratory indicators of acute and chronic renal failure are elevated urea and creatinine levels.14 Mrs. E’s urea levels were high 100 percent of the time she was in the ICU.
Normal urea concentration is 2.9 to 7.5 mmol/L, according to CVH accepted normal values. Mrs. E’s lowest urea value was 10.1 mmol/L on September 19th and her highest concentration was 66.5 mmol/L on October 3rd. Similarly, Mrs. E’s creatinine values were elevated for 95 percent of her stay in hospital. Her lowest creatinine concentration was 94 µmol/L on September 20th and the highest concentration recorded was 348 µmol/L on September 14th. Normal concentration of creatinine in the blood is 58 – 110 µmol/L. A third indicator of kidney function is hypoalbuminemia, as it can be a feature of
Running Head: Sepsis
11
nephrotic syndrome (Finkle, 2004). Mrs. E’s albumin level was low for 100 percent