My father-in-law has had quite a few narrow escapes. In the last two years, two out of three narrow escapes have been attributed to septicemia. Or more accurately in his case – Urosepsis.

My father-in-law suffers from multiple complications including Complete Renal Failure (CRF), Cerebral Hemorrhage induced Hemiplegia (paralysis of one side of the body), Diabetes Mellitus Type II and Hypertension. While we perform Peritoneal Dialysis (CAPD) to address the renal failure, there is little we can do about his paralysis. An year worth of physiotherapy later, we concluded that his paralysis was here to stay.

His blood pressure is generally on the higher side and without medicines shoots up-to 180+/90+. We were quite surprised when his BP gradually fell to 130/70 levels and we did not have to give him BP medicines anymore. Gradually, he pressure started falling further. While most of the day it hovered around 110/65 levels, occasionally it would dip to 90/60.

This was totally inexplicable to our untrained minds. We started wondering whether we were providing him with sufficient salt intake? was he suffering from dehydration? Was this a reaction to some medication? Was his blood sugar too high or too low?

Noticeably enough, his consciousness levels were fading and he was having difficulty staying awake and communicating. Upon questioning he would answer that he was feeling fine, but he appeared to be dozing. Simultaneously, we noticed that his BP levels had fallen to as low as 65/48.

We called the Doctor (Dr. P. Sivaram, Urologist, Satya Kidney Center, Hyderabad) immediately and were told that my father-in-law could be suffering from Septicemia and his life was in danger unless he was immediately admitted to the hospital.

7 days, Rs. 90,000/- later, my father-in-law emerged from the hospital awake, hungry and more conscious than he had been since his cerebral hemorrhage. Good news; narrow escape we are told.

The kind Doctor provided us with an explanation about what happened:

• Due to CRF, my FIL’s kidney have trouble producing urine. His 24 hour urine output was a meager 150ml, which would go up-to 350ml with the administration of diuretics. To prevent excessive edema, my FIL’s fluid intake was limited to 900ml/day. This results in reduction in available water in the body, for the body to flush itself. This further results in concentrated or limited urine and high chances that the urinary bladder would develop an infection.
• Due to hemiplegia, my FIL cannot pass urine standing up and has to use the urine pot in sleeping posture. This further complicates the urinary bladder situation as not only he is unable to apply muscular pressure on the urinary bladder, also gravity is unable to drain the bladder. Urine that remains in the bladder starts stagnating and gets infected with bacteria.
• Over a period of time, the bacterial / fungal infection has the potential to cross-over into the blood stream and pollute the blood.
• The bodies immune reaction to presence of bacteria / puss-cells etc. in blood or other internal organs of the body is called ‘sepsis’ (incorrectly termed as septicemia). Most common symptoms of the immune reaction are:
  • Drop in blood pressure, fairly rapidly.
    
  • Disorientation: inability to realize the time of day, position.
  • Confusion: inability to sequence or recall recent events.
  • Inability to stay awake and focused.
• Continued sepsis condition can rapidly affect the kidney, brain, lungs, heart & liver and kill the patient in 24 hours.
• My FIL was administered extensive doses of strong antibiotics such as Meropenem, anti-fungal drugs and Dopamine. It took the Doctors over 48 hours just to bring his BP level back-up-to 120/80 and a further 24 hours before the Doctor agreed that the critical time had passed.
• In the Doctor’s own words – “Septicemia is extremely dangerous and unpredictable. Some patients respond to the treatment, some don’t. Some lives are snuffed out as if a light-bulb fused. It is quite common for patients who seem to be responding to the treatment to suddenly suffer from an organ failure such as heart-attack and die”.

Looking back, my FIL’s MIL (my wife’s grandmother) showed similar symptoms and passed away in her sleep in less than 24 hours. While the lady complained of a mild fever in the morning and was administered antipyretic followed by Saline solution (to contain falling BP), by 7PM she was having trouble keeping awake. She was admitted to the hospital at 10PM and suffered a massive cardiac attack at 4AM the following morning.

In the investigation that followed, it appeared that the lady was suffering from an infected toe since two months and was on homeopathic medicine. She also had a possible ischemic heart condition which had been diagnosed partially. When the septicemia stuck due to infection spreading into her blood, her already weak heart could not cope up.

Could her life have been saved? Definitely. If only someone had spotted the symptoms of septicemia in advance and advised us appropriately. If only information about how to spot septicemia and it’s general tendency to affect the elderly was available and emphasized.