Low Blood Pressure and a Fever: Think About Sepsis

The combination of low blood pressure and a fever is very concerning for sepsis, a potentially life-threatening condition. I have personally treated many patients who were critically ill from sepsis. If sepsis is recognized and treated early, patients do very well. If you don’t recognize sepsis and wait too long before seeking help, you may already have life-threatening complications from sepsis.

In this article, you will learn why it is so important to pay attention to low blood pressure with a fever. You will also learn the basic symptoms of sepsis and find out who is at risk.  You will also learn why sepsis with low blood pressure and a fever needs hospitalization. When you are finished reading, I hope you will think about sepsis and seek help whenever you encounter low blood pressure and a fever.

What is sepsis? Why is it important to recognize the combination of low blood pressure and a fever?

When your body gets overwhelmed trying to fight an infection, it goes into a state of stress. This bodily stress is sepsis. A fever is an important indicator of an infection. To have sepsis, you need to have an infection. When your blood pressure starts to go down during sepsis, it is a definitive sign that your body is overwhelmed and may crash anytime without urgent intervention.

Symptoms of sepsis are usually present with the symptoms of the infection that caused the sepsis. It can be difficult to separate those symptoms. However, there are some common symptoms most patients with sepsis experience. I am not putting low blood pressure and fever on this list because you have heard enough of them by now.

Here are some other common signs and symptoms of sepsis:

  1. Feeling extremely weak
  2. Feeling dizzy or lightheaded
  3. Confusion and disorientation
  4. Feeling cold and clammy
  5. Excessive sweating
  6. Rapid heart rate
  7. Unstoppable shivering
  8. Fast breathing
  9. Restlessness and extreme discomfort throughout the body
  10. Fainting or feeling like you are fainting

If you see any of these symptoms together with low blood pressure and a fever, you need to call 911 and get yourself or your loved one evaluated in the emergency department right away. Medical societies and hospital committees keep reminding doctors to look for and recognize symptoms of sepsis early so that they can save more lives.  However, unlike a stroke or heart attack, there are not many public education campaigns to raise awareness about sepsis. If you don’t get anything else from reading this article, you can still save lives by telling your friends and families not to ignore low blood pressure and a fever.

Infographic showing the relationship between low blood pressure, a fever and sepsis
Low Blood Pressure and a Fever: Think Sepsis.

Who is at risk for sepsis?

Anyone can have sepsis, but if you fall into one of the following categories, your risk for sepsis is significantly higher than other people. If you are in this category and you have a fever, it is important to check your blood pressure to make sure you don’t have the combination of low blood pressure and a fever.  If you have any of the conditions listed below, it might be a good idea to keep a simple blood pressure machine at home. You can buy automated ones at your local pharmacy.

Here is the list:

  1. You are getting chemotherapy for cancer
  2. You were recently hospitalized for a serious illness
  3. You had a recent, major surgery
  4. You are on medications that lower your immune response
  5. You have untreated HIV infection
  6. You have uncontrolled diabetes
  7. You have underlying serious heart or lung problems
  8. You have decreased mobility
  9. You are older and weaker
  10. You are on regular dialysis for kidney failure

Do you need hospitalization for low blood pressure and a fever?

Yes, you will be hospitalized most of the time if you have low blood pressure and a fever. Only a very small percentage of people with low blood pressure and a fever are discharged home from the ER after treatment.

What to expect when hospitalized for low blood pressure and a fever?

The treatment for your low blood pressure and fever starts in the ER. As soon as they check your blood pressure and confirm a low reading, they will start the sepsis protocol if you have a fever or other signs of infection. Any blood pressure reading below 90/60 will trigger the response. If you are not familiar with blood pressure readings, the upper number is called the systolic pressure and the lower number is called the diastolic pressure. Any one of the numbers below the threshold is a cause for concern. Low blood pressure from sepsis is usually also accompanied by a high heart rate.

They will place an IV line and start pumping IV fluids into your veins. You will be hooked up to a heart monitor and they will watch your heart rate and oxygen levels closely as they continue to run the IV fluids. They will also get you started on IV antibiotics based on the type of infection that caused your sepsis.

If you have low blood pressure and a fever but they do not know where the infection is, they may order a CAT scan to look for a possible source of the infection. They will draw blood and send it to the lab for testing. They will also collect your urine sample for testing.

After initial treatment in the ER, they will transfer you to the medical floor of the ICU. When you are being hospitalized for low blood pressure and a fever, you may be transferred to the general medical floor if your blood pressure improves after treatment in the ER.  If your blood pressure remains low despite treatment, you will be transferred to the ICU. 

Treatment of low blood pressure and fever on the regular medical floor

Your blood pressure has to be stable and improving in order to continue treatment on the medical floor. If your blood pressure goes low again, they will transfer you to the ICU right away. They will continue IV fluids and IV antibiotics and check your vital signs frequently. You will be hospitalized until your fever comes down. They may monitor you in the hospital for 24 hours or more after the last fever. If everything looks good after that, you may go home on antibiotics.

Treatment of low blood pressure and a fever in the ICU

Treatment of low blood pressure and a fever in the ICU is very different from the treatment of low blood pressure and a fever on the medical floor. You will get more invasive procedures and monitoring in the ICU. Sepsis with low blood pressure and a fever is a life-threatening condition and you may need life support devices. If your oxygen is low or your breathing is compromised, you will be placed on a ventilator. You will also get strong medications through your IV line to artificially bring your blood pressure up. These measures will continue until your blood pressure improves and remains stable. Despite everything, some patients admitted to the ICU for low blood pressure and a fever do not make it and succumb to the sepsis. The estimated number of people that die in any given year from sepsis varies based on different data, but is estimated to be at least more than 250,000 people a year.

In conclusion, the combination of low blood pressure and a fever is very concerning for sepsis. Sepsis is a treatable but life-threatening condition. Early diagnosis and treatment makes a great difference in the outcome of patients with sepsis.