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• ALT 2× upper limit of normal for age
TABLE 10.3
RECOMMENDED LABORATORY TESTING IN SUSPECTED SEPSIS
Source testing • Blood culture
• Urinalysis, urine culture
• Consider other cultures based on suspected source (e.g.,
lumbar puncture, drainage of abscess, or fluid collection)
• CXR and other focused radiologic studies
• Influenza and other viral testing
• Consider procalcitonin, C-reactive protein as biomarkers for
presence of infection
Perfusion
• Lactate
• Base deficit
• Central venous oxygen saturation (ScvO2 )
Respiratory
Hematologi c
Renal
Hepatic

• Blood gas if clinically indicated
• Complete blood count
• Coagulation studies (PTT, PT/INR, fibrinogen, d-dimer)
• Serum creatinine
• Transaminases (ALT, AST)
• Bilirubin
• Albumin

There have been efforts to determine whether additional laboratory testing
including white blood cell count, immature neutrophils, C-reactive protein (CRP),
and procalcitonin may have predictive value for sepsis in children with

compensated shock. Increased procalcitonin has been associated with an
increased likelihood of bacterial infection and septic shock. While these
biomarkers may suggest a patient is more likely to require treatment for bacterial
sepsis, optimal thresholds and their clinical utility have yet to be demonstrated
rigorously. Increasing evidence shows that both venous and arterial lactate levels
in the ED are associated with risk of organ dysfunction in pediatric sepsis and risk
of death at the time of pediatric intensive care unit (PICU) admission. While the
optimal cutoff remains to be defined, lactate ≥2 mmol/L is worrisome and
associated with worse outcome.