Sepsis: Inflammation and White Cell Count Essay

2255 WordsSep 14, 201010 Pages
This is the case study of Mr. Jones, a 65 year old male, who was admitted to the emergency department with persistent cough and episodes of chest pain over the last five days. He appeared to be experiencing worsening dyspnoea, fever and feeling unwell. It was also noted that he had a poor urine output over the last 24 hours. An indwelling catheter was inserted which only obtained 20 mLs of amber urine. Mr. Jones clinical assessment revealed that his Glasgow Coma Score was 11/15. He was opening his eyes to speech, only making inappropriate words and localizes to pain. He was also pyrexial with a temperature of 39.0 ˚C, diaphoretic with hot peripheries, hypotensive BP 90/45 mmHg (MAP 60 mmHg), and tachyopneic at 30breaths/min and…show more content…
Mr. Jones white cell count is elevated and revealed at 1400 mm while his CRP is also raised. Cytokinines are the one of the primary mediators that signal other cells to release additional mediators such as tumour necrosis factor-a (TNF-a) interleukin (IL)-1, IL-6, IL-8, interferon, leukotrienes, histamine, bradykinin, prostaglandins, thromboxane A2, serotonin, nitric oxide, arachidonic acid, platelet-activating factor (PAF), oxygen free radicals and myocardial depressant factor (Munford, 2001:67). If the invading organism is a gram negative bacterium, endotoxins are also released, which further stimulate the production of these inflammatory mediators (Jones & Bucher, 1999:134). Tumour necrosis factor (TNF) is responsible for the disruption of the tight junction between endothelial cells which results in an increased permeability to plasma proteins and fluid, which worsens fluid accumulation in the alveoli further impairing gas exchanged (Bersten & Soni, 2009:709). TNF comprises of two different molecules, firstly TNFa which leads to programmed cell death in target cells, and when combined with IL-1 which acts on the central nervous system causing lethargy (Marieb, 2004). TNFB stimulates granulocyte activity and B cell proliferation which shows an increase in neutrophil count (Jean- Baptise, 2007:63). Monocytes, macrophages, lymphocytes, astrocytes and endothelial cells secrete IL-1 which promotes fever, anorexia,
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