Sepsis symptoms: What are the early signs of sepsis?

Overview: What does sepsis feel like?

Sepsis is a life-threatening medical condition requiring immediate medical attention. Rarely the immune system responds to an infection is dysregulated and extreme and compromises organ function. Sepsis may transform into septic shock. This is the most severe form and has a high mortality rate. While bacterial infections are the most common cause of sepsis, sepsis can occur from other types of infections including viral infections. 

What does sepsis feel like? People with sepsis feel very sick. The most common symptoms are high fever (over 100.9F) and chills, though some people may have a low temperature (less than 96.8F). It’s also common for the heart rate to be above 90 at rest and for breathing to get fast (more than 20 breaths per minute). Low blood pressure is very common, causing symptoms of weakness, dizziness, and confusion. Keep in mind that 80% of sepsis cases are diagnosed in an emergency room and the remaining are diagnosed in hospitalized patients. So in both the patient and family members, there’s rarely any doubt that something is seriously wrong. The primary goal of sepsis treatment is survival, so time is of the essence. The sooner treatment starts, the more likely the person will live.

What are the early signs of sepsis?

The most common early signs of sepsis are:

• Fever

• Chills

• Low body temperature

• Fast heartbeat

• Fast breathing

• Mental changes such as confusion

• Symptoms of low blood pressure are lightheadedness, dizziness, confusion, and fainting

Sepsis is a rapidly-progressing condition. Symptoms can appear suddenly and worsen quickly. Sudden onset or rapid deterioration is a sign that emergency medical help is needed.

RELATED: What happens when your blood pressure is too low

Other sepsis symptoms

Sepsis may present differently depending on the underlying infection, the organs affected, and the severity of tissue and organ damage. The Centers for Disease Control and Prevention (CDC) recommends that both healthcare professionals and others be aware of the most common signs of sepsis including:

• Fever

• Chills

• Feeling cold

• Confusion or disorientation

• Fast heart rate

• Rapid breathing

• Extreme pain

• Clammy or sweaty skin

Other symptoms may include:

• Feeling bad

• Weakness or fatigue

• Loss of appetite

• Diarrhea

• Nausea

• Vomiting

• Sweating

• Flushing

• Redness

• Skin rash

• Skin sores

• Urination problems

• Joint pain

• Joint swelling

• Muscle pain

• Headache

• Seizures

• Difficulty swallowing

• Difficulty breathing

• Hyperventilation

• Blue skin

Low blood pressure is a common symptom of sepsis and may indicate severe sepsis. Symptoms of low blood pressure include:

• Lightheadedness

• Dizziness

• Mental changes such as confusion or disorientation

• Weakness

• Fainting

Sepsis vs. septic shock symptoms

Septic shock is the most severe form of sepsis. When shock occurs, the cascade of immune dysfunction is causing organ injury, affecting circulation, and disrupting the body’s metabolic functions. About 40% of people diagnosed with septic shock die. The most obvious sign of septic shock is low blood pressure which occurs in 40% of patients with sepsis and is difficult to treat. 

Though the words are sometimes used as synonyms, sepsis is different from septicemia (or “blood poisoning”). While sepsis is caused by the body’s overly active immune response to an infection, septicemia is a bacterial infection of the blood. However, septicemia can rapidly evolve into sepsis, so the symptoms are identical. The difference is this: sepsis can be caused by any infection anywhere in the body. Septicemia starts when bacteria enter the bloodstream and quickly cause sepsis.

Stages of sepsis: How can I tell which one I have?

Sepsis is diagnosed based on its severity, but sepsis rapidly worsens. These stages include:

• Sepsis: Sepsis is a systemic inflammatory response resulting from an infection and that compromises organ function. It is marked by symptoms of an inflammatory response such as fever, fast breathing, and fast heartbeat. It frequently causes low blood pressure, decreased blood flow and oxygenation to the rest of the body. This leads to symptoms of mental changes, decreased urination, and lactic acidosis.

