Chameleon condition: A reflection for Sepsis Month

By Hesham Hassaballa, MD, FCCP, FAASM | Associate Regional Medical Director for Critical Care 

A patient arrives at the hospital emergency department complaining of a fast, irregular heart rate. Her symptoms present as a type of cardiac arrhythmia known as rapid atrial fibrillation. She’s admitted to the hospital and immediately started on heart rate-reducing medication.  

It’s not working — her heart rate speeds further. Even after more heart-reducing medication is prescribed, nothing can get her heart under control. After being transferred to the ICU, medication now being given continuously, she suddenly develops shock. One by one, her organs fail, and she passes away.  

Her diagnosis? Septic shock from an unrecognized infection.  

September is Sepsis Awareness Month. Sepsis is the No. 1 diagnosis we see in the ICU as critical care clinicians and one of the top killers of patients admitted to the ICU every single year. 

What is essential to remember about sepsis — and what makes it so dangerous — is that patients don’t check themselves into the hospital saying, “I have sepsis.” Rather, they describe their symptoms with phrases like “I’m weak,” “I’ve been vomiting,” or, like our patient described above, “My heart is beating strangely fast and irregularly.” 

While it was known that she had myelodysplastic syndrome, a condition that weakens the immune system and renders patients vulnerable to life-threatening infections, her sepsis manifested as rapid atrial fibrillation, and our treatment came too late once the real issue came to light.  

As clinicians, we must always have a high index of suspicion for sepsis and be on the lookout for this great chameleon of life-threatening diseases. The sooner we suspect a patient has sepsis, the sooner we can aggressively intervene. If we miss the diagnosis or are too late with fluid resuscitation or antibiotics, it can become impossible to stop the horrifying cascade of organ failure that ultimately claims the lives of so many patients worldwide.  

Given that sepsis is the most common condition we care for in the ICU, every program in our practice discusses sepsis care in its quarterly performance reviews. And we lend our decades of expertise to our hospital partners to improve outcomes for patients afflicted with this terrible disease.  

Sepsis is one of those conditions that keeps critical care clinicians honest: it rarely presents in a typical fashion, which is why during Sepsis Awareness Month — and every other month — we must always keep sepsis in the forefront of our clinical minds.