Sepsis
EVERYTHING YOU NEED TO KNOW ABOUT SEPSIS
Sepsis is a life-threatening condition, however, it can be treated if caught early. Each person may experience symptoms differently. Here at Boots, we want to help you understand the signs and symptoms which could potentially save a life.
WHAT ARE THE SYMPTOMS?
Symptoms in children
A child may have sepsis if he or she:
- Is breathing very fast
- Has a 'fit' or convulsion
- Looks mottled, bluish, or pale
- Has a rash that does not fade when you press it
- Is very lethargic or difficult to wake
- Feels abnormally cold to touch
Symptoms in adults
An adult may have sepsis if they show any of these signs:
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
Severe breathlessness
It feels like you're going to die
Skin mottled or discoloured
Call 111 or contact your GP if you're worried about an infection
Call 999 or visit A&E if someone has one of the sepsis symptoms
Just ask "could it be sepsis?"
UNDERSTANDING & TREATING SEPSIS
Sepsis is a life-threatening condition with an estimated 123,000 cases of sepsis per year in England and around 36,800 associated deaths.** Here, we cover what you need to know about sepsis, including the symptoms, causes, types of treatment and what action to take if you think you or someone else has sepsis. Knowing the signs of sepsis could save someone’s life. The sooner it’s detected and treated, the greater the chance of making a full recovery.
Sepsis, sometimes called septicaemia or blood poisoning, is a life-threatening reaction to an infection that can lead to tissue damage, multiple organ failure and sometimes death, especially if it’s not spotted early and treated promptly. This happens when the body’s immune system overreacts to the infection.
Sepsis is a medical emergency and you should call 999 as soon as possible if you suspect you or someone else has sepsis.
The symptoms of sepsis vary from person to person and can differ between adults, children and babies. If you notice any of the below symptoms in yourself or someone else, call 999 or go straight to A&E for urgent medical attention.
An adult may have one or more of the following symptoms:
• Acting confused, having slurred speech or not making sense
• Extreme shivering or muscle pain
• Blue, grey, pale or blotchy skin, lips or tongue – this may be easier to see on the palms of the hands or soles of the feet with brown or black skin
• Passing no urine in a day
• A rash that doesn’t fade when you roll a glass over it
• Difficulty breathing, breathlessness or breathing very fast
• An increased heart rate
• Body swelling
You should also call 111 if you, your child or someone else is showing the below signs or you’re concerned about an infection. If you’re unsure if it’s sepsis, don’t worry, it’s still best to call 111. They can advise you on what to do and arrange a phone call from a nurse or doctor or call an ambulance.
Signs you should call 111 are if you or someone else is:
• Feeling very unwell or there’s something seriously wrong
• Not urinating all day (for adults and older children) or in the last 12 hours (for babies and young children)
• Vomiting and can’t keep any food or fluids down
• Noticing swelling or pain around a cut or wound
• Having a very high or low temperature, feeling hot or cold to touch or shivering
Sepsis happens when your body’s immune system responds abnormally to an infection, leading to tissue damage, organ failure and death. Your immune system works to fight any germs such as bacteria and viruses, and helps to prevent infection. However, sometimes the immune system goes into overdrive and starts to attack our organs and other tissues. It can happen as a response to any injury or infection and can be triggered by:
• A chest infection that causes pneumonia
• A urine infection in the bladder
• A problem in the abdomen, such as a burst ulcer or a hole in the bowel
• An infected cut or bite
• A wound from trauma or surgery
• A leg ulcer or cellulitis
The infection can start anywhere in your body – it may be in one part or widespread – but the most common parts of the body affected are:
• Lungs
• Urinary tract
• Tummy (or abdomen)
• Pelvis
• Skin
The source of the infection can’t always be identified.
