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General Surgery · CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)

Treatment of sepsis

Sepsis

Sepsis treatment is based on a combination of etiotropic and pathogenetic approaches. Intensive care is administered for a prolonged period, until complete restoration of homeostasis and achievement of a sustained improvement in the patient's condition.

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Infusion volume50–60 ml/kg/day
Target diuresisAbout 3 L/day
Nutrition4000–5000 kcal/day
Protein1–1.5 g/kg per day
2 min readFor medical studentsUpdated Sep 20, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Detoxification and infusion therapy

Combating toxemia is one of the key stages of treatment. The main detoxification method is forced diuresis, with urine output reaching about 3 liters per day. Furosemide and mannitol are used to stimulate diuresis.

The infusion program involves the administration of 50–60 ml of fluid per kilogram of the patient's body weight. The infusion regimen includes:

  • Polyionic solutions and saline mixtures.
  • 5% dextrose solution.
  • Dextran (average molecular weight 50,000–70,000).
  • Specific mixtures (e.g., a combination of povidone, sodium, potassium, calcium and magnesium chlorides, and sodium bicarbonate).

If necessary, extracorporeal blood purification methods are used: plasmapheresis, hemofiltration, or hemoperfusion.

Transfusion therapy and homeostasis correction

Transfusions aim to restore acid-base balance (ABB) and electrolyte balance. The following are used for correction:

  • For alkalosis — 1% potassium chloride solution.
  • For acidosis — 5% sodium bicarbonate solution.

To compensate for protein losses, amino acid solutions, protein, albumin, as well as dry and fresh native blood plasma are used. If anemia develops against the background of sepsis, regular transfusions of packed red blood cells or fresh stored blood are indicated.

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Nutritional support

Patients with sepsis require a high-calorie diet providing 4000–5000 kcal/day. Protein requirement is 1–1.5 g per kilogram of body weight. The diet must include vitamins, fresh vegetables, and fruits.

Enteral nutrition is the priority (if the gastrointestinal tract functions normally). In cases where independent food intake is impossible, the patient is switched to total or supplemental parenteral nutrition.

Immunotherapy and glucocorticoids

Immunotherapy is selected depending on the stage of the process and the state of the immune system:

  • Specific: antistaphylococcal plasma, immunoglobulins (IgG + IgA + IgM).
  • In cellular immunity suppression (decreased T-lymphocytes): thymus preparations, leukocyte mass transfusion, interleukin-2.
  • Passive immunization is indicated for acute sepsis, whereas active immunization (toxoids, autovaccines) is indicated for chronic sepsis or during convalescence.

Glucocorticoids are used primarily as replacement therapy (following hormonal status assessment). In the event of bacterial-toxic shock, high-dose prednisolone is prescribed for a short course (2–3 days) (500–800 mg on the first day, then 150–50 mg/day). To manage allergic reactions, 100–200 mg/day is sufficient.

Class and exam questions

What volume of infusions is indicated for a patient with sepsis?

On average, the infusion program is calculated based on 50–60 ml of fluid per kilogram of body weight per day.

How is acid-base balance corrected?

In alkalosis, a 1% potassium chloride solution is administered, while 5% sodium bicarbonate solution is used if acidosis is detected.

In which cases is active immunization used in sepsis?

Active immunization (e.g., with toxoids or autovaccines) is used in chronic sepsis or during the convalescence stage after acute sepsis.

Why are proteolysis inhibitors used in sepsis?

Proteolysis inhibitors (e.g., aprotinin) are used due to high levels of kininogens, as kinins play a significant role in microcirculation disorders.

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What else to study on this topic

  • Diagnostic criteria for bacterial-toxic shock
  • Mechanisms of microcirculation disorders induced by kinins
  • Indications for extracorporeal detoxification methods (plasmapheresis, hemadsorption)
  • Features of parenteral nutrition in severe multiple organ dysfunction syndrome
  • Symptomatic treatment of sepsis: anticoagulants and cardiotonic agents

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Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

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The entire section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

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