Biomarkers In Sepsis | Clinical Nursing Classroom – Makeupclass

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Sepsis is considered a global health burden with a significant economic impact. 

Overall, sepsis is associated with substantial hospital mortality of 25%-30% globally, which increases to 40%-50% in patients with complications and in lower-income countries. 

An estimated 30 million cases of sepsis each year result in more than 8 million deaths

In the United States alone, spending on sepsis was estimated at US $20 billion (5.2% of hospital costs) in 2011 (Canadian Medical Association, 2017).

Infection prevention and control, early detection and immediate infection treatment are crucial in tackling sepsis.

Sepsis can be defined as a dysregulated systemic host response to the presence of infection which could result in life-threatening organ dysfunction. 

“Lactate levels should be kept below 2mmol/L in sick patients, especially the critically ill.” 

Therefore, it is imperative to identify infection early and initiate treatment immediately to prevent the negative progression of sepsis to severe sepsis and eventually septic shock

Sepsis biomarkers are tools or characteristics that help to pick and measure ongoing infectious processes in the body and their severity, even when the host has not yet presented obvious signs and symptoms of infection. 

They also help to evaluate the effectiveness of pharmacological intervention and guide the initiation, continuation or termination of antibiotics therapy. 


Lactate is an end product of anaerobic respiration. 

High blood lactate is due to an imbalance between lactate production and clearance. 

The liver and kidneys are primarily responsible for lactate clearance in the body. 

So any damage to these organs will cause lactate build-up in the body system. 

In times of stress, the oxygen requirement of body tissues outweighs the oxygen delivery, which can lead to tissue hypoperfusion

This process induces a switch from aerobic to anaerobic metabolism, causing lactate to build up.

Since sepsis poses oxidative stress on the body, a high lactate level can also be a pointer to determining the presence of infection, provided other factors that can cause elevated lactate (such as dehydration, malignancy, liver disease, mitochondria disorder, etc.) have been ruled out. 

Monitoring lactate levels can also provide valuable information regarding a patient’s response to therapy. 

Lactate levels should be kept below 2mmol/L in sick patients, especially the critically ill. 

Several studies have associated high lactate levels with increased mortality. 

C-Reactive Protein (CRP)

CRP is a protein produced majorly in the liver. 

Its level increases significantly during acute inflammation, hence its use as a well-established biomarker of infection (bacterial or viral) and inflammation. 

Although its low specificity may be a primary drawback as a biomarker of sepsis in adults, it is commonly used to screen for early-onset sepsis (occurring during 24 hours of life) because its sensitivity is generally considered very high in this period. Target CRP level <10mg/dl.

Procalcitonin (PCT)

PCT is normally produced by the parafollicular cells of the thyroid but can also be produced by the neuroendocrine cells of the lung and the intestine in response to proinflammatory stimuli.

PCT is a biomarker used to predict the likelihood of a patient having a bacterial infection and how severe that infection might be. 

Its specificity makes it more reliable than CRP.

There is a need to balance the urgency of initiating antibiotic therapy with the imperative of avoiding injudicious antibiotic use (antibiotic stewardship). 

Monitoring PCT levels shortens the patient’s exposure to antibiotic therapy and, consequently, the length of hospital stay.


Kang HE and Park DW. Lactate as a Biomarker of Sepsis. Infection and Chemotherapy Journal. 2016; 48(3): 252-253.

Dugani S, Veillard J and Kissoon N. Reducing the global burden of sepsis. Canadian Medical Journal. 2017; 189(1): E2-E3.

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The National Drug Dosage Calculation Competition For Nurses (2023)

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Hurry! You have 30 minutes .

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NDDCCN Stage One

This is the stage one of the NDDCCN 2023. Best of luck.

Enter the same details you used during ID submission. If it is different, your answers will be nullified.

1 / 30

1. The MD orders your patient to start an IV Heparin drip at 16 units/kg/hr and to administer a loading bolus dose of 60 units/kg IV before initiation of the drip. You’re supplied with a Heparin bag that reads 12,500 units/250 mL. The patient weighs 198 lbs. What is the flow rate you will set the IV pump at (mL/hr)?

2 / 30

2. The doctor orders a Dobutamine infusion to be started at 10mcg/kg/min. The patient weighs 180lbs. You are supplied with a 250mL bag of Dobutamine that reads 2mg/ml. How long will it take for the Dobutamine infusion to complete?

