Constitutional

Hyperthermia or hypothermia, tachycardia, wide pulse pressure, tachypnea, and mental status changes are early systemic signs of infection and septic shock. Endotoxin, TNF, IL-1, and interferon-a have all been shown to elicit febrile responses in humans. Acute hyperventilation with respiratory alkalosis (Pa co2 £30 mmHg) is common in sepsis. The etiological mechanism of this tachypnea is thought to be due either to the direct effects of endotoxins or secondary to kallikreins, bradykinin, prostaglandins, or complement activation.

The most frequent mental status change in sepsis is mental obtundation. The neurological findings are nonfocal and range from mild disorientation to confusion, lethargy, agitation, and coma. The pathophysiology is still unknown; an altered state of amino acid metabolism producing a state similar to portosystemic encephalopathy or decreased cerebral blood flow with secondary disruption of the blood-brain barrier are proposed mechanisms.

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