Case history

Case history

A 78-year-old woman presents to hospital for an elective right hemicolectomy. She has a past medical history of hypertension, angina on exertion, and diabetes mellitus. She is independently mobile, does her own shopping, and has a 30-pack-a-year history of smoking. The operation was uncomplicated. On day 5 post-surgery, she becomes confused. On examination, she has a Glasgow Coma Scale score of 14/15. She has a temperature of 38.5°C (101.3°F), a respiratory rate of 28 breaths/minute, and oxygen saturations of 92% on 2 L of oxygen per minute. She is tachycardic at 118 beats per minute, and her blood pressure is 110/65 mmHg. On chest auscultation, she has coarse crackles in the right lower zone. Her surgical wound appears to be healing well and her abdomen is soft and not tender.

Other presentations

Sepsis may complicate benign primary infections found in any age group and requires a high suspicion for the clinical signs of systemic inflammatory response (tachycardia, fever, tachypnoea, or respiratory compromise).

Altered mental status may also be a presenting feature, especially in older patients. Mild disorientation or confusion is common with more severe presentations, including significant anxiety, agitation, and loss of consciousness.

Other features that may be present include reduced urine output; a mottled or ashen appearance; cyanosis of skin, lips, or tongue; or presence of a non-blanching rash on the skin.[3]

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