I suspect sepsis - have I been fobbed off?

[teamaven]

I called an ambulance for my 5 year old daughter this morning (who is never ill and I’ve never phoned an ambulance so to me it was serious). She woke up at 1:30am screaming and crying that her lower left side hurt. She said she couldn’t move and wouldn’t settle all night despite us thinking she’ll be fine and trying to go back to sleep - then started complaining of a headache at the back of her head and her temp went up to 39.9.

She was extremely hot to the touch, a bit confused and lethargic so I panicked and called an ambulance. After an hour of Neurofen her temp went down to 38.4 and stayed like that for a couple of hours.

I suspected a urine infection (possibly that had developed into sepsis!) because she has had one before and her pull up (she’s still in them at night) was so heavy and absolutely reeked. Her urine test showed signs of infection so the doctor agreed it was probably an infection that had travelled up.

Now, I did ask him to do a blood test anyhow and he said it wouldn’t show anything, but would it not show how bad the infection is ie sepsis? He sent us home with 10 days oral antibiotics and daughter is asleep now but I’m scared that based on her symptoms it was much worse than just a urine infection? The very high temp, lethargy, confusion, headache?

Can anyone provide what the usual pathway is when a child comes in with those symptoms? I feel like we shouldn’t have been sent home - at least to be observed over a few hours?

Honestly if you think something is up take her to a and e. You are probably being paranoid but you know what you pay your taxes it’s your NHS.

I know that, but anyone reading your post with a relative with sepsis might not and be devastated.

The source of her pain is a nasty UTI. Hopefully a couple of doses of antibiotics and she'll perk up. Don't forget to keep her on regular painkillers too.

A blood test won't show sepsis.

There is no clear indicator if a patient is septic or not.

As health care professionals we never look at one number or indicator we look at the whole picture

It does sound like your little one is really quite poorly, I hope she improves soon!

What advice did the doctor give you about the next 24 hours or so?

Generally (I am not a doctor!), once the antibiotics and analgesia go in, you wouldn't really expect them to deteriorate further or develop new symptoms. So if she is getting worse then I would not hesitate to call 111 for advice, or 999 if she is becoming very seriously unwell with red flag symptoms.

My friend presented at A&E. Can't remember what for, but they took bloods. He seemed fine and was about to go home when the blood work came back. He had sepsis. Infection markers were through the roof. The medical practitioner was very surprised as that's not how he was presenting.
Anyway, it was the result of the blood work that triggered his treatment (two weeks of intravenous antibiotics).
If you are thinking about taking your daughter to A&E, I'd do it. Better to be safe than sorry.

This is absolute rubbish. Sepsis is not diagnosed from a blood test alone.

In my country she would get her infection markers checked with a fingerprick test as a matter of course

Which country?
The child in question has an infection, hence a course of antibiotics.....so a blood test would show what? An infection....what's already being treated......

Once again, Sepsis, isn't diagnosed from a blood test, or one marker, or one result, it is diagnosed by looking at the bigger picture and assessing treatments and responses.

First of all UTI can cause sepsis

second it is not clear if they assessed her for appendicitis?

Any infection can cause sepsis.

How do you know what they have assessed her for, were you there?

OP, if you are worried just take her back and trust your instinct. A UTI shouldn't mean she can't lift her head.

There is something called Martha's Rule but you have to be in hospital and condition deteriorating rapidly.

Your condition doesn't have to be deteriorating rapidly to ask for a review under Martha's law.

Your condition doesn't even have to be deteriorating.

As a carer, relative, member of staff, anyone can ask for a review or a second opinion under Martha's.

However not all hospitals have a a team responding to those calls. Its an initiative that's being rolled out.

I’ve had terrible utis with and without then developing sepsis.

Did they do basic obs on her? If they did and they are fine then I’d expect them to send you home with safety netting advice.

A temp that high will cause a headache. And a kidney infection will make you feel pretty rough. If she gets worse after starting to take the antibiotics or they aren’t working at all after 24hrs then she needs to be seen again by somebody. Otherwise, keep her fluids up and make sure she is still passing urine and carry on with the antibiotics.

Agree!!!! A blood test will definitely show sepsis!! CRP, white cells and neutrophils and other results will be through the roof!!!
i was told by the Paediatric assessment unit my son just had gastritis and we were sent home, I asked for a blood test but they didn't do it. During the night he became delerious, high temperature and had the "sepsis smell" (very sour smell). He went straight back in and the bloods showed a CRP in the 200s (it's a marker of inflammation that's meant to be under 5). Turned out he had a ruptured appendix and had emergency surgery there and then.
I don't want to frighten you OP but definitely go back immediately if things don't get better/deteriorate. It's good she's on oral antibiotics but if they don't help she may need admitting for IV antibiotics.

It isn’t diagnosed by blood work alone but as a consultant once said to me ‘you’re young, you can look ok until you are suddenly not.’ It forms part of the picture sometimes it’s a bigger part than others if the body is compensating.

Kidney infections can make you feel absolutely awful. I had one with such a bad fever that I was hallucinating. Antibiotics tend to give some improvement within 24 hours and a lot of improvement within 3 days. I would see how she is tomorrow. She has been checked by a medical professional and they have ruled out sepsis, tbf it doesn’t sound like she has the usual symptoms such as not passing urine

The OPschild has a known infection. Those markers will be high anyway. A CRP of 200 is high but doesn’t necessarily indicate sepsis you could get that with bacterial infection without sepsis. Hence the whole picture needing to be taken into account.

Sepsis usually one of the symptoms is reduced urine output as the infection is widespread and affects other organs.

If your concern is there isn’t a UTI and something has been missed then trust your judgement and get her seen again if you need to. I presume they listened to her chest, palpated her tummy, checked all her other observations?

Trust your judgement.

I think temp going down is a good sign. I dont think it does with sepsis.

If you are in any way worried read Martha Mills story and ask for a second opinion under Martha's rule.

Finland. They do the test as if its elevated over a certain level it indicates the infection has likely gone into the kidneys which requires a longer course of antibiotics than for a UTI. Very high levels are associated with sepsis (sepsis isn't the only cause of very high CRP levels but when combined with other symptoms it is a very good indicator). Its also very useful to have a CRP measurement prior to commencing treatment as if the patient doesn't seem to improve checking CRP levels again can indicate if the treatment is working or not. The test also often measures white blood count too, which is another useful indicator.

Did they do observations, ie pulse, blood pressure, sats, resp rate? If so then she can’t have had a high enough PEWS score to need a sepsis bundle otherwise they’d have done one.

A blood test will not show sepsis.

They would have assessed her vital signs and assessed her as fit to go home.
It might be worth you counting her heart rate and logging alongside temperature, and blood pressure if you have a machine (long shot).

Did they tell you what to look for e.g sucking in chest, mottled skin, confusion?

Is she getting worse? If so go back or call for advice. She will need a few doses of antibiotics in her to see a big difference