• Septic shock occurs when blood pressure is low and can’t be improved with fluids or medications leading to multiple organ failure and death.

RELATED: What are normal blood oxygen levels?

When to see a doctor for sepsis symptoms

Sepsis symptoms require emergency treatment. While many of the symptoms are typical of infections, sepsis symptoms usually worsen quickly. The sooner treatment starts, the better the chances of surviving.

An emergency room doctor follows specific treatment guidelines, combining both diagnosis and immediate treatment. 

The first order of business is to evaluate the symptoms and evaluate vital signs. If sepsis is likely, treatment begins. The second order of business is to identify the source of infection using blood tests, urine tests, stool tests, skin tests, or sputum samples depending on the symptoms. They may also need to culture spinal fluid, joint fluid, or lung fluid, again, depending on the symptoms. X-rays, CT scans, or other imaging is required to find where the infection is located. Even after this exhaustive workup, doctors identify the source of infection in only half of sepsis cases. Blood tests also measure the severity of the immune response by measuring white blood cells and other inflammatory markers in the blood. 

Once sepsis is diagnosed, additional diagnosis, tests, and imaging will be required when treating the infection.

RELATED: What are normal CRP levels?

Complications of sepsis

Both treated and untreated sepsis can lead to serious complications including

• Blood clots

• Limb amputation

• Multiple organ failure

• Death

Long-term complications of sepsis include

• Serious illness

• Lung injury

• Delirium

• Weakness

• Accelerated hardening of the arteries

• Early death

How to treat sepsis symptoms

Sepsis is a medical emergency. The goal of treatment is to survive with as few complications as possible. Treatment is swift and follows well-studied guidelines including diagnostic tests, frequent assessments, and expedited treatments following a three-hour timeline. In order, these treatments are:

• Initial fluid resuscitation with IV fluids and mineralized fluids

• Antibiotics

• Vasopressors (usually norepinephrine) to raise blood pressure in people with septic shock

• Mechanical ventilation in people with severe lung injury

While most people will start in an emergency room, they will be transferred to a hospital room if they don’t have septic shock. They will usually then be treated by a hospitalist physician or a specialist in infectious diseases. If they do have septic shock, they will be transferred to an ICU (intensive care unit). 

Sepsis should never be treated at home, nor with natural remedies.

Signs sepsis is getting better

Symptoms of sepsis should improve in two to four days, but may take several days of antibiotic therapy to start feeling better. It may take longer to feel normal again. Most people will fully recover, but some will have long-term or chronic problems such as sleeplessness, pain, chronic organ dysfunction, or amputations. 

Healthcare professionals are in the best position to determine how well a person is recovering from sepsis. Recovery includes assisting the patient with tasks of daily living like getting up, walking, and going to the bathroom. Physical therapists are consulted to help with discharge destination planning. If the patient needs more help than can be arranged at home, the patient may be discharged to a rehabilitation facility to help with gaining strength and function. Once a person is sent home, they may need supportive care to fully recover daily functioning. 

Recovery can be helped by:

• Taking all medications as instructed

• Following all other instructions from healthcare providers

• Keeping all follow-up appointments

• Keeping a symptom diary to share with healthcare professionals

• Resting

• Eating a healthy diet

• Exercising carefully and under supervision

What’s next? Additional resources for people with sepsis symptoms

Test and diagnostics

• Bacterial sepsis, StatPearls

• Get ahead of sepsis, Centers for Disease Control and Prevention (CDC)

• Sepsis: basic symptoms, Sepsis Alliance

• Sepsis: diagnosis and management, American Family Physician 

Treatments

• I survived sepsis. What’s next?, Centers for Disease Control and Prevention (CDC)

• Sepsis: diagnosis and management, American Family Physician 

• Sepsis treatments and medications, SingleCare

• Septic shock, StatPearls

Scientific studies and clinical trials

• The Third International Consensus definitions for sepsis and sepsis shock (Sepsis-3), JAMA

More information on related health conditions

• What’s the difference between septicemia and sepsis?, Meningitis Research Foundation