Sepsis (blood poisoning)

Sepsis is not a disease in its own right but a complication: it is the body's response to an infection when the defensive reaction runs out of control and starts damaging its own tissues and organs. It can start from anything at all — from pneumonia, from a urine infection, from flu, from a scratch that has become infected, from a tooth, from a surgical wound. It leaves no time for deliberation and the first hours decide everything, which is why the signs that mean calling an ambulance immediately come first on this page.

In an adult, call an ambulance at once if any of these appear

• confusion, slurred speech or talking nonsense, not knowing where they are, unusual drowsiness or being hard to rouse;
• severe breathlessness or very fast breathing, a feeling of not getting enough air, difficulty speaking in full sentences;
• violent shivering or severe muscle pain, like a bad bout of flu but sharper;
• no urine for around half a day: none passed all day, or far less than usual;
• mottled, blotchy, pale, grey or bluish skin, with blue lips and tongue; on brown or black skin this shows up better on the palms, the soles, the lips, the tongue and the inside of the eyelids;
• a feeling that you are dying or that something is very seriously wrong — that feeling deserves to be believed;
• a rash that does not fade when a glass is pressed against it;
• severe pain or swelling around a wound, a cut, a bite or a surgical stitch line.

An ambulance is called on the single European number 112, which works in Spain, Italy, Portugal, Poland and Ukraine; your own country may also have its own emergency number, so it is worth knowing it in advance. Do not drive yourself: with sepsis you can lose consciousness on the way.

In a child, the same urgency but different signs

• very fast breathing, grunting on breathing out, the skin sucking in between and under the ribs, flaring nostrils;
• a fit or convulsion;
• a rash that does not fade when a glass is pressed against it, the same as in meningococcal infection;
• floppiness: the child is limp, not responding as they usually do, impossible to wake, or not focusing their eyes;
• unusually cold hands and feet while the body feels hot, with mottled or greyish skin;
• in a baby, refusing feeds, repeated vomiting, a weak, unusually high-pitched cry, a bulging or tense soft spot on the head, or a dry nappy for around half a day.

Do not wait for several signs to gather: one is enough. And the fact that a doctor saw them recently is no reassurance — sepsis unfolds over hours, and a child who in the evening "just had a temperature" can be seriously ill by night. If they seem worse to you than in any illness they have had before, seek help again.

Say the word "sepsis" out loud

It sounds odd, but it works. When you ring for an ambulance or arrive at the emergency department, say it plainly: "I think this could be sepsis", and explain why: there was an infection, and now there is confusion, breathlessness, shivering, no urine. That sentence moves you out of the queue of people with a fever and into a different sequence: sepsis is looked for using a defined protocol, and naming it noticeably speeds up the examination, the tests and the start of treatment.

Say as well if the person is in a higher-risk group: recent surgery, chemotherapy, a spleen that has been removed, diabetes, or childbirth or the end of a pregnancy within the last six weeks. Take the list of their medicines with you.

If you have been assessed and sent home and things then get worse, go back or call an ambulance again. A first assessment does not cancel out a second one, and insisting here is entirely appropriate.

Why sepsis is missed so often

The main trap is that it looks like an ordinary infection: temperature, exhaustion, aching. There is no single sign that identifies it. But there are a few things worth knowing in advance.

There may be no fever at all. In sepsis the temperature can be high, but it can equally be normal or low, with the person cold to the touch. In someone who is seriously ill, a low temperature is more worrying than a high one, not less.

In an older person, confusion is often the only sign. They suddenly stop recognising their surroundings, muddle their words, become drowsy or, conversely, agitated, and stop getting up. Relatives put it down to age or to "the dementia getting worse", while behind it sits a urine infection or a pneumonia that has already tipped into sepsis. A sharp change in an older person's behaviour over hours or a day is a symptom, not a personality.

Sepsis is not catching. The infection that set it off may be, but sepsis itself does not pass from one person to another. And the old name "blood poisoning" is misleading: what matters is not that germs reached the blood but how the body answered them.

