Pharmacokinetics in sepsis

Sepsis is a heterogeneous syndrome caused by a dysregulated host response to systemic infection whereby uncontrolled pro- and anti-inflammatory processes lead to tissue injury, immune suppression and organ dysfunction.1 The response to sepsis has profound effects on many physiological processes and body systems. These can have significant effects on absorption, distribution, metabolism and elimination of drugs, with potential implications for treatment regimens and the incidence of adverse effects. Furthermore, these adverse effects may be increased or decreased by our therapeutic interventions. In addition to requiring treatment in critical care, many patients with sepsis undergo anaesthesia and surgery. This article reviews the pathophysiology of sepsis in relation to its effects on the pharmacokinetics of the drugs commonly used in anaesthesia and critical care. This is needed to predict pharmacodynamic effects, ensure correct dosing and avoid harm. Altered pharmacokinetics in sepsis also has implications for drug-drug interactions but this is outside the scope of this article.