Sepsis differential diagnosis

| Resident
Survival
Guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

## Overview

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Sepsis must be differentiated from other syndromes such as the acute bacterial endocarditis, myocardial ring abscess, subacute bacterial endocarditis and bacterial meningitis.[1]

## Differential Diagnosis

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Sepsis must be differentiated from other causes of shock and fever based on clinical and hemodynamic findings.

Classification of shock based on hemodynamic parameters. [2][3] Type of Shock | Etiology | CO | SVR | PCWP | CVP | SVO2 | RVS | RVD | PAS | PAD

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Cardiogenic | Acute Ventricular Septal Defect | ↓↓  | ↑  | N — ↑  | ↑↑  | ↑ — ↑↑  | N — ↑  | ↑  | N — ↑  | N — ↑
Acute Mitral Regurgitation | ↓↓  | ↑  | ↑↑  | ↑ — ↑↑  | ↓  | ↑  | N — ↑  | ↑  | ↑
Myocardial Dysfunction | ↓↓  | ↑  | ↑↑  | ↑↑  | ↓  | N — ↑  | N — ↑  | N — ↑  | ↑
Right Ventricular Infarction | ↓↓  | ↑  | N — ↓  | ↑↑  | ↓  | ↓ — ↑  | ↑  | ↓ — ↑  | ↓ — ↑
Obstructive | Pulmonary Embolism | ↓↓  | ↑  | N — ↓  | ↑↑  | ↓  | ↓ — ↑  | ↑  | ↓ — ↑  | ↓ — ↑
Cardiac Tamponade | ↓ — ↓↓  | ↑  | ↑↑  | ↑↑  | ↓  | N — ↑  | ↑  | N — ↑  | N — ↑
Distributive | Septic Shock | N — ↑↑  | ↓ — ↓↓  | N — ↓  | N — ↓  | ↑ — ↑↑  | N — ↓  | N — ↓  | ↓  | ↓
Anaphylactic Shock | N — ↑↑  | ↓ — ↓↓  | N — ↓  | N — ↓  | ↑ — ↑↑  | N — ↓  | N — ↓  | ↓  | ↓
Hypovolemic | Volume Depletion | ↓↓  | ↑  | ↓↓  | ↓↓  | ↓  | N — ↓  | N — ↓  | ↓  | ↓

Abbreviations: CO: cardiac output, CVP: central venous pressure, PAD: pulmonary artery diastolic pressure. PAS: pulmonary artery systolic pressure, RVD: right ventricular diastolic pressure.RVS: right ventricular systolic pressure. SVO2: systemic venous oxygen saturation, SVR: systemic vascular resistance.

Other non-infectious causes of systemic inflammatory response syndrome (SIRS) that must be considered include:

* Postoperative recovery
* Penetrating trauma
* Burns
* Transplant rejection
* Hyperthyroidism
* Addisonian crisis
* Blood product transfusion reactions
* Serum sickness
* Immunizations
* CNS infarction or hemorrhages
* Leukemia
* Malignant hyperthermia
* Neuroleptic malignant syndrome
* Serotonergic syndrome
* Delirium tremens
* Metformin lactic acidosis

## References

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1. ↑ Machowicz R, Janka G, Wiktor-Jedrzejczak W (2017). "Similar but not the same: Differential diagnosis of HLH and sepsis". Crit. Rev. Oncol. Hematol. 114: 1–12. doi:10.1016/j.critrevonc.2017.03.023. PMID 28477737.
2. ↑ Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicine. Baltimore: William Wilkins. ISBN 0-683-06754-0.
3. ↑ Judith S. Hochman, E. Magnus Ohman (2009). Cardiogenic Shock. Wiley-Blackwell. ISBN 9781405179263.

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