Lab Case 24

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A 57 year old man is brought in to your Emergency Department by ambulance. He has had shortness of breath for a day and feels unwell. He is sweaty and has significantly increased work of breathing.He has a history of metastatic lung cancer, has completed a course of experimental chemotherapy a few weeks ago.

Vital signs:

BP 110/60

PR 130/min

O2 sats 99% on 15l

RR 30/min

T 34 degrees celcius

Describe and Interpret his blood results

 HAEMOGLOBIN:       130                   g/L(133 - 170)
         RCC:                        3.90                   x 10^12/L
         PCV:                        0.400
        MCHC:                      324                   g/L (320 - 360)
         MCV:                       103                    fL (82 - 99)
         MCH:                       33.40                 pg

 PLATELETS  :  55             x 10^9/L         (140-400)

 WCC        :                 51.0                 x 10^9 (4.0 - 11.0)
 Neutrophils:                41.8                 "  (1.8 - 7.5)
 Lymphocytes:             5.1                   "  (1.0 - 4.0)
 Monocytes:                2.5                  "  (0.1 - 1.2)
 
INR      :                1.7                    (0.8 - 1.2)
PT      :                19.6                           sec

APTT      :              31               sec    (24 - 34)

Fib'gen   :              0.5               g/L    (1.6 - 4.0)



     Na          K            Cl          HCO3        Urea     Creat
   mmol/L      mmol/L       mmol/L       mmol/L      mmol/L    umol/L
  (134 - 146) (3.4 - 5.5) (95 - 108)   (22 - 32)   (3.0 - 8.0)  <120

   137           4.0          93          14        11.6      131




 ABG
                                            Units  Ref Range
          pH:     7.24                    (7.35 - 7.45)
        pCO2:     24                        mmHg   (36 - 44)
         pO2:     99                        mmHg   (80 - 95)
        HCO3:     16                        mmol/L (20 - 26)
     Base XS:    -10                        mmol/L (-2 - 4)

     Glucose:       9.5  
     Lactate:      14.5


What are the criteria for SIRS, sepsis, severe sepsis and septic shock?