3 / 30

3. A pediatric patient has a body surface area of 1.03 square meter. The physician orders an IV medication that has a normal adult dose of 50 mg. Round off to the nearest whole number

4 / 30

4. A pediatric patient is 80 lbs and 4 feet 9 inches. The physician orders an oral medication that has a normal adult dose of 50 mg. What dose will be given to the patient? Round to nearest whole number

5 / 30

5. You have on hand ergocalciferol (Calciferol) liquid 8000 units/2 mL. Your order reads ergocalciferol 220,000 units PO daily. How many ml should you prepare the correct dose?

6 / 30

6. The doctor orders a 500 ml bag of Normal Saline to infused at 20 gtt/min. The drip factor is 10gtt/mL. You start the IV infusion at 0500 hours. At what time will the infusion be complete?


7 / 30

7. A patient admitted with a head injury has been ordered for D5NS at 25ml/h. The IV tubing has a calibration of 10gtt/ml. What is the correct rate of flow for this patient?

8 / 30

8. A health care provider prescribes Ondansetron (Zofran) 8 mg p.o. after meal; Available: Zofran in a 100 ml bottle labeled 4 mg/tsp.; How many ml will the nurse administer after lunch?

9 / 30

9. What is the maximum safe daily dose to be administered to baby Sola whose doctor orders Zithromax. The safe dose range for this medication is 11-13 mg/kg/day and weight = 90 lbs

10 / 30

10. A patient is ordered to start an IV Dopamine drip t 5mcg/kg/min. The patoent weighs 180lbs. You have a bag of Dopmine that reads 400mg/250ml. What will you set the Iv pump drip rate (ml/hr) at?

11 / 30

11. A 12-year-old child was admitted to the emergency department because of an asthma attack. Upon assessment, you found out that the child’s weight measures 82.4 lbs. The primary care provider ordered 2 mg/kg of methylprednisolone (Solu-Medrol). The available stock dose is 125 mg/2mL. How many cubic centimeters will the nurse administer?

12 / 30

12. Calculate the dose of vincristine in ml for a four years old boy with leukemia weighing 37 lb and is 97cm tall. The dose required is 2 mg/m^2 and the drug comes in 1 mg/ ml. Round off to 1 decimal place

13 / 30

13. The primary healthcare provider (PHCP) prescribes ½ gram of acetaminophen, by mouth, every six hours. The nurse has administered 3 doses. How many total milligrams has the client received?

14 / 30

14. An infant weighs 2.5 kg. What is the required amount of fluid per day?

15 / 30

15. A 52 year old man was prescribed 1/4L of Dextrose b.d. How many ounces (oz) of fluid will the man receive daily

16 / 30

16. Your patient has an order to infuse 100ml of D51/2NS with 40 MEq of KCl over the next 60 minutes. The set calibration is 15gtt/ml. What is the correct rate of flow for this patient? 

17 / 30

17. A patient is receiving fluid from two IV lines. One line is running at 65ml/h; the other at 70ml/h. What volume of fluid would the patient receive via IV over 12 hours?

18 / 30

18. A child is prescribed erythromycin. The recommended dosage is 40 mg/kg/day, 4 doses daily. If the child’s weight is 15 kg, calculate the size of a single dose.

19 / 30

19. You have an order to administer heparin sodium IV at 500 units per hour. It is supplied by your pharmacy as 25,000 units in 250ml of D5W. For how many milliliters per hour should you program the controller?

20 / 30

20. You have enoximone 100mg in 100ml, and the rate at which the pump is running is 30ml/h. What dose is the pump delivering in mcg/kg/min. (patient’s weight = 96kg)

21 / 30

21. The physician ordered 12.5 ml of antacid. The label reads 200 mcg/tsp. How many mg are contained in the dose?

22 / 30

22. A nurse practitioner prescribes clindamycin (Cleocin) Oral Susp 1200 mg po qid; Directions for mixing: Add 4 oz of water and shake vigorously. Each 2.5 mL will contain 50 mg of Cleocin. How many tsp and tbsp of Cleocin will you administer in the ratio 1 to 1 respectively?

23 / 30

23. Physician’s order says “ Infuse Regular Insulin at 6 units/hr”. You are supplied with an IV bag of the prescribed medication that reads “125 units per 250mL.” What will you set the infusion pump at (mL/hr) so your patient will receive 6 units/hr?

24 / 30

24. A nurse administered 11 mls of a drug to a patient after reading the physician’s prescription of 1.25 mg/lb. The label of the drug read 15 mg/ml. What is the weight of the patient in kilograms?

