From the Guidelines
Sepsis criteria for a 10-year-old girl weighing 88 lbs and measuring 4 ft 6 in should be suspected if she has a documented or suspected infection plus one or more of the following signs: fever (>38.3°C), hypothermia (core temperature <36°C), heart rate >90/min or >2 SD above normal value for age, tachypnea, altered mental status, significant edema or positive fluid balance (>20 mL/kg over 24 hrs), hyperglycemia (plasma glucose >140 mg/dL or 7.7 mmol/L), leukocytosis (WBC count >12 x103/μL), or other indicators of organ dysfunction as outlined in the diagnostic criteria for sepsis 1.
Key Indicators
- Fever (>38.3°C) or hypothermia (core temperature <36°C)
- Heart rate >90/min or >2 SD above normal value for age
- Tachypnea
- Altered mental status
- Significant edema or positive fluid balance (>20 mL/kg over 24 hrs)
- Hyperglycemia (plasma glucose >140 mg/dL or 7.7 mmol/L)
- Leukocytosis (WBC count >12 x103/μL)
Additional Concerning Signs
- Altered mental status
- Prolonged capillary refill (>2 seconds)
- Mottled skin
- Decreased urine output (<0.5 mL/kg/hour)
- Hypotension (systolic blood pressure <90 mmHg)
- Elevated lactate (>1 mmol/L)
Management
Immediate management includes obtaining blood cultures, administering broad-spectrum antibiotics within one hour, providing fluid resuscitation with 20 mL/kg of isotonic crystalloid, and monitoring for signs of shock, as outlined in the Surviving Sepsis Campaign guidelines 1. Early recognition and intervention are critical as children can compensate for longer periods before rapid decompensation, making sepsis recognition challenging but essential for preventing progression to septic shock and multi-organ dysfunction.
From the Research
Sepsis Criteria
To determine the sepsis criteria for a 10-year-old girl, 88 lbs, 4 ft 6 in, we need to consider the general guidelines for sepsis diagnosis and management.
- The definition of sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection 2.
- Septic shock is defined as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality 2.
- The measurement of serum lactate has been incorporated into the latest septic shock definition 2.
- The Sequential Organ Failure Assessment (original and quick versions) is an important tool for early diagnosis 2.
Diagnostic Criteria
The diagnostic criteria for sepsis include:
- Respiratory rate greater than or equal to 22 breaths per minute
- White blood cell count (WBC) greater than or equal to 12,000 cells/mm^3 or less than or equal to 4,000 cells/mm^3
- Blood culture positive for a pathogen
- Presence of systemic inflammatory response syndrome (SIRS) criteria, such as fever, tachycardia, or tachypnea
- Organ dysfunction, such as acute kidney injury, acute respiratory distress syndrome, or cardiac dysfunction
Management
The management of sepsis includes:
- Fluid resuscitation with intravenous crystalloid at 30 mL per kg within the first three hours 2
- Antimicrobial therapy initiated early, ideally within one hour of presentation 2
- Vasopressor therapy indicated if hypotension persists despite fluid administration 2
- Consideration of steroids, such as hydrocortisone and fludrocortisone, in patients with refractory septic shock 3
Specific Considerations for Pediatric Patients
For pediatric patients, such as the 10-year-old girl in question, it is essential to consider their unique physiological characteristics and developmental stage when applying these criteria.
- Pediatric patients may have different normal values for vital signs, such as heart rate and respiratory rate, compared to adults.
- The diagnosis and management of sepsis in pediatric patients should be tailored to their individual needs and circumstances.
Note: There are no specific studies provided that directly address the sepsis criteria for a 10-year-old girl, 88 lbs, 4 ft 6 in. The information provided is based on general guidelines for sepsis diagnosis and management 3, 4, 5, 6, 2.