Sepsis Imposters: Don’t Be Fooled!

As nurses, we are trained to be on high alert for sepsis, but don’t be fooled! This episode covers sepsis imposters: the sneaky diagnoses that present similarly to sepsis but could prove deadly if misdiagnosed. Follow along as Dawn Carpenter, DNP shares real-life case studies that will help you identify the subtle clues that could make the right diagnosis… and potentially save a life.

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Important Clinical Concepts

Leukemoid Reactions

A leukemoid reaction is an increase in the WBCs, which can mimic leukemia. The reaction is due to an infection or another disease and is not a sign of cancer (e.g. trauma, surgery).

Sepsis Imposters


  • How it can mimic sepsis: leukocytosis, low grade fever, tachypnea, hypoxia
  • Prevention: pulmonary toileting (incentive spirometer), early mobilization, postural drainage
  • How to differentiate from true sepsis:
    • Timing: Atelectasis commonly occurs 12-48 hours after surgery or acute event
    • Will appears on chest x-ray, CT, or ultrasound

Malignant Hyperthermia

  • How it can mimic sepsis: fevers, tachycardia, hypoxia, hypotension
  • Treatment: Dantrolene, aggressive cooling measures
  • How to differentiate from true sepsis:
    • Extremely high fevers
    • Masseter spasms, generalized muscular rigidity
    • Occurs rapidly after surgery (offending agents can be Succinylcholine, Halothane, ether, desflurane, sevoflurane, isoflurane)

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Seratonin Syndrome

Increased serotonergic activity in both the peripheral and central nervous systems. The classic triad of symptoms includes neuromuscular abnormalities, autonomic hyperactivity, and mental status changes. It is usually triggered by two or more serotonergic medications.

  • How it can mimic sepsis: fevers, tachycardia, tachypnea
  • Prevention: Make sure that your patient’s home medications are documented
  • Treatment: Stop offending agents, Cyproheptadine (Serotonin agonist)

Neuroleptic Malignant Syndrome (NMS)

A rare but potentially life-threatening neurological disorder that can be triggered by the use of certain medications, particularly antipsychotic drugs. It is considered a severe adverse reaction to these medications. Haldol is implicated in 44% of all NMS patients.

  • How it can mimic sepsis: fever, tachycardia, tachypnea
  • Treatment
    • Stop offending agents
    • Bromocriptine or Amantadine (increase dopamine activity to counteract the dopamine depletion)
    • Dantrolene (to help alleviate the severe muscle rigidity)
    • Benzodiazepines
  • How to differentiate from true sepsis: NMS presents with severe muscle rigidity, tremors, and autonomic dysfunction (fluctuations in blood pressure, heart rate, and diaphoresis)

Acute Myeloid Leukemia (AML)

A blood cancer that affects that is characterized by the rapid and uncontrolled growth of abnormal myeloid cells — a type of white blood cell that is responsible for fighting infections.

Important note: Patients with AML are more susceptible to infections. These infections may trigger sepsis in a person with AML.

  • How it can mimic sepsis: Leukocytosis, fever, hypotension, fatigue
  • Diagnosis: Manual differential of CBC, bone marrow biopsy
  • Treatment: Chemo
  • How to differentiate from true sepsis: Hyperleukocytosis, patient not responding to antibiotics


  • How it can mimic sepsis: Fever, tachycardia, tachypnea
  • Diagnosis: Patient history, urine tox
  • Treatment: Benzodiazepines
  • How to differentiate from true sepsis: Restlessness, severe anxiety, hallucinations, delusions