25 / 30

25. A pediatric patient is ordered a medication dose of 100mg/m^2 a day by mouth for 5 days. The patient weighs 55 lbs and is 4 feet 5 inches tall. What’s the daily dose of medication he will receive ? Round off to 1 d.p

26 / 30

26. The Doctor orders Amoxil for a child that weighs 30 kg. The safe dose range for this medication is 50 mg/kg/day every 8 hours. Calculate the milligram for a single dosage

27 / 30

27. 500 mL of Packed Red Blood Cells is to be administered over 4 hours to a patient diagnosed with anemia, how many ml/hr will you administer the blood transfusion?

28 / 30

28. The nurse receives a prescription from the primary healthcare provider (PHCP) for 0.375 mg of digoxin intravenously (IV). The nurse has a vial that reads digoxin 0.25 mg/mL(0.5-2 ng/mL). How many mL will administer the appropriate dose?

29 / 30

29. You have an order to administer 100 mL of Ceftriaxone Sodium 1g infusion for over 30 minutes. At what hourly rate will the infusion be set at?

30 / 30

30. A patient is ordered to start an IV Dopamine drip at 7.5 mcg/kg/min. The patient weighs 115 lbs. You have a bag of Dopamine that reads 200mg/250ml. What will you set the IV pump drip rate?

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Fadodun Oluwadmilola

Fadodun Oluwadamilola

Oluwadamilola Agnes Fadodun is a nurse and researcher. She graduated from the prestigious School of Nursing University College Hospital UCH, Ibadan, The University of Ibadan, and The University of Lethbridge, Alberta, Canada where she obtained her Registered Nursing, Bachelor of Science in Nursing, and Master of Science in Nursing respectively.  She is highly passionate about community development, through community service and policy. Oluwadamilola’s long-term goal is to be a voice for the underrepresented and underprivileged groups in her home country, Nigeria, and also be an advocate of change globally through her profession, Nursing.

Olasunkanmi Daniel

Olasunkanmi Daniel

Olasunkanmi Daniel (popularly known as Nurse Dannz), is a registered nurse and an undergraduate student from the Faculty of Nursing LAUTECH Ogbomosho, Nigeria. An Entrepreneur, Blogger, writer and Web Developer.

Daniel is the National Drug Dosage Calculation Competition for Nurses (NDDCCN) Head of Finance and Budget.

Daniel is the Author of the Book “Dannz’s Basic Histology.” This book is the first of its kind written on Histology for Nurses and other healthcare professionals. It is a book that has been resourceful to a lot of Nursing students across all universities.

His utmost priority is finding solutions to the curiosity of men and also service to humanity.

Eunice Aramide Awe

Eunice Aramide Awe

I am Eunice Aramide Awe, a student nurse studying at the University of Ibadan and the winner of the NDDCN 2022. I am a Christain who is selfless and committed to getting things done, as such, I have held several roles as a student. For example, I serve as the current assistant class representative and I have willingly served at various committees in my department.

The health and safety of pregnant mothers and newborns is what I’m passionate about. Hence, I look forward to serving more in this capacity as a midwife.

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OSONUGA Olusegun Olukayode

OSONUGA Olusegun Olukayode

OSONUGA Olusegun Olukayode, a student of Obafemi Awolowo University, Ile-Ife (a.k.a Oba Awon University). He is a native of Ijebu in Nigeria.

Olukayode happens to be a seeker of knowledge and change and it has reflected in his attitude to always participate in politics, research, and other social and health-related programs either as a team member or as a volunteer.

His love for nursing research has driven him to be inquisitive and not settle for less in every situation he finds himself in. Lastly and most importantly, he’s a child of the Most High and without him, nothing can be accomplished.

Khadijat Yusuf

Khadijat Adewumi YUSUF

Khadijat Adewumi YUSUF is a nursing student at the University of Ibadan and a youth representing Ibadan South East 1 constituency at the Oyo state youth parliament.

She holds leadership positions and discharges her duties diligently, parts of which are Library prefect during her secondary school days,  director of studies while in the School of Nursing, Eleyele, and Current Editor in chief of her departmental local press among others.

She contributes in her little ways to ensuring academic excellence among folks right from secondary school age till now. 

