Samantha Chanel De Vera
May 19, 2022, 8:35 AM
Multiple organ dysfunction syndrome (MODS) refers to severe acquired dysfunction of at least two organ systems lasting at least 24 to 48 hours in sepsis, trauma, burns, or severe inflammatory conditions so that homeostasis cannot be maintained without intervention(Neviere, 2022). For instance, a patient came in for severe encephalopathy. He was hypotensive on admission. When labs were drawn, the patient was on severe metabolic acidosis with acute renal failure and thrombocytopenia. The provider ordered multiple labs to rule out many conditions that may have caused his renal failure. Based on this case, patients’ differential diagnoses are adrenal insufficiency, cardiogenic shock, hypovolemic shock, and obstructive shock. The provider eventually consulted nephrology, and this patient was immediately started with hemodialysis. In less than 24 hours, the patient’s urine culture was positive, and his blood cultures showed bacteremia. Hence, the patient was diagnosed with severe sepsis. The severity of sepsis is graded according to the associated organ dysfunction and hemodynamic compromise. Severe sepsis is the presence of sepsis and one or more organ dysfunctions(Felner & Smith, 2017). Organ dysfunction may be defined as hypotension, acute lung injury including acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), thrombocytopenia, altered mental status, mottled skin, capillary refill greater than 3 seconds, renal dysfunction, hepatic dysfunction, cardiac dysfunction based on echocardiography or measurement of cardiac index, or lactic acidosis indicating hypoperfusion(Felner & Smith, 2017). Treatment initiated on admission was the two bundles of care, including blood culture, antibiotics, lactic acid level, IVF, and vasopressor. He also received some blood products and eventually deescalated antibiotics based on susceptibility.
Felner, K., & Smith, R. L. (2017). Sepsis and shock. In S. C. McKean, J. J. Ross, D. D. Dressler, & D. B. Scheurer (Eds.), Principles and practice of hospital medicine (2nd ed., pp. 25422566). McGraw-Hill.
Neviere, R. (2022, March 27). Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate.