Sepsis One of the most fascinating disruptions of body functions is sepsis. Sep

Sepsis
One of the most fascinating disruptions of body functions is
sepsis. Sepsis is an overwhelming infection that sets off a cascade of
inflammation leading to multisystem organ failure. Dysregulation of body
systems occurs, and organ dysfunction follows. Sepsis protocols help to
identify at-risk individuals and interventions occur to help prevent
life-threatening complications. As an ICU nurse sepsis is a daily
occurrence in our patient population. Understanding pharmacodynamics and
pharmacokinetics alterations in sepsis can help direct medical intervention to
help treat the massive infection. Intervention
Once sepsis is suspected, treatments must be quickly addressed
before the patient’s body is further compromised. Sepsis triggers are
hypotension, tachycardia, fever, tachypnea, and difficulty breathing. Rapid intervention is necessary. Blood cultures (to isolate possible bacteria)
prior to antibiotic administration, fluid resuscitation, supplemental oxygen
when necessary, and lactic acid levels should be assessed. Antibiotics
should not be delayed due to the aggressive nature of sepsis (Centers for
Disease Control and Prevention, 2021). Antibiotic therapy is vital for
sepsis infections and multiple antibiotics will be started until a source is
discovered. Pharmacokinetics
A patient is admitted to the ICU with severer sepsis from unknown
origin and started on broad spectrum antibiotics. She is young and
healthy at baseline with no known health comorbidities. She is intubated
due to severe acidosis, pH at 7.0. She is on vasopressors with minimal
positive effects, her lactic acid level is 4, and she is unresponsive. Although she is started on multiple antibiotics she continues to decline
hemodynamically. The pharmacokinetics of drug efficacy is altered due to
her body’s ability to function properly. Drug metabolism is disrupted due
to multisystem organ failure and plasma dysfunction. The
severe inflammatory response (release of cytokines, proteases, and other
inflammatory products) is causing capillary leakage and secondary
hypovolemia. As hypotension and hypovolemia worsen her acidosis increases
and her organ begin to shut down. Acidosis will further dysfunction of
her organs and how her body metabolizes medication. Endothelial damage
allows disruption of intravascular fluids (antibiotics included) Shock liver
and acute kidney injury further decreases excretion and metabolism of
antibiotics (like vancomycin). Pharmacodynamics
The dysfunction in her body led to unpredictable
hemodynamics. Her body did not react to medications as desired due to
sepsis. Alteration in pH changes the permeability of cells and plasma levels.
Drugs have a half-life and without proper metabolism and excretion, there could
be a potentially dangerous build-up within her body. The half-life of
medications helps determine intervals of doses (Rosenthal & Burchum,
2021). Vancomycin is one medication septic patients may be put on with
initial intervention. As her kidney function decreased, vancomycin
levels increased warranting dosing adjustments to prevent further damage. Plasma levels of these potentially harmful antibiotics were closely monitored
until a specific bacterium was isolated and therapy could be
discontinued. Plan of Care
For
this specific patient, the plan of care was vastly dependent on her
response. Correction of her acidosis and antibiotic treatments helped her
body begin to regain functionality. Her kidneys were acutely injured
requiring continuous renal replacement therapy. As the metabolic acidosis
was corrected and excessive medication that was not metabolized (due to organ
dysfunction) was cleared she finally began to regain hemostasis. Capillary leakage stopped, kidneys began producing urine and clearing waste
products, and her vital signs stabilized. Her plan of care was
continually adjusted as the bacterium was isolated and treatment could be targeted
more effectively. References
Centers for Disease Control
and Prevention. (2021, August 10). How is sepsis diagnosed and treated? Centers
for Disease Control and Prevention. Retrieved March 2, 2022, from https://www.cdc.gov/sepsis/diagnosis/index.html
Charlton, M., & Thompson, J. P. (2019). Pharmacokinetics in
sepsis. BJA education, 19(1), 7–13. https://doi.org/10.1016/j.bjae.2018.09.006
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics
for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO:
Elsevier.
FYI:
It would be great to use different articles for refernces.