![]() Septic shock can compromise hepatic blood flow and metabolism. Differential diagnosis of fever is probably one of the most challenging. Drowsiness: The patient cannot be easily aroused by touch or noise and cannot maintain. Definitions: Confusion: A behavioral state of reduced mental clarity, coherence, comprehension, and reasoning. While symptoms usually develop during the first two Evaluation of stupor and coma in children unresponsiveness,' is the most profound degree to which arousal and consciousness are impaired. Dysfunction in either the reticular activating system in the upper brainstem or a large area of 1 or both cerebral hemispheres. Sepsis can originate from hepatic or peri-hepatic infections.Ĭomorbid hepatic disease can affect drug metabolism. Keywords: Altered Mental Status Fever Meningitis Listeria monocytogenes. It is characterized by fever, rigidity, and altered mental status (eg, agitated delirium, confusion, mutism, or catatonia). May show elevated bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma glutamyl transpeptidase More Serum electrolytes may be deranged blood urea may be elevatedĮlevated creatinine may occur in sepsis associated with renal dysfunction. Our case demonstrates the importance of maintaining a wide differential for altered mental status, especially after negative initial diagnostic work-up of more common aetiologies. WBC count is sensitive but not specific for the diagnosis of sepsis. Recent studies indicate that autoimmune encephalopathy and specifically Hashimoto's encephalitis is under-reported. Further investigations should be targeted based on the clinical presentation, in order to narrow down the differential diagnosis. WBC count >12×10⁹/L (12,000/microlitre) (leukocytosis) WBC count 10% immature forms low platelets More May be elevated levels >2 mmol/L (>18 mg/dL) associated with adverse prognosis even worse prognosis with levels >4 mmol/L (>36 mg/dL) elevated MoreĮlevated serum lactate indicates tissue hypoperfusion, and is most reliably assessed using an arterial sample. Other cultures (e.g., sputum, stool, and urine) should be taken as clinically indicated. Blood cultures should be taken immediately, and preferably before antibiotics are started, provided their sampling will not delay administration of antibiotics.
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