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1. Discuss about E. Coli and try to relate with sepsis and site of surgery of the pt.

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1. Discuss about E. Coli and try to relate with sepsis and site of surgery of the pt.

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Escherichia coli also known as  E. Coli.

Normal flora in the intestines mostly in the bowel, harmless and helps keep our GIT healthy. Yet some strains can cause diarrhea in contaminated food and water.

Causative agents for 75-95% of UTI due close proximity from its normal flora region. May be associated with the patient’s past history of hernia repair surgery.

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Gram negative bacilli.

A lactose fermenter.

Small circular isolated colonies

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Risk factors of E. Coli infection : Young and old age, weakened immune system, low stomach acid levels, abdominal cramping, sudden, severe watery diarrhea that may change to bloody stools, loss of appetite or nausea and vomiting (uncommon), fatigue, fever.

Most common cause of pyelonephritis that complicates urosepsis. Urosepsis implies clinically evident severe infection of the urinary tract and/or the male genital tract with features consistent with systemic inflammatory response syndrome(SIRS). It may be associated with multi-organ dysfunction, hypo-perfusion or hypo-tension.

Also due to the nature of E. Coli being a gram negative microorganism, it induces the release of cellular cytokines by macrophages after it has been engulfed. These proinflammatory cytokines will then cause inflammation and hypotension with  subsequent organ hypoperfusion. High grade fever and organ dysfunctions occurs and give high risk of death.

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1. Anatomy of kidney - Brief anatomy of kidney & relate to the patient in the case.    

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1. Anatomy of kidney - Brief anatomy of kidney & relate to the patient in the case.    

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1. Discuss the basic functions and role of kidney and clinically relate it with patient in the case.                

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1. Discuss the basic functions and role of kidney and clinically relate it with patient in the case.                

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- Kidneys are paired, reddish brown in colour and bean-shaped organs. -They are retroperitoneal organs and the right kidney is slightly lower and smaller than the left because of the presence of the liver. -The function of the kidney is to regulate blood volume and composition, help regulate blood pressure and pH, produce hormones and excrete waste.

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- Kidneys are paired, reddish brown in colour and bean-shaped organs. -They are retroperitoneal organs and the right kidney is slightly lower and smaller than the left because of the presence of the liver. -The function of the kidney is to regulate blood volume and composition, help regulate blood pressure and pH, produce hormones and excrete waste.

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1. Regulations of body fluids and electrolyte balance

2. Regulations of fluid osmolarity and electrolyte concentration

3. Regulation of blood pressure (RAAS system)

4. Secretion, metabolism and excretion of hormones and enzymes

5. Regulation of acid-base balance

6. Elimination of waste product

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1. Lab test 1,2,3 - Define, interpret and relate each test results with the pt condition during the admission.                                  

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1. Lab test 1,2,3 - Define, interpret and relate each test results with the pt condition during the admission.                                  

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to refer

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PART 2: Clinically related it with case 

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PART 2: Clinically related it with case 

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Back to renal autoregulation, renal failure can disturb renal autoregulation

Renal autoregulation as general is that when increases blood pressure, the afferent arteriole constrict while efferent arteriole dilate and vice versa.

Renal autoregulation have 2 mechanisms which are myogenic reflex and tubuloglomerular feedback

Myogenic reflex will modulate the opening of afferent and efferent arterioles, to control the pressure in the glomerulus via vasoconstriction/vasodilation of the arterioles. Arteriolar vascular smooth muscle contracts inherently in response to the stretch accompanying increased pressure within the vessel. It cannot compensate for extreme blood pressure.

Meanwhile, tubuloglomerular feedback acts in concert with the myogenic reflex and involves the juxtaglomerular apparatus. Macula densa detects in [NaCl] of the tubular fluid and contributes to the subsequent adjustment of the diameter of the afferent/efferent accordingly.

The patient has kidney failure, the autoregulation totally does not function well.

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PART 1: Clinically related it with case 

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PART 1: Clinically related it with case 

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The bacteria that cause inflammation or damage to the kidney tubules, to the small blood vessels in the kidneys, or to the filtering units in the kidneys.

Diabetes mellitus and hypertension also contribute to acute kidney injury.

