Recognizing the Early Signs of Sepsis

Early signs of sepsis may include severe pain, shortness of breath, and mental confusion. Sepsis starts with an infection in any part of the body and spreads through the blood. When this happens, your immune system launches a severe inflammatory response that can affect every system in your body.

Untreated sepsis can progress to septic shock, a potentially fatal complication that causes low blood pressure and multi-organ failure. Sepsis can develop quickly from initial infection to septic shock and even death in as little as 12 hours.

Early Signs of Sepsis

Sepsis is a life-threatening immune response to an infection that has entered your bloodstream. Early recognition and quick treatment are key to surviving sepsis.

The signs and symptoms of early sepsis can also occur in other conditions and infections, making it difficult to identify in the early stages. It is important to call your healthcare provider if you have an infection that is not getting better with treatment, or if you suddenly develop fever or other symptoms, as sepsis can progress and become very dangerous very quickly.

According to the Sepsis Alliance, the early symptoms in adults can be remembered with the acronym TIME:

• Temperature (either higher or lower than normal)
• Infection (especially a bacterial infection that is not treated and spreads)
• Mental decline (meaning sudden changes, confusion, sleepiness)
• Extremely ill (shortness of breath, severe pain, or discomfort)

When you are sick with an infection, it can be hard to tell if you are starting to feel worse. Generally, people who develop sepsis will start feeling more tired or confused and may have shaking or chills.

Others may not know they have an infection but should note symptoms if they've been exposed to someone who is ill or has recently had surgery, an invasive medical procedure, or a wound that breaks the skin.

Sepsis Stages

An infection in the bloodstream and the body's inflammatory response to that can quickly progress in severity, but, in general, sepsis severity is often categorized in three stages:

• Sepsis: This is the initial extreme inflammatory response to infection with symptoms that can include fever, mental decline, and extreme illness.
• Severe sepsis: Sepsis becomes severe sepsis when there are signs of organ dysfunction. This might include difficulty breathing, difficulty urinating, and changes in mental status.
• Septic shock: Severe sepsis becomes septic shock when the blood pressure drops too low. This may be accompanied by organ failure, rapid pulse and breathing, dizziness, and possibly death.

It can be hard to pinpoint exactly when an infection moves into the bloodstream, but when it does, quick recognition and treatment are critical to avoiding septic shock.

Symptoms

Sepsis can share signs and symptoms (like fever) with other types of infections. However, in sepsis, the symptoms will get more pronounced when the infection enters your bloodstream.

Your symptoms may have been limited to one area of your body during the initial infection, but the symptoms of sepsis are felt throughout your entire body (systemic). Early signs of sepsis may include a change in mental status and very fast breathing.

Common signs of sepsis include:

• Fever or low body temperature (hypothermia)
• Shortness of breath
• Shivering or chills
• Severe pain or discomfort
• Confusion or delirium
• Lightheadedness due to low blood pressure
• Rapid heartbeat
• Skin rash or mottled skin
• Warm skin
• Clammy or sweaty skin
• Nausea and vomiting
• Diarrhea
• Rash
• Decreased urination

In Children and Newborns

Children, especially newborns, may experience additional and different early symptoms, which include:

• Blueish discoloration of the skin
• A rash that does not fade upon pressing it
• Convulsions
• Rapid breathing
• Vomiting
• Changes in eating
• Jaundice
• Low blood sugar
• Inability to urinate

These signs require immediate emergency attention, as neonatal sepsis (which can occur within the first 90 days of life) is a leading cause of infant death.

Septic Shock

Sepsis can get worse quickly and requires intensive treatments to control. Signs of severe sepsis or septic shock include:

• Low blood pressure, especially when standing
• Trouble breathing, such as shortness of breath
• Confusion or disorientation
• High or very low temperature, chills
• Lightheadedness
• Racing heart
• Decreased urination
• Restlessness or agitation
• Fatigue or lethargy
• Cool, pale skin
• Skin rash or discoloration

Causes

Sepsis is caused by the body's overactive inflammatory response to an infection that can eventually lead to organ failure or tissue damage.

The infection often originates as a bacterial infection somewhere in the body (such as a urinary tract infection, pneumonia, or a wound). It can also be caused by a viral infection (such as the flu or COVID-19) or a fungal infection.

Risk Factors

All types of infections can lead to sepsis, but there are certain risk factors that can increase your risk of developing it. For example, people who are very young (less than 12 months) and older adults are at particularly high-risk for developing sepsis. Other sepsis risk factors include:

• Diabetes
• Urinary diseases
• Intestinal diseases
• Immune system diseases
• Urinary catheter use
• Intravenous lines
• Leukemia
• Lymphoma
• Long-term antibiotic use
• Recent infection
• Recent surgery
• Use of steroid medications
• Organ or bone marrow transplants

When to See a Healthcare Provider

It's important to see your healthcare provider if you are ill and not improving.

Your provider may want to do blood tests to look for evidence of sepsis, including blood cultures to identify a specific infectious organism. However, studies have shown that in about a quarter to one-third of people hospitalized with sepsis or septic shock, the source of infection is never conclusively identified.

Treatment

Sepsis treatment usually requires hospitalization and the administration of intravenous (IV) antibiotics as quickly as possible.

Sepsis cannot be treated with home remedies. It is considered a medical emergency and requires specialized medical treatment in a hospital. Delaying treatment could lead to serious complications or even death.

You will be monitored for progression into septic shock. If this happens, you will need additional treatments to fight the infection and keep blood flowing to all of your organs.

As sepsis spreads through the body, your blood vessels widen to deliver more immune cells to all your tissues. However, this widening (dilation) of the blood vessels is also what causes your blood pressure to drop and blood flow to other parts of the body to decrease.

If this happens, your medical team will work to maintain adequate blood pressure and supply throughout your body while the infection is treated. Treatments used in septic shock may include:

• Oxygen to help with breathing
• Intravenous (IV) fluids
• Mechanical ventilation if there is lung failure
• Vasopressor medications to maintain your blood pressure
• Sedatives
• Blood thinners to prevent clotting
• Dialysis if there is kidney failure

If you are being treated for septic shock, expect to be admitted to an intensive care unit (ICU) for at least several days.

Outlook

More than 1.7 million Americans get sepsis each year, and about 350,000 people in the United States die from sepsis annually.

Sepsis must be treated quickly to avoid developing septic shock. Early sepsis is usually treated with antibiotics and IV fluids.

Once sepsis progresses, it has a high rate of severe complications and death, especially for those with a weakened immune system or a chronic illness. Of those who survive, up to 50% suffer from post-sepsis syndrome, which may include a combination of physical and psychological symptoms.

Summary

Sepsis is a serious condition that can develop from any infection. Sepsis is a progression of an infection that can quickly turn into septic shock or even lead to death. Recognizing the signs of sepsis early and getting treatment immediately is essential to improving your outcomes and helping you recover.

Follow your healthcare provider's recommended treatment plan, and seek additional care if the infection worsens or does not improve with treatment.