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June 15, 2004

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Question from Cedar Rapids, Iowa, USA:

My girlfriend is currently in the ICU (Intensive Care Unit) and has been diagnosed with sepsis. She was found in her apartment in a diabetic coma and was rushed to the Emergency Room. Her blood sugar at the time was 2000 mg/dl [111.1 mmol/L]. She is on a respirator, but they've been slowly decreasing the amount of oxygen she receives (she's at 40 percent now). She was on three different medications to keep her blood pressure up, but she's off all of them now (and her blood pressure is actually high, which is also concerning). She was on nitric oxide to help her lungs intake oxygen, but they've backed off it now and for a while she wasn't on it at all. She has pneumonia, but they think it's been slowly improving. She is sedated most of the time due to the discomfort of the oxygen tube. They've had some problems with blood clots, but she's on heparin and there hasn't been anything recent. Her kidneys are still putting out urine. In addition to kidney damage, they think there may be some heart damage and also are worried about the possibility of brain damage. The main thing I'm concerned with is the sepsis, and I'm having difficulty getting any information out of the doctor and I can't find much on-line. From on-line reading it seems that the mortality rate is 50-60 percent for people with other serious conditions. The main thing I'm curious about is the timeframe involved with recovery, and I can't find anything on-line and the doctors and nurses won't say anything about it. She's been in the ICU for eight days. I just want to know if there are any sort of average or general timeframe for recovery, like, if most of the people that recover do so within two weeks, three weeks, a month and a half, or what? The majority of her friends and family focus on her blood pressure, oxygen levels, pulse, etc. and think that since she's doing a lot better in that regard, she's doing a lot better in general. With the sepsis looming over her I don't think that's necessarily the case. I realize the primary focus of this isn't really diabetes related, but I can't find anyone else to ask. I'm worried sick and would appreciate any information about the sepsis, or what to expect about long term health problems with her kidneys/heart/brain/etc. I realize the doctors don't like to get peoples' hopes up or let them down unnecessarily, and probably don't like giving out any information at all in the litigious society that we live in, but their unwillingness to even discuss anything long term is driving me insane. If she doesn't make it through the short term there's nothing I can do, but if she does, and I'm remaining optimistic, despite everything I've read, I'd like to be as prepared as possible for long term problems.

Answer:

Reading your description of your girlfriend’s condition tears me up. Please know I hope for all the best for you and yours. Sepsis is a very complicated situation. It is a condition that affects multiple organ systems and has a variable outcome. How quickly she recovers is dependant upon control of the underlying problem. In this case, it would be the control of blood sugars and pneumonia. The outcome of heart, kidney, brain, and other systems is dependant upon supportive care. That is where all those numbers come into play. Once the process of sepsis occurs, it is a process that does not go away immediately. The reason you have had problems finding an answer to your question is that there is no specific answer. Again, the response it dependant upon treating the underlying condition. It sounds from your description that there will be a prolonged recovery. I pray things will recover for the best.

JTL