It may lead to poor perfusion of nephrons, which in turn leads to a decrease in the GFR. Fundamentally, it is related to an imbalance in the delivery of nutrition and oxygen to the nephrons during periods of increased energy demand. Therefore, any process that affects the systemic circulation or decreases renal perfusion can compromise the GFR

In a healthy individual, autoregulatory functions are in place, which helps to uphold the GFR.

Low GFR leads to low urine output.

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The patient still has persistent high blood pressure even though he took amlodipine medication that controls hypertension because the arteriole cannot constrict/contract well to regulate blood pressure.

One of the functions of the kidney is regulating blood pressure.

The kidney regulates the blood pressure via Renin- Angiotensin- Aldosterone system (RAAS), if RAAS system disrupts normal renal blood flow and glomerular filtration rate (GFR).

Regarding RAAS system, because the patient also had diabetes mellitus worsen the kidney vascular and eventually lead to glomerular hyperfiltration which will activate RAAS and lead to hypertension.

Increased glomerular hyperfiltration leads to proteinuria that indicates inflammation of the kidney.

Disrupted RAAS system and GFR also lead to imbalance in osmolarity in the kidney.

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Definition: It is a test to assess the adequacy of ventilation, oxygenation, and the acid-base status of the body by measuring the levels of pH, oxygen, carbon dioxide, and bicarbonate in arterial blood. The levels of pH and bicarbonate assist in the diagnosis of renal and other metabolic conditions.

Interpretation

o   pH- LOW (acidosis)

o   PaCO2- LOW (repiratory alkalosis)

o   HCO3- LOW (metabolic acidosis)

o   Base excess- LOW (metabolic acidosis)

o   PaO2- NORMAL

o   O2 saturation – NORMAL

Relation with pt condition

o   Pt have metabolic acidosis as both pH and bicarbonate level is low.

o   Main causes of metabolic acidosis are acute kidney injury and CKD.

o   Metabolic acidosis is characterized by primary reduction in serum concentration of bicarbonate, a secondary decrease in arterial partial pressure of CO2 (PaCO2) and a reduction on blood pH

o   it occurs when either an increase in production of nonvolatile acids/loss of bicarbonate from body overwhelms the mechanisms of acid-base homeostasis/when renal acidification meachanisms are compromised.

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The Effect of Electrolytes on Blood Pressure

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The Effect of Electrolytes on Blood Pressure

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Excess sodium intake in daily diets could disturb the regulation of blood pressure.

It could be associates with increase in systolic and diastolic blood pressure.

Sodium is almost contained in everything food such as from chips and bread to even some medicine. When the patient eat too much sodium, thekidneys have the job of clearing it from the body. But if the kidneys are damaged, the organs can’t remove sodium efficiently.

Reduction of potassium intake or supplementation has also been repeatedly shown to increase the blood pressure of especially hypertensive persons.

In addition, the WHO recommends that sodium consumption should be less than 2000 mg (5 g of salt) and potassium intake at least 3510 mg for adults per day.

This reflects the significant importance of healthy nutrition, in this case salt reduction and increase of dietary potassium intake, on blood pressure.

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Definition: A blood test which mesures a large number of blood parameters, most notably the Haemoglobin (blood count), white cell count (WCC) and Platelet count.

Interpetration:

o   WBC- HIGH (infection/immune reponse)

o   Hb- LOW (Anaemia)

o   Haematocrit- LOW (low RBC)

o   Platelet- LOW (thrombocytopenia)

Relation with pt condition

o   Acute kidney injury describes as a syndrome by rapid decline in the ability of the kidney to eliminate waste products, regulate acid-base balance, and manage water homeostasis. When this impairment is prolonged and entered chronic phase, erythropoietin secretion by this organ is decreasing and toxic metabolic accumulates and causes hematological changes include decrease of HCT, MCV and RBC and platelet counts

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Definition: a screening test for abnormal blood clotting because it examines the factors most often associated with a bleeding problem. It does not cover all causes of bleeding tendencies.

Interpetration:

o   aPTT- HIGH (an abnormality of the intrinsic and final common coagulation pathway)

o   INR- HIGH (blood coagulates too slowly cause high risk of bleeding)

Relation with pt condition

o   Research demonstrated that patients with acute kidney injury can also suffer from coagulation system disorders due to uraemia or anticoagulation during renal replacement therapy.

o   The results revealed that patients with AKI showed endothelial dysfunctions and elevated coagulation.

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2. Define suprapubic region and its related anatomical structures. 