Sepsis is hardest of all to recognise in babies and young children, in people with dementia, in people with a learning disability and generally in anyone who cannot describe what they feel. There you go by behaviour: stopped eating, stopped responding, not themselves.

Who is at higher risk

Sepsis can develop in anyone with any infection, including the young and fit. But some people are affected more often:

• babies in their first year, especially those born prematurely;
• older people, particularly if frail and not very mobile;
• people with diabetes or long-term kidney, liver or lung disease;
• people with weakened immunity: on chemotherapy, on medicines that suppress the immune system, after a transplant, or living with HIV;
• people without a spleen or with a spleen that does not work properly, including those with sickle cell disease;
• people who have had recent surgery, or who have catheters, drains or venous lines;
• women during pregnancy and in the first weeks after giving birth, a miscarriage or a termination;
• people with extensive burns or large wounds, and people who inject drugs.

If you or someone close to you is on this list, seek help sooner and mention the risk straight away. Sepsis cannot be prevented outright, but the chance of the infections it grows from can be reduced: keep vaccinations up to date, including the yearly flu vaccine and pneumococcal vaccination for those for whom it is advised, with timings set by your national schedule; clean, dress and watch any wounds; take prescribed antibiotics exactly as directed and finish the course; wash your hands, and do not put off seeing a doctor if an infection is not settling or keeps coming back.

What happens in hospital

Sepsis is treated only in hospital, and treatment starts before all the results are back, because waiting for confirmation costs too much. In the first hours blood is usually taken for cultures and for tests showing how the organs are working, the source of the infection is looked for, fluids are given through a drip along with oxygen and an intravenous broad-spectrum antibiotic, and urine output is monitored. The antibiotic is given as early as possible: with suspected sepsis the count is in hours, and if blood pressure drops, in minutes.

After that, treatment depends on the response. Once the cultures allow it, the antibiotic is narrowed to one that targets the organism found. If the infection sits in a focus that can be removed — an abscess, an inflamed gallbladder, an infected line — that focus is opened, drained or taken out, and without this the drugs often will not work.

If blood pressure cannot be maintained, this is septic shock: it calls for intensive care, medicines to support the circulation and sometimes a ventilator and temporary dialysis. A hospital stay can run from a few days to several weeks.

After discharge: recovery is slower than people expect

Most people recover fully from sepsis, but it usually takes months, which surprises patients and their families alike. The cluster of after-effects is known as post-sepsis syndrome, and includes:

• heavy fatigue and muscle weakness, breathlessness on ordinary exertion;
• poor sleep, nightmares, intrusive memories of the hospital;
• trouble with memory, concentration and finding words;
• low mood, anxiety, irritability and sometimes post-traumatic stress disorder;
• loss of appetite, weight loss, hair falling out, brittle nails;
• more frequent infections during the first months.

What helps: building activity back gradually rather than competing with the person you were; eating little and often; agreeing lighter hours at work; protecting your sleep; and not keeping anxiety and low mood to yourself but telling a doctor about them, because they are as much a part of the after-effects as weak legs. It is also worth remembering that for a while after sepsis the risk of another serious infection is higher, so at the first signs of a new infection it is better to seek advice earlier than you otherwise would.

Online consultation

Sepsis itself is not treated online: suspected sepsis needs an ambulance and a hospital, and no remote appointment replaces that. But an Oladoctor doctor has plenty to offer around it. You can work out whether it is time to call an ambulance when you or someone close to you has a lingering infection and their condition is changing; understand why an infection is not settling on antibiotics and what to do next; go over how to care for a wound or a surgical stitch line and which changes in it are worrying; and check which vaccinations make sense if you are in a risk group. And separately, support after discharge: going through the discharge summary, planning the return to work and activity, and dealing with insomnia, anxiety and fatigue. If your description shows the doctor that urgent care is needed, you will be told immediately and before anything else.

This material is for information only and does not replace medical advice.