Q: I have noticed a trend: within an hour after patients with sepsis receive their first dose of an antibiotic appropriate for their infection, their blood pressure may decrease precipitously. This decrease has been explained as the antibiotic’s effect on the bacteria wall, lysing it and releasing the endotoxin that causes the cardiac depressant effect. The classic case is an emergency department report of stable blood pressure, but the first blood pressure measurement when the patient arrives in the intensive care unit is in the 70s. The nurse from the emergency department is surprised at the change, but nurses in the intensive care unit see this enough to insist that such patients have 2 working intravenous catheters before they leave the emergency department. We can’t find any literature that discusses this concern.

A: Thomas Ahrens, RN, PhD, replies:

Do antibiotics induce hypotension during sepsis? This interesting observation has been reported...

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