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2. Define suprapubic region and its related anatomical structures. 

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2. Relate with the CBD catheter and central catheter.

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2. Relate with the CBD catheter and central catheter.

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2. Lab test 4,5,6,7,8,9 - define, interpret and relate each test results with the pt condition.( Post-Operative Acute Kidney Injury (Renal Failure) 

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2. Lab test 4,5,6,7,8,9 - define, interpret and relate each test results with the pt condition.( Post-Operative Acute Kidney Injury (Renal Failure) 

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2. Compare & contrast between urine sample and blood sample and conclude the test in relation with the pt.

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2. Compare & contrast between urine sample and blood sample and conclude the test in relation with the pt.

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The results from urine and blood samples are the same. Resistant to ampicillin, cefazolin, cefepime, cefuroxime, tetracycline. And sensitive to amoxicillin/ clavulanic acid, ertapenem, gentamicin That means there is a presence of bacteria in the blood which is called bacteremia. How can this happen? E.coli can get from the complication of previous surgery, maybe from the surgery instruments itself. The bacteria gets into the blood and goes around the body. From his chief complaint, he experienced nausea, vomiting, suprapubic pain and inability to urinate which indicate that the bacteria already actively attack the upper part of the urinary tract. This can lead to acute kidney infection. The bacteria actively multiply.

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3. Sepsis                                    - Define sepsis and discuss briefly with relation to the patient's past surgery history.                                      - Relate gram -ve E. Coli.       - Relate with the chosen iv ceftriaxone treatment.

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3. Sepsis                                    - Define sepsis and discuss briefly with relation to the patient's past surgery history.                                      - Relate gram -ve E. Coli.       - Relate with the chosen iv ceftriaxone treatment.

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1. Define and clinically relate with patient about dysuria, nausea, vomiting, inability to urinate, distended & tender on palpation and all the vital signs.

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1. Define and clinically relate with patient about dysuria, nausea, vomiting, inability to urinate, distended & tender on palpation and all the vital signs.

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Here are the list of vital signs of the patient given in our case. Please use it as your references :)
1. Temperature: 39.5 degree Celcius
2. Heart rate: 125 bpm
3. Respiratory rate: 28 breath per min
4. BP: 140/95 mmHg
5. SPO2: 99%
6. Pain score: 8/10

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Dysuria: a symptom of pain, discomfort or burning when urinating

Nausea: sensation of an urge to vomit, can be acute or prolonged

Inability to urinate: urinary retention which means inability to completely or partially empty the bladder

Distended and tender on palpation: distension occurs when gas/fluid accumulates in the abdomen causing expansion = bloated

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Temperature (nl: 36.1-37.2): a physical quantity that expresses hot and cold. Pt has fever which indicates infection and inflammation

Heart rate (nl: 60-100 bpm): number of times heart beats per minute. Pt is tachycardic, can be caused by many arrhythmias

Respiratory rate (nl: 12-16 breaths per min):  number of breaths per minute. Pt is having tachypnea

BP (nl: 120/80 mmHg): blood pressure against arterial's walls. Pt is hypertensive which mean persistent high blood pressure

SPO2 (nl: 95% - 100%): fraction of oxygen-saturated haemoglobin relative to total haemoglobin in blood. Pt has normal oxygen saturation, meaning he has normal blood oxygen levels.

Pain Score (0: no pain, 10: worst pain possible): Pt having severe pain (8/10) at suprapubic region

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2. Discuss and relate to the pt about Diabetes Mellitus, Hypertension & Acute Kidney Injury.

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2. Discuss and relate to the pt about Diabetes Mellitus, Hypertension & Acute Kidney Injury.

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1. Discuss briefly the ADME, MOA, indications, contraindications and side/adverse effect of Metformin, Amlodipine and IV Ceftriaxone.

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1. Discuss briefly the ADME, MOA, indications, contraindications and side/adverse effect of Metformin, Amlodipine and IV Ceftriaxone.

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-The anatomy of the abdominal area of the human body can be divided into nine regions including the suprapubic region, also called the hypogastric region.    -The hypogastrium (also called the hypogastric region or suprapubic region) is a region of the abdomen located below the umbilical region. The pubis bone constitutes its lower limit. The roots of the word hypogastrium mean ‘below the stomach’ while the roots of suprapubic mean ‘above the pubic bone’.

