pseudosepsis

Within last two weeks, I have diagnosed and treated 3 H1N1 pneumonia with ARDS. One who is severely obese (BMI>60), one pregnant lady who just had LSCS due to fetal distress and then a student who presented as acute exacerbation of bronchial asthma eventhough the last attack was more than 15 years ago. I used fluid restriction strategy with frusemide to keep even balance, according to FACTT trial and ARDS net ventilation strategy but with initial PEEP of 14-16cmH2O.
I have noticed in one patient, the WCC rised to more than 30,000 but her cultures were all negative. Anyway, I'd changed all of her lines. Her condition was alway stable with only low grade fever.
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Pseudosepsis
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Conditions that mimic sepsis
Common disorders:
1. Diuretic induced hypovolemia
2. Acute GI hemorrhage
3. Acute PE
4. Acute MI
5. Acute (oedematous/necrotic) pancreatitis

Uncommon disorders:
1. Diabetic ketoacidosis
2. SLE flare
3. Relative adrenal insufficiency
4. Rectus sheath hematoma

Several conditions may present with acute abdominal pain accompanied by fever, leukocytosis with a left shift and hypotension mimicking intra-abdominal sepsis. Such patients may have SG catheter readings that are compatible with sepsis. These medical disorders include diabetic crisis in diabetic ketoacidosis, luetic crisis in patient with syphilis, right rectus syndrome in patients with EBV infectious mononucleosis, rectus sheath hematoma, acute porphyria, SLE flare involving the peritoneum, acalculous cholecystitis due to vasculitis, dissecting AAA, splenic rupture, and pseudoappendicitis due to yersinis enterocolitica or other organism. These medical mimics of acute intra abdominal sepsis are serious disorders, many of which have specific treatments.
The correct presumptive diagnosis is essential for effective therapy of sepsis as well as in the disorders mimicking sepsis.