Sepsis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

Sepsis must be differentiated from other syndromes such as the acute bacterial endocarditis, myocardial ring abscess, subacute bacterial endocarditis and bacterial meningitis.^[1]

Differential Diagnosis

Sepsis must be differentiated from other causes of shock and fever based on clinical and hemodynamic findings.

**Classification of shock based on hemodynamic parameters.** ^[2]^[3]
Type of Shock	Etiology	CO	SVR	PCWP	CVP	SVO2	RVS	RVD	PAS	PAD
Cardiogenic	Acute Ventricular Septal Defect	↓↓	↑	N — ↑	↑↑	↑ — ↑↑	N — ↑	↑	N — ↑	N — ↑
	Acute Mitral Regurgitation	↓↓	↑	↑↑	↑ — ↑↑	↓	↑	N — ↑	↑	↑
	Myocardial Dysfunction	↓↓	↑	↑↑	↑↑	↓	N — ↑	N — ↑	N — ↑	↑
	Right Ventricular Infarction	↓↓	↑	N — ↓	↑↑	↓	↓ — ↑	↑	↓ — ↑	↓ — ↑
Obstructive	Pulmonary Embolism	↓↓	↑	N — ↓	↑↑	↓	↓ — ↑	↑	↓ — ↑	↓ — ↑
Obstructive	Cardiac Tamponade	↓ — ↓↓	↑	↑↑	↑↑	↓	N — ↑	↑	N — ↑	N — ↑
Distributive	Septic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑	N — ↓	N — ↓	↓	↓
Distributive	Anaphylactic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑	N — ↓	N — ↓	↓	↓
Hypovolemic	Volume Depletion	↓↓	↑	↓↓	↓↓	↓	N — ↓	N — ↓	↓	↓

Abbreviations: CO: cardiac output, CVP: central venous pressure, PAD: pulmonary artery diastolic pressure. PAS: pulmonary artery systolic pressure, RVD: right ventricular diastolic pressure.RVS: right ventricular systolic pressure. SVO2: systemic venous oxygen saturation, SVR: systemic vascular resistance.

Other non-infectious causes of systemic inflammatory response syndrome (SIRS) that must be considered include:

Postoperative recovery
Penetrating trauma
Burns
Transplant rejection
Hyperthyroidism
Addisonian crisis
Blood product transfusion reactions
Serum sickness
Immunizations
CNS infarction or hemorrhages
Leukemia
Malignant hyperthermia
Neuroleptic malignant syndrome
Serotonergic syndrome
Delirium tremens
Metformin lactic acidosis

References

↑ Machowicz R, Janka G, Wiktor-Jedrzejczak W (2017). “Similar but not the same: Differential diagnosis of HLH and sepsis”. Crit. Rev. Oncol. Hematol. 114: 1–12. doi:10.1016/j.critrevonc.2017.03.023. PMID 28477737.
↑ Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicine. Baltimore: William Wilkins. ISBN 0-683-06754-0.
↑ Judith S. Hochman, E. Magnus Ohman (2009). Cardiogenic Shock. Wiley-Blackwell. ISBN 9781405179263.

Template:WikiDoc Sources

[pmid28477737-1] Machowicz R, Janka G, Wiktor-Jedrzejczak W (2017). “Similar but not the same: Differential diagnosis of HLH and sepsis”. Crit. Rev. Oncol. Hematol. 114: 1–12. doi:10.1016/j.critrevonc.2017.03.023. PMID 28477737.

[isbn0-683-06754-0-2] Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicine. Baltimore: William Wilkins. ISBN 0-683-06754-0.

[isbn9781405179263-3] Judith S. Hochman, E. Magnus Ohman (2009). Cardiogenic Shock. Wiley-Blackwell. ISBN 9781405179263.

[1]

[2]

[3]