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-The anatomy of the abdominal area of the human body can be divided into nine regions including the suprapubic region, also called the hypogastric region.    -The hypogastrium (also called the hypogastric region or suprapubic region) is a region of the abdomen located below the umbilical region. The pubis bone constitutes its lower limit. The roots of the word hypogastrium mean ‘below the stomach’ while the roots of suprapubic mean ‘above the pubic bone’.

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Related anatomical structures of suprapubic region                                            

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Related anatomical structures of suprapubic region                                            

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Muscular Components

The rectus abdominis is a long, flat muscle extending from the sternum (breastbone) to the pubis. It helps support and compress the abdominal wall and aids in expelling breath and waste. It is intersected by a center vertical line and three horizontal lines of tendon. The lowest fibers of this muscle also help in leg movement by assisting in hip flexion and stabilizing the pelvis.

Blood Vessels

The primary artery in the pelvic area is the internal iliac artery or hypogastric artery. Its origin is from the common iliac artery which splits from the aortic artery just above the pelvis. The hypogastric artery moves down through the suprapubic region, splitting into anterior and posterior trunks. It supplies blood to the lower abdomen, hips, thighs and reproductive organs. The hypogastric artery lies behind the ureter and in front of the iliac vein.

Nerves

The nerves that serve the muscles and organs of the lower abdominal and pelvic regions begin at the superior hypogastric plexus in the lower abdomen where they split into the left and right hypogastric nerves. These nerves branch through the pelvic region and receive sensory input from the skin, muscles and organs of the lower abdomen. Branches of the hypogastric nerves provide input to these organs and muscles from the spinal column.

Organs

The suprapubic region holds the urinary bladder, the sigmoid colon and the upper female reproductive organs. The urinary bladder stores liquid waste as urine for elimination. The sigmoid colon connects the large intestine to the rectum and holds solid waste as feces in preparation for elimination.

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Bladder-inserted catheters promote(CBD) nosocomial urinary tract infection (UTI) by allowing direct inoculation of microrganisms into the bladder during their insertion or during post - placement manipulation of the catheter or its drainage system.

E. coli is most common microorganism that are associated with UTI.

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A central catheter is a type of catheter that is placed in a large vein that allows multiple IV fluids or medication to be given for medical treatment and blood to be drawn.

Since it is placed directed in a large vein, so it increase the risk of bloodstream infection or also can be known as catheter-related sepsis.

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A renal profile is a group of tests that may be performed together to evaluate kidney (renal) function. The tests measure levels of various substances, including several minerals, electrolytes, proteins, and glucose (sugar), in the blood to determine the current health of your kidneys.

so next, ill talk about it one by one. i start first with:
-Creatinine and BUN reading is high: means: Increased creatinine and BUN levels in the blood may mean that your kidneys are not working as they should. Your healthcare practitioner will consider other factors, such as your medical history and physical exam, to determine what, if any, condition may be affecting your kidneys.

-eGFR so low : When eGFR is very low, generally under 15 mL/min/1.73m2, it can be a sign of kidney failure or serious disease.

-K+ high: Potassium levels are typically interpreted along with results from other tests done at the same time, such as the results of other electrolyte tests. Low and high potassium levels can be caused by various conditions and diseases. Examples of conditions that can cause high potassium levels include: Kidney disease.

-Na+ high: Help evaluate and monitor a variety of chronic or acute illnesses involving the brain, lungs, liver, heart, kidney, thyroid, or adrenal glands.

-Cl- is high: An increased level of blood chloride (called hyperchloremia) usually indicates dehydration, but can also occur with other problems that cause high blood sodium, such as kidney diesease.

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Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood. Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease. Abnormal liver function test results don't always indicate liver disease.

All the reading is normal except for ALB reading slightly low: Low albumin levels can also be seen in inflammation, shock, and malnutrition. They may be seen with conditions in which the body does not properly absorb and digest protein.

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CRP reading is high. A CRP test measures the amount of CRP in the blood to detect inflammation due to acute conditions or to monitor the severity of disease in chronic conditions. CRP is a non-specific indicator of inflammation and one of the most sensitive acute phase reactants. A high or increasing amount of CRP in the blood suggests the presence of inflammation but will not identify its location or the cause.

