The sepsis syndrome may present with either a subtle or obvious, rapidly progressive clinical picture. Neurologic symptoms most frequently include altered mental status with irritability, confusion, or lethargy. Poor feeding, lack of spontaneous motor activity, and hypotonia are common findings. Hyperpyrexia, defined as a rectal temperature higher than 41.1°C, may occur, although this is not specific for sepsis. Hypothermia may occur, particularly in infants under 3 months of age, and is a grave finding. Tachypnea and retractions may reflect hypoxia or the development of metabolic acidosis. Early septic shock is accompanied by subtle findings of resting tachycardia, widened pulse pressure, warm distal extremities, and brisk capillary refill. Subsequently, classic signs of hemodynamic compensation occur, including weak distal pulses, delayed capillary refill, and cool extremities. Ultimately, these are followed by signs of decompensation with decreased sensorium and hypotension. Cutaneous findings may include petechiae, which may progress to coalescent purpura over hours to days.
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