Articles: sepsis.
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Southern medical journal · Jun 1980
Bacteremia related to IV cannulation: variability of underlying venous infection.
During 1977, 22 of 66 cases of nosocomial bacteremia in our hospital were directly or indirectly attributable to infection from the intravenous (IV) site. IV-site-related bacteremia (IVSRB) occurred most frequently in patients with serious underlying disease. The characteristic clinical picture was one of fever, tachycardia, and hypotension. ⋯ Short percutaneous plastic catheters were incriminated in most cases, and gram-negative rods, especially Klebsiella and Serratia, were the most frequent infecting bacteria. Initial treatment consisted of removal of the IV cannula and administration of parenteral antibiotics. Although no deaths could be attributed to recognized and treated IVSRB, it resulted in significant morbidity including the need for excision of veins contiguous with the IV site in six patients.
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The patient had classic ECG changes of hypothermia (sinus bradycardia, prolonged PR interval, prolonged QT interval, and Osborn waves). These changes occurred in hypothermia resulting from sepsis, without exposure being a factor. Documentation of Osborn waves in this clinical setting supports the theory that they result as a direct consequence of myocardial cooling.
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Hypoglycemia has rarely been described as a clinical sign of severe bacterial sepsis. We recently encountered nine patients in whom hypoglycemia (mean serum glucose of 22 mg/dl) was associated with overwhelming sepsis. Clinical disease in these patients included pneumonia and cellulitis; in three patients, no focus of infection was apparent. ⋯ Depleted glycogen stores, impaired gluconeogenesis and increased peripheral glucose utilization may all be contributing factors. Incubation of bacteria in fresh blood at room temperature does not increase the normal rate of breakdown of glucose suggesting that the hypoglycemia occurs in vivo. Hypoglycemia is an important sign of overwhelming sepsis that may be more common than has previously been recognized.