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- the effects of endotoxins have been blamed for all the effects of Gm neg septicemia;
   - hyperpyrexia, vasoconstriction followed by vasodilation, ...
   - the initial clinical symptom of bacilemia is usually a shaking chill;
   - it is not unusual for the patient to initially have an elevated BP followed by a marked fall in blood pressure;
       - often drops to shock levels within 4 hrs;
   - leukopenia is not unusual but is followed shortly by a leukocyte count of 18,000 to 25,000;
   - shortly after the shaking chill, the temperature rises to 103 (39.4) to 104 (40.0) or even higher;
       - this is usually associatted with mental confusion;
   - the pt becomes severely hypovolemic and acidotic and has hyper-coagulation, cardiac stress, and depressed urine volumes due to renal
       tubular disassociation if this chain of events is not stop;
- renal shutdown may be bypassed by the use of diuretics (Lasix or Mannitol), provided a large amount of replacement fluid is given;
   - Lasix 40 mg IV or Mannitol in the form of Osmitrol 250 cc of a 10% sol. may be utilized

 Concepts in Emergency and Critical Care: Pathogenesis of Disseminated Intravascular Coagulation in Sepsis.

Concepts in Emergency and Critical Care: Effect of Stored-Blood Transfusion on Oxygen Delivery in Patients With Sepsis.

Concepts in Emergency and Critical Care: Reevaluation of the Role of Cellular Hypoxia and Bioenergetic Failure in Sepsis.

 Nitrogen oxide levels in patients after trauma and during sepsis.

Amino acid alterations and encephalopathy in the sepsis syndrome.

The effect of stress level, amino acid formula, and nitrogen dose on nitrogen retention in traumatic and septic stress.

Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study [see     comments.]

L-arginine pathway in the sepsis syndrome

Concepts in Emergency and Critical Care: Ventilator-Associated Pneumonia: A Multivariate Analysis.

Sepsis of the hip in paraplegic patients.

Colloid oncotic pressure and body water dynamics in septic and injured patients.