Clinical Mimics: An Emergency Medicine–Focused Review of Sepsis Mimics

• Published in: The Journal of emergency medicine 2017-01, Vol.52 (1), p.34-42
• Main Authors: Long, Brit, MD, Koyfman, Alex, MD
• Format: Article
• Language: English
• Subjects: Anaphylaxis - diagnosis; Decision Support Techniques; Diabetic Ketoacidosis - diagnosis; Diagnosis, Differential; Diagnostic Errors; Emergency; Emergency Service, Hospital - organization & administration; Humans; mimic; Pancreatitis - diagnosis; Pneumonia, Aspiration - diagnosis; Poisoning - diagnosis; resuscitation; sepsis; Sepsis - diagnosis; Sepsis - therapy; septic shock; SIRS; Systemic Inflammatory Response Syndrome - etiology
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.07.102

Abstract Background Sepsis is a common clinical condition, and mortality and morbidity may be severe. The current definition of sepsis involves systemic inflammatory response syndrome (SIRS) criteria, which is met by many conditions. Objective This review evaluates the SIRS continuum, signs and symptoms of sepsis, mimics of sepsis, and an approach to management for sepsis mimics. Discussion The current emergency medicine definition of sepsis includes SIRS, a definition that may be met by many conditions. Because of common pathophysiologic responses, these diseases present in a similar manner. These conditions include anaphylaxis, gastrointestinal emergency, pulmonary disease, metabolic abnormality, toxin ingestion/withdrawal, vasculitis, and spinal injury. Many of these conditions can be deadly if they are not diagnosed and managed. However, differentiating between sepsis and mimics can be difficult in the emergency setting. Laboratory abnormalities in isolation do not provide a definitive diagnosis. However, a combination of history, physical examination, and adjunctive studies may assist providers. For the patient in extremis, resuscitation must take precedence while attempts to differentiate sepsis from mimics are underway. Conclusions SIRS and sepsis exist along a continuum, with many other conditions overlapping because of a common physiologic response. A combination of factors will assist providers in differentiating sepsis from mimics rather than using diagnostic studies in isolation. Resuscitation should be initiated while attempting to differentiate sepsis from its mimics.