Published online May 16, 2016. doi: 10.12998/wjcc.v4.i5.130
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
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.