Sepsis

“You know, Curmudge, the human body is quite amazing.”

“I agree, Jaded Julie, but it’s not always amazingly good. The body I know best seems to be getting older and slower, and the body I loved most shut itself down rather suddenly a few months ago. Perhaps I need more explanation of this ‘amazing’ stuff.”

“Okay. As an example, let’s use the condition called sepsis. Were you aware that only one out of three Americans has ever heard the word ‘sepsis’ and that it is the tenth most common cause of death? In sepsis bad things occur because of actions taken by parts of the body to protect themselves.”

“Julie, if you are inspired by the same sepsis I’ve been reading about, you have a mighty morbid sense of amazement. But as a compulsive learner, if there’s more that I need to know, let’s get on with it. Tell me about sepsis.”

“Well Curmudge, old codgers like you might recognize the term, ‘blood poisoning,’ but that’s an inadequate description. Sepsis is not an infection in of itself; it’s a systemic (whole-body) response to infection or injury. Specifically, bacteria, a fungus, or a virus overwhelm the bloodstream. This is called septicemia.”

“So far so good (or bad), Nurse-Educator, but where do these bad guys come from?”

“Lots of places: the bowel (peritonitis), the kidneys (pyelonephritis), the lining of the brain (meningitis), the lungs (bacterial pneumonia), the skin (cellulitis). In hospitalized patients, common sites of infection include IV lines, surgical wounds and drains, and bedsores.”

“Thus far, everything I’ve heard is bad. Where does the ‘amazing’ stuff occur?”

“Let’s start simple. When the body incurs an insult—from a minor injury to the entry of bacteria and bacterial toxins into the bloodstream—the immune system is activated. Cells of the endothelium—the lining of blood vessels—respond by initiating the inflammation process. This involves dilation of blood vessels and consequent leakage. The cells—seeking to maintain internal equilibrium (homeostasis)—try to reestablish control through the process called coagulation, the formation of blood clots. They are an interlacing fibrous network of a substance called fibrin.”

“Hooray for blood clots. That’s why I grew a beard…so I wouldn’t have to worry about cutting myself shaving.”

“Don’t speak too soon, Curmudge. There’s a lot more biochemistry going on. The body views blood clots as an abnormality, so it cranks up the process of fibrinolysis to get rid of them. Sort of like when a bruise loses its purple coloration. Tissue plasminogen activating factor (t-PA) forms plasmin, the workhorse of fibrinolysis.”

“Hey Julie, I know about t-PA. That’s what they give victims of an ischemic stroke, the type of stroke often caused by a blood clot.”

“Unfortunately in sepsis, inflammation and coagulation overpower fibrinolysis, and the sepsis victim has microvascular thrombosis, i.e., blood clots in his capillaries.”

“I can see now that when that happens throughout the body, the patient is in deep trouble. As you said originally, the human body is amazing; each of these processes is essential. But problems arise when one process becomes dominant and forces homeostasis out of balance. It is just too much of a good thing. So what happens to a body when it is full of little blood clots?”

“It would seem as if the body is trying to self-destruct. Back during inflammation, when the blood vessels are dilating, the body senses that blood pressure is dropping. It’s time to set priorities, so vasoconstrictors are released to constrict blood vessels and elevate blood pressure in order to maintain blood flow to the vital organs, the heart and brain. Of course, that shunts blood away from the ‘non-vital’ organs such as lungs, kidneys, gastrointestinal tract, and skin.”

“Obviously Julie, the patient, who has a whole-body outlook, takes a dim view of the so-called ‘non-vital’ organs’ losing their blood supply and shutting down. It’s evident that without major assistance from skilled health care, the patient will expire.”

“I hate to leave the patient in such a precarious situation, but we won’t talk about the role of health care in sepsis until next week. Until then, Curmudge, please hold your breath.”

Affinity’s Kaizen Curmudgeon