MAY, 2019 | Th e HEALTH
COLUMN
19
My father
could not
recognise
me!
SEPSIS ALERT
BY DR TAN TOH LEONG
S
ARAH, was in a panic when she brought her
68-year-old father, a patient of mine, to our
emergency room. Her father has been acting
weirdly the last few days after a fever. Her
father is a resident of an old-folks home,
he recently started acting aggressively and
urinated indiscriminately. It worsened on the day
we met, in addition her father was totally unable to
recognize her. He was otherwise well before this. What
was wrong?
Upon further examination of Sarah’s father, he
was having high-grade fever and severe dehydration.
His lungs were infected, causing breathlessness. He
presented with all the signs and symptoms of sepsis
(slurred speech, extreme shivering, passing less
urine, severe breathlessness, feelings of doom, and
skin mottling). He was immediately treated for severe
pneumonia with ‘septic encephalopathy’.
Brain malfunction
Sarah’s father was suff ering from septic encepha-
lopathy. ‘Septic’ mean sepsis related condition.
‘Encephalopathy’ is a combination of two Latin’s
words; ‘Encephalo’ means brain, and ‘pathy’ means
malfunction. The brain malfunctions in various
conditions. However, in acute malfunction, it usu-
ally associates with sepsis. It also mimics stroke,
but stroke will not be accompanied by fever. Septic
encephalopathy is a reversible condition when the
underlying source of infection is treated.
Septic encephalopathy is brain malfunction medi-
ated by the infl ammatory response during sepsis.
Up to 70% patients with sepsis have some degree of
encephalopathy. If the condition is left untreated,
the patient will commonly experience a degree of
long-lasting cognitive impairment following recovery
Early detection of sepsis encephalopathy is
crucial. Early treatment can prevent long-term
cognitive impairment and depression. In usual
circumstances, the patient will need to be
hospitalized and started on antibiotic. He/she may
need drip for rehydration. If the patient’s condition
worsen, admission to ICU for intensive treatment is
warranted. ”
from sepsis. Septic encephalopathy can present in
hyperactive or hypoactive delirium stage.
Subclinical encephalopathy may be identifi ed by
family members as the patient being “not quite right”
even though abnormalities are not obvious to the
doctor. Patients may progress to coma in more serious
situation. In Sarah’s father’s case, he was suff ering
from hyperactive delirium. Patients may suff er other
symptoms such as reduced appetite, severe dehydra-
tion, extremely tiredness, muscle twitching and
tremor. Seizure may sometimes occur but it is rare.
Worrisome outcome
Th e prognosis of this condition is quite worrisome.
About 40 percent of sepsis survivors have cognitive
impairment during the fi rst year and it may persist
for years. Up to 60 percent of sepsis survivors have
long-term symptoms of depression and/or anxiety.
If delirium is persisted, the patient may have a high
chance of dying.
What should we do when our loved ones have
similar condition? I am sharing 3 easy steps for you
to follow.
• Do a quick check if he/she is having signs and symp-
toms of sepsis (slurred speech, extreme shivering,
passing less urine, severe breathlessness, feelings
of doom, and skin mottling).
• Do not attempt to feed him/her if he/she is in
delirium, because it will lead to choking and aspira-
tion to the lung.
• Call a doctor for consultation or home visit, or send
to hospital.
Early detection of sepsis encephalopathy is crucial.
Early treatment can prevent long-term cognitive
impairment and depression. In usual circumstances,
the patient will need to be hospitalized and started on
antibiotic. He/she may need drip for rehydration. If
the patient’s condition worsen, admission to ICU for
intensive treatment is warranted.
With this, I hope we are more prepared and ready to
pick up early signs of sepsis. Early detection of septic
encephalopathy saves lives! — Th e Health
Dr Tan is currently the President for the Malaysian Sepsis
Alliance and a member of the Global Sepsis Alliance. He
also holds the position of Senior Lecturer, Consultant
Emergency Physician, and Student Aff air Coordinator
(Alumni at Hospital Canselor Tuanku Muhriz UKM.