Nag DS, Chatterjee A, Samaddar DP, Singh H. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy. World J Clin Cases 2016; 4(5): 130-134 [PMID: 27182528 DOI: 10.12998/wjcc.v4.i5.130]
Corresponding Author of This Article
Dr. Deb Sanjay Nag, Associate Specialist, Department of Anaesthesiology and Critical Care, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831001, India. debsanjay@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 16, 2016; 4(5): 130-134 Published online May 16, 2016. doi: 10.12998/wjcc.v4.i5.130
Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy
Deb Sanjay Nag, Abhishek Chatterjee, Devi Prasad Samaddar, Harprit Singh
Deb Sanjay Nag, Abhishek Chatterjee, Devi Prasad Samaddar, Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
Harprit Singh, Department of Urology, Tata Main Hospital, Jamshedpur 831001, India
Author contributions: Nag DS, Chatterjee A and Singh H were responsible for management of the case, writing of the case report and research for the discussion; Samaddar DP was responsible for writing of the case report, final editing and research for the discussion.
Supported by Tata Main Hospital, Jamshedpur, India.
Institutional review board statement: Review board’s statement is not needed for case reports. Written permission is taken from the head of the institution for publication of the case report.
Informed consent statement: Written informed consent has been taken from the patient for the publication of the case report.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Deb Sanjay Nag, Associate Specialist, Department of Anaesthesiology and Critical Care, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831001, India. debsanjay@gmail.com
Telephone: +91-943-1166582 Fax: +91-657-2224559
Received: November 14, 2015 Peer-review started: November 16, 2015 First decision: February 2, 2016 Revised: February 24, 2016 Accepted: March 9, 2016 Article in press: March 14, 2016 Published online: May 16, 2016 Processing time: 160 Days and 3.4 Hours
Abstract
We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives.
Core tip: Postoperative sepsis can initially manifest as delirium only, with other florid manifestations developing later. When delirium is the only initial manifestation, it should be treated with haloperidol, and benzodiazepines are best avoided. Awareness that delirium can be the only initial presentation of sepsis, having a low threshold for its diagnosis after urological surgery and aggressive early management, can save lives.