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Procalcitonin reading is high. Procalcitonin is a substance produced by many types of cells in the body, often in response to bacterial infections but also in response to tissue injury. The test may occasionally be ordered when someone has tissue damage from trauma, surgery, the procalcitonin test may be ordered when a seriously ill person has symptom such as extreme pain or discomfort just like the patient did.

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Lactate is high A number of conditions can cause elevated lactate levels. They are separated into two groups according to the mechanism by which they cause lactic acidosis. there are two type of lactic acidosis which are, Type A and Type B (which for this patient case).

Type B lactic acidosis is not related to delivery of oxygen but reflects excess demand for oxygen or metabolic problems and common cause is kidney or liver disease..

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Urine Output (over 24-Hour in ED)  is so low : Low urine output, or no urine output, occurs in the setting of kidney failure and urinary obstruction. As the kidneys fail or are compromised in their ability to function, the kidneys lose the ability to regulate fluids and electrolytes and to remove waste products from the body.

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so i will briefly define sepsis, it is the presence of infection in association with systemic inflammatory response syndrome (SIRS)

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Relation of Diabetes Mellitus ,Hypertension & Acute Kidney Injury

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Relation of Diabetes Mellitus ,Hypertension & Acute Kidney Injury

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Diabetes Mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. The chronic hyperglycemia and attendant metabolic dysregulation may be associated with secondary damage in multiple organ systems, especially the: Kidneys, Eyes, Nerves and Blood vessels. The morbidity associated with longstanding diabetes is due to Damage induced in large- and medium-sized muscular arteries (diabetic macrovascular disease and in small vessels (diabetic microvascular disease) by chronic hyperglycemia. Once hyperglycemia becomes established, multiple pathophysiological disturbances, including hypertension, altered tubuloglomerular feedback, renal hypoxia, lipotoxicity, podocyte injury, inflammation, mitochondrial dysfunction, impaired autophagy, and increased activity of the sodium–hydrogen exchanger, contribute to progressive glomerular sclerosis and the decline in glomerular filtration rate. As the result, diabetes causes Tubular injury and Persistent and severe disturbances in blood flow. Hypertension is long-term medical condition in which the blood pressure in the arteries is persistently elevated. The nephrons in the kidneys are supplied with a dense network of blood vessels, and high volumes of blood flow through them. Over time, uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden. These damaged arteries are not able to deliver enough blood to the kidney tissue. Damaged kidney arteries do not filter blood well. Kidneys have small, finger-like nephrons that filter your blood. Each nephron receives its blood supply through tiny hair-like capillaries, the smallest of all blood vessels. When the arteries become damaged, the nephrons do not receive the essential oxygen and nutrients — and the kidneys lose their ability to filter blood and regulate the fluid, hormones, acids, and salts in the body.  Damaged kidneys also fail to regulate blood pressure. Healthy kidneys produce a hormone called aldosterone to help the body regulate blood pressure. Kidney damage and uncontrolled high blood pressure each contribute to a negative spiral. As more arteries become blocked and stop functioning, the kidneys eventually fail. As the result, hypertension causes Tubular injury and Persistent and severe disturbances in blood flow. Both Tubular injury and Persistent and severe disturbances in blood flow are pathogenesis of Acute Kidney Injury.

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role of endotoxins in gram negative sepsis

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role of endotoxins in gram negative sepsis

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as what fayyadh mentioned above, the most likely causative microorganisms associated with this is E.coli and we know that E.coli is a gram negative bacteria that is associated with endotoxins.

so what is actually the role of endotoxins ?

They are liberated when the bacteria die and the cell wall break apart

It mediates production of proinflammatory cytokines such as tumor necrosis factor (IL-1 and IL-6), which will mediate adhesion of polymorphonuclear leukocytes to the endothelium  with consequent capillary leak, coagulation and vasodilation

i want to also talk about the mechanism of the endotoxins itself which are:

Macrophage ingest gram negative bacterium (in this case e-coli)

The bacterium degraded in vacuole, releasing endotoxins that induce the macrophage to produce cytokines IL-1 and TNF-alpha

The cytokines are released into the bloodstream by the macrophages through which they travel to hypothalamus of brain

The cytokines induce the hypothalamus to produce prostaglandins which reset the body’s ‘thermostat’ to a higher temperature , this will lead to fever

so yea i hope you are all clear about this part :)

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Indication

Hypertension

Angina

Coronary Artery disease

Administration - orally
MoA

Inhibits transmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations → inhibits cardiac and vascular smooth muscle contraction → dilating main coronary and systemic arteries