Sepsis doesn’t discriminate, meaning anyone with an infection can get it. However, some are more susceptible to infections which can make them more vulnerable to sepsis. This includes:
• Babies under one year old, particularly if they’re born prematurely (before 37 weeks of pregnancy), or if the mother had an infection while pregnant
• Women who have just given birth, had a miscarriage or an abortion
• The elderly, typically people over 75 years old
• People with long-term health conditions like diabetes
• People with a weakened immune system, such as those who’ve recently had an organ transplant or chemotherapy
• People with medical conditions that weakens the immune system, like HIV or leukaemia
• People who’ve recently had surgery or are in hospital with a serious illness
• People who’ve had a urinary catheter fitted
• People who are genetically prone to infections
• People who have wounds or injuries from an accident
• People who are on a mechanical ventilation (where a machine is used to help you breathe)
• People who have to stay in hospital for a long period of time
Sepsis in babies is usually caused by a bacterial infection in any part of the body. It can also be caused when a surgical procedure has taken place and bacteria has entered the body.
Sepsis is more likely to occur in babies that are premature as they have weaker immune systems, and their skin and gut is more fragile than in babies born at full-term. This means they’re more vulnerable to infections, which can happen through equipment such as ventilation tubes.
Sepsis is a medical emergency, if your baby or young child has one or more of the following symptoms, call 999 immediately:
• Breathlessness, breathing fast or having difficulty breathing (you may notice grunting noises or their stomach sucking under their ribcage)
• A rash that does not fade when you roll a glass over it, the same as meningitis
• Blue, grey, pale or blotchy skin, lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
• Having a ‘fit’ or convulsion
• Being sleepier than normal or difficult to wake
Other symptoms include:
• An abnormal temperature that’s either too high or too low
• Feeling abnormally cold to touch
• Fewer or no wet nappies
• Having a disinterest in feeding or being very irritable
• A weak, high-pitched cry that’s not like their usual cry
• Generally appearing unwell
Sepsis in children is more common in those under one year of age but older children can still be at risk. Children with pneumonia, urinary tract infections, meningitis and severe skin infections can rapidly deteriorate and develop sepsis.
A child under five may have sepsis if they:
• Aren’t eating
• Are vomiting repeatedly
• Have not passed urine for 12 hours
As children get older, their exposure to illness can increase as they attend nursery, go to school and participate in other activities.
Initial symptoms of sepsis in children may include:
• A fever
• A cough or sore throat
• Vomiting
• Diarrhoea
These may then develop into:
• Shivering, a high fever or feeling very cold
• Extreme pain or discomfort
• Clammy or sweaty skin
• Confusion or disorientation
• Shortness of breath
• A high heart rate
• A rash that doesn’t fade when you roll a glass over it
• Passing little or no urine
• General illness or a previous injury
Seek urgent medical attention if a child has any of the above symptoms.
As we go through the ageing process, the immune system becomes less effective at fighting against infections. This results in older people contracting more infections that are often more severe. Every infection means those that are elderly are at a greater risk of developing sepsis. This includes common infections that occur in the elderly, such as pneumonia and urinary tract infections (UTI).
The elderly also may develop chronic illnesses such as diabetes, kidney disease or heart failure which can make them more susceptible to sepsis.
Symptoms of sepsis in the elderly include:
• Heart beating faster than usual
• A change in body temperature that’s too high or too low
• Rapid breathing
• Shaking
• Confusion
If an elderly person has any of these symptoms you must seek urgent medical attention.
Septic shock is an extremely life-threatening condition that occurs when your blood pressure drops to a dangerously low level following an infection. People with weakened immune systems are more likely to get septic shock.
Initially, the infection can cause sepsis, but if it’s left untreated, the toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues. This can affect your heart's ability to pump blood to your organs, which lowers your blood pressure and means blood doesn't reach vital organs, such as the brain and liver.
