GIM Question 5 Instructor

What are the criteria for Systemic Inflammatory Response Syndrome (SIRS)?
SIRS is a system-wide inflammatory response to an inciting agent. The criteria for diagnosing SIRS are the presence of 2 or more of the following:

  • Temperature >38.5oC or <35.0oC
  • Heart rate >90 beats/min
  • Respiratory rate >20 breaths per minute (or arterial CO2 tension <32mmhg, or need for mechanical ventilation)
  • WBC >12 000/mm3 or <4000/mm3 or >10% band forms

What is the definition of Sepsis? Severe Sepsis?
Sepsis is SIRS caused by a documented infection. Any presentation of SIRS from an unknown etiology should be worked up for an infectious cause to rule out sepsis.

Severe sepsis is sepsis with hypotension (SBP<90, MAP <70)

What is your initial workup and management for a patient with suspected sepsis?
Initial workup:

  • CBC, Lytes, Cr, BUN, AST, ALT, ALP
  • Serum Lactate (a marker for tissue hypoperfusion)
  • Serum glucose (may be elevated in sepsis)
  • Urine dip, Urine C&S
  • CXR
  • Lumbar puncture (consider if suspect meningitis)
  • Blood cultures x2 (blood cultures x3 with a new murmur for suspected infectious endocarditis)

Acute management:

  • IV NS to maintain BP and prevent shock
  • Empiric IV broad-spectrum antibiotics (differnet hospitals may have different protocols). Switch to narrow-spectrum antibiotics once a specific pathogen has been identified
  • Treat hyperglycemia (if present) with insulin


  1. Annane D, Bellissant E and Cavaillon JM. Septic shock. Lancet. 2005, 365:63-78.
  2. Dellinger R.P. et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Intensive Care Med. 2013; 39:165-228.

Subscribe to Pearls

Uncle Sam wants you to subscribe to Medical Pearls

Subscribe today! It’s always free, and you can easily unsubscribe at any time. We will never share your email address. Subscribe to...

Multiple Pearls
Cardiology Pearls
Endocrinology Pearls
Hematology Pearls
Nephrology Pearls
Rheumatology Pearls
Transplant Pearls
General Internal Medicine Pearls
Instructor Pearls

Subscribe to receive your pearls today—it's free!