A 72-year-old woman is brought to the emergency department from a nursing facility due to fever, chills, and hypotension. The patient has a history of diabetes mellitus, ischemic stroke, and neurogenic bladder. She has an indwelling urinary catheter. Temperature is 38.8 C (102 F), blood pressure is 80/40 mm Hg, and pulse is 130/min. The patient is lethargic and disoriented. Her extremities are warm, and her breathing is rapid and shallow. Lungs are clear on auscultation and there are no heart murmurs. There is left costovertebral angle tenderness. The urine in her catheter appears cloudy. Her leukocyte count is elevated with left shift, and urinalysis shows pyuria and bacteruria. Which of the following chemical mediators is most responsible for this patient's current condition?

Question

A 72-year-old woman is brought to the emergency department from a nursing facility due to fever, chills, and hypotension.  The patient has a history of diabetes mellitus, ischemic stroke, and neurogenic bladder.  She has an indwelling urinary catheter.  Temperature is 38.8 C (102 F), blood pressure is 80/40 mm Hg, and pulse is 130/min.  The patient is lethargic and disoriented.  Her extremities are warm, and her breathing is rapid and shallow.  Lungs are clear on auscultation and there are no heart murmurs.  There is left costovertebral angle tenderness.  The urine in her catheter appears cloudy.  Her leukocyte count is elevated with left shift, and urinalysis shows pyuria and bacteruria.  Which of the following chemical mediators is most responsible for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Tumor necrosis factor-alpha is released from activated macrophages and is one of the most important mediators of the systemic inflammatory response in sepsis.  Other cytokines responsible for inducing the systemic inflammatory response include IL-1 and IL-6.

A 72-Year-Old Woman Is Brought to the Emergency Department from a Nursing