From the Guidelines
Cold sepsis, also known as hypothermic sepsis, is a life-threatening condition that requires immediate medical attention, characterized by signs and symptoms including abnormally low body temperature, confusion or altered mental status, extreme weakness, difficulty breathing, rapid heart rate despite the low temperature, low blood pressure, decreased urine output, pale or mottled skin, and cold extremities, as outlined in the diagnostic criteria for sepsis 1.
Key Signs and Symptoms
The key signs and symptoms of cold sepsis include:
- Abnormally low body temperature (below 36°C or 96.8°F)
- Confusion or altered mental status
- Extreme weakness
- Difficulty breathing
- Rapid heart rate despite the low temperature
- Low blood pressure
- Decreased urine output
- Pale or mottled skin
- Cold extremities
- Shivering
- Slurred speech
- Drowsiness These signs and symptoms are critical to recognize, as cold sepsis is associated with worse outcomes than fever, and prompt medical attention is essential to prevent progression to septic shock and organ failure.
Diagnostic Criteria
The diagnostic criteria for sepsis, as outlined in the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 1, include:
- Infection, documented or suspected, and some of the following:
- General variables: fever (>38.3°C), hypothermia (core temperature <36°C), heart rate >90/min or more than two SD above the normal value for age, tachypnea, altered mental status, significant edema or positive fluid balance (>20 mL/kg over 24 h), hyperglycemia (plasma glucose >140 mg/dL or 7.7 mmol/L) in the absence of diabetes
- Inflammatory variables: leukocytosis (WBC count >12,000/μL), leukopenia (WBC count <4,000/μL), normal WBC count with greater than 10% immature forms, plasma C-reactive protein more than two SD above the normal value, plasma procalcitonin more than two SD above the normal value
- Hemodynamic variables: arterial hypotension (SBP <90 mmHg, MAP <70 mmHg, or an SBP decrease >40 mmHg in adults or less than two SD below normal for age)
- Organ dysfunction variables: arterial hypoxemia (PaO2/FiO2 <300), acute oliguria (urine output <0.5 mL/kg/h for at least 2 h despite adequate fluid resuscitation), creatinine increase >0.5 mg/dL or 44.2 μmol/L, coagulation abnormalities (INR >1.5 or aPTT)
- Tissue perfusion variables: hyperlactatemia (>1 mmol/L), decreased capillary refill or mottling
Management
If cold sepsis is suspected, immediate medical attention is crucial, and management should include:
- Prompt antibiotic therapy
- Fluid resuscitation
- Supportive care to prevent progression to septic shock and organ failure It is essential to recognize the signs and symptoms of cold sepsis and to provide prompt and effective management to improve outcomes and reduce morbidity and mortality.
From the Research
Signs and Symptoms of Sepsis
- The signs and symptoms of sepsis are not explicitly listed in the provided studies, but it is mentioned that sepsis is a medical emergency and life-threatening condition due to a dysregulated host response to infection 2.
- Sepsis can be caused by various pathogens, including gram-negative and gram-positive bacteria, as well as fungal and viral pathogens 3.
- The most common sites of infection are the lung, abdomen, catheter-associated bloodstream, and urinary tract 3.
Diagnosis and Treatment of Sepsis
- Early diagnosis and treatment of sepsis are crucial to reduce mortality, and broad-spectrum antibiotics should be administered as soon as possible, ideally within the first hour of diagnosis 3, 2, 4.
- The choice of antibiotics should be based on the likely pathogens involved and should be reevaluated daily to optimize efficacy and prevent resistance 2, 4.
- De-escalation of antibiotics should be considered after 3 to 5 days, and the duration of antibiotic therapy is typically limited to 7 to 10 days 4.
Cold Sepsis
- There is no specific information on "cold sepsis" in the provided studies, and it is not clear what is meant by this term.
- Sepsis is typically characterized by fever, tachycardia, and other signs of inflammation, but it is possible that "cold sepsis" refers to a specific subtype or presentation of sepsis that is not well-represented in the provided studies.