In April, I covered delirium and noted that there are many underlying etiologies that can cause it. One such etiology is infection.

Infection and our body

Our bodies are constantly fighting infections. Our skin is the first barrier, but we are often exposed to pathogens through open wounds, our respiratory system, or our mouths. Most infections can be thwarted by our normal immune response, but once the pathogen enters the bloodstream and becomes a systemic infection or sepsis, it is much harder to fight. Healthy patients may need antibiotics to fight these infections, and patients with risk factors may require more aggressive treatments. In the most extreme cases, patients may be hospitalized and require IV antibiotics and life-sustaining measures until the infection resolves.

What is sepsis?

In the simplest terms, sepsis is an infection that is widespread through the body and affects the functioning of our organs. The kidneys, brain, heart and lungs are commonly affected.

How can infection cause delirium?

According to Dittrich et.al. (2016), the incidence of delirium in critically ill patients runs between 50-80%. The presence of the pathogen causes a systemic inflammatory response that wreaks havoc in our brain. The blood has a difficult time getting where it is supposed to go and the influx of cells that respond as part of the immune response cause the brain to malfunction.

How fast does delirium set in?

Delirium can set in within a few hours or can take several days. Elderly people are at significant risk for a rapid onset of symptoms. It is not uncommon for family members to bring a patient into the ER with confusion and say “they were fine 2 hours ago,” then find out that they have a urinary tract infection.

How does this apply to criminal cases?

I have seen cases where an elderly patient died of sepsis and the family member was charged with negligent homicide. It is important to have a medical professional provide education on how quickly a patient can deteriorate from what is a seemingly minor infection.


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