Septic shock is a medical emergency, call 999 urgently if you or someone else is showing signs of septic shock including:
• A severe drop in blood pressure that causes dizziness when standing up
• A change in mental state such as extreme confusion or disorientation
• Diarrhoea
• Strong sleepiness or trouble staying awake
• Nausea and vomiting
• Cold, clammy and pale skin
If you have septic shock, you may be transferred to an intensive care unit (ICU) to help support your body’s functions and organs while you undergo treatment. The treatment usually involves one of the following, depending on what’s best suited to you:
• Oxygen therapy
• Fluids given through a vein (intravenously)
• Medications to help increase blood flow
• Some antibiotics
• Surgery (in some cases)
Septic shock can be fatal. It’s a serious health condition that needs treating urgently
Meningitis is an infection of the protective lining around the brain and spinal cord (meninges) that’s caused by bacteria, virus or fungi invading the body. This can cause septicaemia. Septicaemia is blood poisoning caused by the same bacteria as meningitis, which triggers sepsis. Both meningitis and sepsis are serious, life-threatening illnesses and you must call 999 if you suspect you or someone else is showing symptoms of either condition. Meningitis can affect more than 2.5 million people globally each year,† and while it can happen to anyone, it’s most common in babies, young children, teenagers and young adults.
Symptoms include:
• A high temperature (fever)
• Being sick
• A severe headache
• A rash that does not fade when a glass is rolled over it (but a rash will not always develop)
• A stiff neck
• A dislike of bright lights
• Being very sleepy or having difficulty waking
• Drowsiness or unresponsiveness
• Confusion
• Seizures (fits)
It’s important to note that not everyone will experience the same symptoms and they can appear in any order. However, the initial symptoms are usually fever, vomiting, headache and generally feeling unwell.
There are vaccinations available that offer protection against certain strains of meningitis, which we’ve covered within our ‘Treating sepsis’ section.
Find out more information on meningitis symptoms, causes and treatment
Although there isn’t a test for sepsis, it can often be diagnosed by testing your:
• Blood
• Temperature
• Heart rate
• Breathing rate
As well as the above, a doctor may want to do further tests to locate the infection and which part (or parts) of the body have been affected, These include:
• Urine or stool samples
• A wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
• Respiratory secretion testing – taking a sample of saliva, phlegm or mucus
• Blood pressure tests
• An X-ray, ultrasound scan or a CT scan
Sepsis is a medical emergency. Once a diagnosis has been given, treatment should start urgently.
The symptoms of sepsis can worsen quickly, meaning hospital treatment is needed urgently. If it’s not treated early, it can lead to severe sepsis or septic shock and cause your organs to fail which is life-threatening.
Within one hour of arriving at the hospital, you should begin to receive urgent medical treatment, as well as antibiotics. You’ll then be given treatment depending on your symptoms, the area and organs affected, the cause of the infection and the extent of damage. These include:
• Treatment in an intensive care unit (ICU)
• A machine to help you breathe (a ventilator)
• Surgery to remove areas of infection
For babies, doctors will also treat infections with antibiotics, however, these will be given to babies through a small plastic tube in a cannula or line (a plastic tube into the vein). The length of baby treatment will depend on whether or not their blood lumbar puncture results show any signs of infection.
Treatment is often the same for adults and children and may require you to stay in the hospital for several weeks. Remember, the sooner sepsis is identified and treated, the more likely you are to make a full recovery.
Most people can make a full recovery from sepsis if it’s identified and treated early, however it can take a long time. The severity of the original infection, the length of the hospital stay, the treatment administered and past medical history can all impact recovery time.
Recovering from sepsis can be physically and emotionally challenging, with some effects lasting for months or even years after you’ve had sepsis. These long-term effects are what’s known as post-sepsis syndrome (PSS) and can include physical symptoms such as:
• Feeling excessively tired or weak
• Lack of appetite
• Getting ill more often
• Chest pain
• Breathlessness
• Swollen limbs
• Joint pain
As well as psychological symptoms including:
• Post-traumatic stress disorder (PTSD)
• Changes in your mood
• Experiencing anxiety for sepsis returning
• Having nightmares or flashbacks
• Having difficulty sleeping (insomnia)
While the exact cause of post-sepsis syndrome isn’t known, it’s thought to be a combination of the body’s immune responses, changes in blood flow to the organs and the effects of certain medical interventions given during treatment.