She exhibits diligence in her activities and this has been reflected in her academic pursuit, extracurricular activities, and relationship with folks. She was the best student during her secondary school days, the best student in the Weeding examination at Oyo state college of Nursing, Eleyele 2016 basic set before she left for UI, and the first runner-up in national drug dosage calculation for Nurses 2022. 

Recently, she was nominated among the five from the College of Medicine, University of Ibadan for interprofessional education in an institution in Rwanda.

Also, recently, she organized a capacity-building session themed; on setting the pace right for secondary school students to equip them for the transition stage.

She loves volunteering and she does volunteer for different organizations in different capacities.

John Inawole

About John Inawole

John Inawole is a dedicated and accomplished individual who recently obtained his certification as a Registered Nurse (RN). His passion for healthcare and commitment to patient well-being led him to pursue his education at the prestigious School of Nursing, University College Hospital in Ibadan.

Throughout his academic journey, John demonstrated exceptional leadership qualities and was consistently selected for various leadership positions. His ability to inspire and motivate others, combined with his strong work ethic, allowed him to excel in these roles and make a positive impact within his academic community.

His educational background, clinical acumen, combined with his leadership experience, compassionate nature, and dedication to improving patient outcomes, John Inawole is poised to make a significant impact in the healthcare industry.

Samuel Adeleke

About Samuel Adeleke

Samuel Adeleke is a Registered Nurse and an undergraduate student from the Faculty of Nursing, Ladoke Akintola University of Technology in Ogbomoso. He is a Graphic Designer who is passionate about developing and implementing projects that would raise the standard of healthcare delivery.

Samuel is the National Drug Dosage Calculation Competition for Nurses’ (NDDCCN) Head of Media & Publicity.

The organization Team Smile Medical Mission, which aims to promote resilient innovation in the healthcare sector, was founded by Samuel.

He feels that wisdom is the most important quality in everything and that attitude has a greater influence on success than aptitude.

Nrs Oluwatobi Adewumi

About Adewumi Oluwatobi

Oluwatobi, a Nurse, author, and health tech entrepreneur who is transforming the healthcare landscape in Nigeria.

With his groundbreaking startup, he is making affordable and safe healthcare products and services accessible to all through a multivendor e-commerce platform, Also, His innovation is a game changer in the industry.

He is also the co-founder of a startup (Carecode Digital Health Hub) that is equipping healthcare professionals with digital skills through training and education, empowering the next generation of healthcare workers to embrace digital technology

In addition to this, Oluwatobi is the author of a guidebook titled HEALTH2TECH: A PRACTICAL GUIDE TO MAKING THE TRANSITION. This is a must-read for health-tech enthusiasts looking to make their way into tech.

Ayinla Daniel

About Ayinla Daniel

Ayinla Daniel is a prolific and passionate writer, editor, web manager and digital content developer with more than five years of experience in healthcare media. 

Daniel is passionate about storytelling in all formats, with a special focus on how technology influences human culture. He is a calm and people-oriented team player who currently works with some of Nigeria’s leading healthcare media teams, and his work as a writer and editor has appeared in numerous digital spaces. 

Daniel is a founder with deep roots in digital health, healthcare media and publishing, and product development for healthcare businesses and brands. 

He’s the founder and editor of Care City and Carecode Digital Health Hub and Evolvehealth Media, an agency that helps healthcare entrepreneurs, startups, businesses, and organizations build digital ecosystems, from brand management to content development, digital technology services, and more. 

Daniel currently lives with his family in Lagos state, Nigeria. When he’s not spending time with his family, he enjoys reading all kinds of stuff, writing for his businesses and personal blogs/newsletters, and binge-watching documentaries and animated movies. 

He also spends his free time in his local church gathering, serving, and fellowshipping with the brethren. 

You can follow Daniel on Twitter, Linkedin & Facebook


David Ogunlabi

About Nrs. David Ogunlabi

David Ogunlabi is a Critical Care Nurse with vast experience in Cardiology and Oncology. He is an instructor in Mechanical Ventilation. He is passionate about leadership, excellence, and purpose.

David is a writer and a public speaker. He is the author of THE NURSE, THE MATH, AND THE MEDICATION (A Handbook on Drug Dosage Calculations). This book has gained both local and international recognition due to its application and huge contributions to medication safety in Nursing practice.

David is the founder of the National Drug Dosage Calculation Competition for Nurses (NDDCCN). He is also the convener of Clinical Nursing Classroom, a platform where nurses gather every month to learn issues pertaining to Clinical Practice.
David loves reading, singing, and helping people. He is married with two kids.