Sepsis is a blood infection. It can't be "seen" but there are other signs that would have been noted by the doctors in his medical record at the ER where he died. If you don't want to believe the conclusion of the ME after autopsy, that's up to you.
JMO
Yep, sepsis is a bacterial infection.
Exactly what I am wanting to know is these " other signs that would have been noted by the doctors in his medical record at the ER where he died "
The defense atty mentioned in his opening ( not evidence ) that Corey had an elevated WCC, elevated glucose & elevated lactic acid. If that is all he has, than this is far from sepsis IMO
Eg you can get an elevated lactic acid from many things, including
seizures , dehydration, excessive exercise ( eg marathon runnuers etc ) , DKA ( diabetic ketoacidosis
)
------------------------------------------------------------------------------------------------------
Does high lactate mean sepsis?
What is lactate? Lactate is a chemical naturally produced by the body to fuel cells during times of stress. Its presence in elevated quantities is commonly associated with sepsis
and severe inflammatory response syndrome.
Lactate is an organic molecule produced by most tissues in the human body, with the highest production found in muscle.1 The body normally produces energy by way of aerobic metabolism, which requires oxygen to break down carbohydrates, amino acids, and fats. Via glycolysis, glucose is converted into pyruvate, which enters the Krebs cycle to produce oxygen and adenosine triphosphate (ATP) or energy. If oxygen isn’t available to body cells, anaerobic metabolism kicks in to produce energy. In this pathway, pyruvate is metabolized by the enzyme lactate dehydrogenase (LDH) into lactate.2 Lactate leaves the cells, enters the bloodstream, and transports to the liver, where it is oxidized back to pyruvate and then converted to glucose via the Cori cycle.1,2 Lactate is cleared from the blood, primarily by the liver and, to a lesser extent, by the kidneys and skeletal muscles.2
Causes of Elevated Lactate
Below are some common causes of lactic acidosis:
Type A:
- Sepsis and septic shock: dysfunction in the microcirculation (where oxygen is exchanged) leads to lactate production, while decreased oxygen delivery contributes to a decrease in lactate clearance.3
- Cardiogenic, obstructive and hemorrhagic shock: may cause decreased oxygen delivery and hypoperfusion.
- Cardiac arrest: ischemia and inflammation following cardiac arrest may cause an increase in lactate.
- Severe lung disease, respiratory failure or pulmonary edema: excessive work of breathing causes anaerobic muscle activity.
- Trauma: hypoperfusion due to blood loss is common in trauma patients and may lead to elevated lactate levels.
Type B:
- Seizures: depending on the type, seizures can produce a significant increase in lactate, but the effect is short-term; once the seizure has resolved, lactate levels typically return to baseline.
- Excessive muscle activity: lactate increases with strenuous exercise due to anaerobic metabolism and may be seen in rhabdomyolysis.
- Regional ischemia: mesenteric ischemia, bacterial peritonitis, acute pancreatitis, extremity compartment syndrome, gangrene and other types of soft tissue infections may elevate lactate.
- Burns and smoke inhalation: smoke inhalation victims are at risk of elevated lactate due to potential inhalation of cyanide and/or carbon monoxide.
- Diabetic ketoacidosis (DKA): due to a change in metabolism; elevated lactate in DKA is not necessarily associated with worse outcomes.
- Thiamine deficiency: low thiamine levels result in anaerobic metabolism and increased lactate production; risk factors for thiamine deficiency include poor nutrition, chronic liver disease, alcoholism, hyperemesis gravidarum, anorexia nervosa, and gastric bypass surgery.
- Malignancy: tumors may cause production of glycolytic enzymes, impaired liver clearance and malnutrition leading to thiamine deficiency.
- Liver dysfunction: the liver is the primary organ responsible for lactate clearance; injury or failure results in decreased lactate clearance.
- Genetic: inborn disorders of metabolism, particularly in the pediatric population, may cause elevated lactate levels.
- Drugs and Toxins that may cause increased lactate:
- Metformin (biguanide)
- Acetaminophen
- (Nucleoside reverse transcriptase inhibitors (NRTI)
- Linezolid
- Beta-2 agonists
- Propofol
- Epinephrine
- Theophylline
- Alcohols (ethanol, propylene glycol and methanol)
- Cocaine
- Carbon monoxide
- Cyanide
Elevated lactate is not just a marker for sepsis and septic shock. Learn about the many causes of high lactate levels and lactic acidosis.
www.nursingcenter.com
So, Corey's raised lactate & glucose could have many many causes other than sepsis, his poor little body had suffered such trauma that his heart was lacerated, he had an epicardial contusion to the outside of the heart, contusions & laceration to his liver, varying degrees of bruising & ages of bruises to multiple areas of his body ( suggesting a pattern of abuse ) & stress cardiomyopathy & so on.
By the time he was taken to hospital his poor little body was shutting down & he soon had a seizure & than cardiac arrest, none of it caused by sepsis IMO
I look forward to how Dr Baden will spin this as sepsis as a COD ( I'm actually surprised he's still cashing in cheques @ 89 yrs of age !)
Poor Corey had no chance.
RIP Corey
