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SEPSIS

JD Middleton
Nutrition Assessment
NUTR 642
OVERVIEW

• Body’s extreme response to an infection


• Caused from already present infection triggers response
throughout the whole body
• Symptoms include
• Confusion or disorientation
• High heart rate
• Fever, shivering, feeling very cold
• Extreme pain or discomfort
• Life threatening and needs to be treated FAST
NUTRITION SCREENING

• At risk populations
• Adults over 65
• People w/ chronic medical conditions (diabetes, lung disease, cancer,
kidney disease)
• People with weakened immune systems
• Children younger than 1
• Any infection can lead to sepsis
FOOD/NUTRITION RELATED HX

• Enteral nutrition should be started as early as possible to fix any


deficiencies and correct breakdown
• 1.5-2.0 g/kg/d PRO
• Total kcal as needed to prevent anymore breakdown
• Common medications used:
• Vancocin (can causes upset stomach)
• Zosyn (can cause diarrhea, constipation, and N/V)
• Levaquin (can cause nausea and diarrhea)
• IV fluids
ANTHROPOMETRIC MEASUREMENTS

• Hyperthermia (>101.0 °F)


• Hypothermia (<96.8 °F)
• Altered mental status
• Tachycardia (>90 bpm)
• Tachypnea (>20 bpm)
• Muscle wasting
BIOCHEMICAL DATA, MEDICAL
TESTS, AND PROCEDURES

• WBC count >12,000 µL-1 (Leukocytosis)


• WBC count < 4,000 µL-1 (Leukopenia)
• BG > 140 (hyperglycemia)
• Creatinine > 2.0 mg/dL
• Bilirubin >2 mg/dL
• Platelet count < 100,000 µL-1
• Lactate > 2.0 mmol/L
NUTRITION FOCUSED PHYSICAL
FINDINGS

• Organ failure is a big aspect of sepsis and needs to be closely


watched
• Respiratory: SaO2 <90%
• Cardiovascular: SBP < 90 mmHg OR < 40 mmHg baseline
• Renal: Output < 0.5 mL/kg/hr
• CNS: altered consciousness
• Glascow coma scale of < 12
• Hepatic: Bilirubin > 4 mg/dL
• Metabolic: Serum lactic acid > mEq/L
• Skin: Petichiae, inflammation, purpura, flushed
CLIENT HX

• Any new/new infection, illness, or recent surgery


• Hx of:
• Malignancy
• Bone marrow transplant
• Catheter
• Solid organ transplant
• Autism
• Immuno- deficiency/compomrised/compressed
COMPARATIVE STANDARDS

• Needs do not increase in early stages of sepsis (day 1-4)


• REE and TEE are lower during this time
• 15 kcal/kg/d and ~1 g/kg/d PRO
• Prevents LBM wasting, weakness, and infections
• Thiamine and vitamin D are often deficient during this time
• Nutrient needs increase during recovery phase (typically after day 4)
• 25-30 kcal/kg/d and 1.2-2.0 g/kg/d PRO
• Improves QoL, reduces further LBM breakdown, and encourages
recovery
• Adjust as needed per pt
NUTRITION DIAGNOSIS

• Common nutrition diagnoses of sepsis include:


• Hypermetabolism
• Inadequate oral food/beverage intake
• Inappropriate infusion of EN or TPN
• Inadequate fat intake
• Excessive CHO intake
NUTRITION INTERVENTION

• Start EN as early as possible (within 24-48 hours of admission)


• Start at low dosing and advance as tolerable
• Like stated in previous slides, energy needs not increase during early
stages
• Increase needs after first few days to increase recovery and prevent
further catabolism
• EN is preferred over PN
• Use PN only when digestive tract is not viable option
NUTRITION
MONITORING/EVALUATION

• Important to monitor and evaluate:


• Changes in organ or metabolic function
• New areas on infection
• Increased LBM wasting
• Weight changes
• Urine input/output
• Temperature
• Mental status
POTENTIAL ENTERAL PRODUCTS

• Opexa (EPA and GLA formulas) is the most common formula in


this population
• Fatty acids from fish and borage oil
• Help lower inflammation and reduces worsening sepsis
• Jevity 1.2 during the later stages
• High PRO for rebuilding LBM/stopping LBM wasting
• Good for long or short term
RESOURCES

• Abbott Laboratories. (2015). Clinical summary. Retrieved April 18, 2018 from
https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/CS%2081596%20Intersce
pt_tcm1226-57895.pd
• Birrel, B. (2013). Rapid identification of sepsis- The value of screening tools. Society of Critical Care
Medicine. Retrieved April 18, 2018 from
http://www.sccm.org/Communications/Critical-Connections/Archives/Pages/Rapid-Identification-of-Sepsi
s---The-Value-of-Screening-Tools.aspx
• CDC. (2018). Sepsis. CDC. Retrieved on April 18, 2018 from
https://www.cdc.gov/sepsis/basic/index.html
• Ibarakiken. (2006). Nutrition diagnosis terms and definitions. Retrieved April 20, 2018 from
http://www.ibarakiken-eiyoushikai.or.jp/H27.11.14eibunde-ta2.pdf
• Medline Plus. (2016). US National Library of Medicine. Retrieved April 20, 2018 from
https://medlineplus.gov/druginfo/meds/a604038.html
• RxList. (2017). Zosyn. RxList. Retrieved on April 20, 2018 from
https://www.rxlist.com/zosyn-drug.htm#description
• Saint Joseph Mercy Health System. (n.d.) ICU severe sepsis screening tool. Retrieved April 19, 2018
from http://survivingsepsis.org/SiteCollectionDocuments/Protocols-Sepsis-Screening-StJoseph.pdf
• Schmidt, G. and Mandel, J. (2018). Evaluation and management of suspected sepsis and septic shock
in adults. Up To Date. Retrieved April 20, 2018 from
https://www.uptodate.com/contents/evaluation-and-management-of-suspected-sepsis-and-septic-shoc
k-in-adults