The earliest manifestation of serious gram– negative infection may consist of a triad of signs that includes:
|A||Tachypnea, hypotension, and an altered sensorium|
|B||Tachypnea, hypotension, and lactic acidosis|
|C||Thrombocytopenia, hypotension and lactic acidosis|
|D||Mild hyperventilation, respiratory alkalosis and an altered sensorium.|
(Ref: Schwartz :Principles of surgery 8th edition page no.205-207 )
a. The development of mild hyperventilation, respiratory alkalosis, and an altered sensorium may be the earliest sign of gram-negative injection. This triad may procede the usual signs and symptoms of sepsis by several hours to several days.
b. Gram-negative sepsis, a relatively rare clinical diagnosis only a few decades ago, is perhaps the most important infectious disease problem in hospitals today.
c. The mortality rate from gram-negative sepsis remains frustratinglyhigh, particularly after the onset of shock.
d. Eschericheae, Salmonellae, Klebsielleae, proteae are the tribes of gram negative bacilli causing the pathology in hospitals.
e. These gram negative bacilli may be gaerobic, facultative or anaerobic.
f. Obligatory anaerobic bacterias, are found in normal flora on skin and the mucous membranes.
g. When the mucosal barrier is disrupted , they cause the manifestations .
h. Escherichia coli was the most commonly isolated pathogen, followed by Klebsiella and Enterobacter species .
i. Liver dysfunction may be revealed by a rise in serum bilirubin levels thatfrequently precedes the clinical signs of infection .
j. A variety of changes in mental status is possible in the septic patient, including disorientation, lethargy, confusion, agitation, and obtundation.