Increases myocardial oxygen delivery in patients with vasospastic angina

Absorption
Bioavailability: 64-90%

Onset: 24-96 hr

Duration: 24 hr (antihypertensive effect)
Distribution -Bound to plasma protein 93-98%
Metabolism - Extensively metabolized in liver by Cytochrome P450 3A4/5 (CYP3A4/5)
Excretion - urine
Elimination Half-life: 30-50 hr
Contraindication - Dihydropyridine hypersensitivity (which can cause liver damage)
Adverse Effect

Headache

Edema

Flushing

Dizziness

Palpitation

Nausea

Male sexual dysfunction

Abdominal pain

Somnolence

Vomiting

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so last but not least of course i want to talk about the management of sepsis. so here are the guidelines in treating/controlling sepsis as it could lead to severe sepsis and also cause sepsis shock

Respiratory stabilization with supplemental oxygen

Iv fluid

Take blood cultures

Gives iv antibiotics

(in this case, the patient is given iv ceftriaxone)

- should be given after blood cultures is made
-this relates back to the insertion of catheters as it may also complicate to further infection (something to keep in mind)

Routine blood, lactate

Monitor urine output

that is all for my SLO ! :)

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Indication - Type 2 Diabetes Mellitus
Administration - oral (tablets, oral solution)
MoA
- Decreases hepatic glucose production
-Decreases GI glucose absorption -Increases target cell insulin sensitivity by increasing peripheral glucose uptake and utilization.

Absorption - Bioavailability: 50-60%
Distribution - Minimally bound to plasma protein
Metabolism - Not metabolized by liver
Excretion - By tubular secretion and excreted unchanged in the urine (90%)

Elimination half-life: 4 - 8.7 hrs
Contraindication

Hypersensitivity

chronic heart failure

metabolic acidosis with or without coma

diabetic ketoacidosis (DKA)

severe renal disease

abnormal creatinine clearance resulting from shock

Septicemia

myocardial infarction

lactation

Adverse Effect

Asthenia

Diarrhea

Flatulence

Weakness

Myalgia

Nausea/vomiting

Chest discomfort

Chills

Dizziness

Abdominal distention

Constipation

Heartburn

Dyspepsia

Low serum vitamin B-12

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Indications

Susceptible bacterial infections of the lower respiratory tract, skin and skin structure, bone and joint

acute otitis media

UTIs

Septicemia

pelvic inflammatory disease (PID),

intra-abdominal infections

Meningitis

uncomplicated gonorrhea.

Administration - IV, IM
MoA - inhibiting cell-wall synthesis by binding to 1 or more penicillin-binding proteins; exerts antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall); bacteria eventually lyse because activity of cell-wall autolytic enzymes continues while cell-wall assembly is arrested
Absorption - completely absorbed  intravenously & intramuscularly
Distribution - Distributed throughout body, including gallbladder, lungs, bone, bile, and CSF (higher concentrations achieved when meninges are inflamed); crosses placenta; enters amniotic fluid and breast milk
Metabolism - in liver
Excretion - Urine (33-67% as unchanged drug), feces

Elimination Half-life: 5-9 hr (normal hepatic and renal function); 12-16 hr (mild-to-severe renal impairment)

Contraindication

diarrhea from an infection with Clostridium difficile bacteria.

hemolytic anemia.

liver problems.

disease of the gallbladder.

severe renal impairment.

yellowing of the skin in a newborn child.

Adverse Effect

Eosinophilia

Thrombocytosis

Diarrhea

Increased blood urea nitrogen (BUN)

Elevated hepatic transaminases

Leukopenia

Rash

Pain

*however, since the e.coli is resistant to ceftriaxone..this IV ceftriaxone treatment will not be
effective to the patient

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there are many predisposing factors that could lead to sepsis. however, everyone is also at risk in developing sepsis.
here are the risk factors

Children younger than one or adult 65 year old and above

Patient with immunosuppressive drugs

People with weakened immune system

Patients with infections

Patients under attachment of foreign materials such as catheter

Post surgery patient

in this case, we discused that the the patient is most likely to develop sepsis from the surgery BUT what i have searched it is considered a rare complication of surgery and if it happens it may due to Infection of incision (opening of the skin). this is a life threatening disease as it cause multi organ failure.