If you or someone else are suffering with post-sepsis syndrome, there are a couple of self-help things you can try:
• Ask about changes to your working hours or conditions during your recovery
• Try to do some gentle exercises to build your strength up, such as chair and yoga exercises – take a look at our healthy lifestyle hub for exercises tips and advice
• Setting a regular sleep pattern may help you drift off
• Try to prevent infections by regularly washing your hands and being mindful of bacteria
• Eating little and often if your appetite is small
Remember, everyone’s sepsis recovery journey is different. Some people may have a more problematic recovery than expected with post-sepsis syndrome, while others may only experience a couple of the above. However, it’s important to take time to heal and always ask for help or advice from your doctor if you’re struggling with the physical or psychological effects, as well as confiding in family and friends for extra support.
For further support, take a look at The UK Sepsis Trust who have a host of resources to help you through your recovery.
FREQUENTLY ASKED QUESTIONS
Sepsis is treatable if you catch it early and start treatment as soon as possible. It involves urgent medical treatment in a hospital, where you’ll be given antibiotics, as well as one of the below treatment options, depending on the severity of sepsis:
• Treatment in an intensive care unit (ICU)
• A machine to help you breathe (a ventilator)
• Surgery to remove areas of infection
You may need to stay in hospital for several weeks.
Sepsis can be triggered by an infection such as pneumonia. While sepsis is a life-threatening, medical emergency that damages the body's organs and tissues, pneumonia is the inflammation of the lungs, caused by a bacterial or viral infection.
So while the two conditions differ in how they affect the body, the main difference between sepsis and pneumonia is that sepsis isn’t contagious, whereas pneumonia can spread from person to person through coughing and sneezing. As well as this, the symptoms of pneumonia are similar to the initial symptoms of sepsis such as:
• Generally feeling unwell
• Fever
• Feeling faint
• Weakness
• Confusion
• Increased heart rate
• Breathing faster
However, a key difference is that the symptoms typically last longer with pneumonia. If you notice symptoms of pneumonia in you or someone else, speak to your GP or call 111.
Find more information on pneumonia and our Pneumonia Vaccination Service.10
While they share some of the same symptoms, sepsis and meningitis are not the same thing. Sepsis is an overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death. Meningitis however, is a life-threatening illness where an infection reaches the lining around the brain and spinal cord. This can cause dangerous swelling and lead to sepsis.
Some of the shared symptoms include:
• A rash anywhere on the body that doesn’t disappear after rolling a glass over it
• Fever
• Vomiting
• Being very sleepy and having difficulty waking
• Confusion
• Generally feeling unwell
If you suspect you or someone else has symptoms of meningitis or sepsis, call 999 immediately for urgent medical help.
**Source: https://www.hee.nhs.uk/ourwork/sepsisawareness
† Source: https://www.meningitis.org/meningitis/vaccine-information
9Eligibility criteria and charges apply. Available in selected pharmacies, subject to availability.
10 Eligibility criteria and charges apply. In most Boots pharmacies, subject to availability. People aged 65 and over are also eligible for a free NHS pneumonia vaccination. If you’re over 65 and haven’t already had the NHS vaccination, speak to your doctor about having this. It’s a different type of vaccination to the one used in the Boots service so you may want to consider having both to further increase your protection against pneumonia. You may also be eligible for the NHS vaccination if you are under 65 and are living with a long-term health condition such as diabetes. The Boots Pneumonia Vaccination Service does not replace the need for the NHS vaccination. Please note, that the pneumonia vaccination won’t protect you from sepsis.
