Cardiovascular dysfunction (after fluid resuscitation with at least 40 mL/kg of crystalloid)
hypotension with blood pressure < 5th percentile for age or systolic blood pressure < 2 standard deviations below normal for age, or
vasopressor requirement, or
two of the following criteria:
unexplained metabolic acidosis with base deficit > 5 mEq/L
lactic acidosis: serum lactate 2 times the upper limit of normal
oliguria (urine output < 0.5 mL/kg/h)
prolonged capillary refill > 5 seconds
core to peripheral temperature difference > 3 °C
Respiratory dysfunction (in the absence of a cyanotic heart defect or a known chronic respiratory disease)
the ratio of the arterial partial-pressure of oxygen to the fraction of oxygen in the gases inspired (PaO2/FiO2) < 300 (the definition of acute lung injury), or
arterial partial-pressure of carbon dioxide (PaCO2) > 65 torr (20 mmHg) over baseline PaCO2 (evidence of hypercapnic respiratory failure), or
supplemental oxygen requirement of greater than FiO2 0.5 to maintain oxygen saturation ≥ 92%
Neurologic dysfunction
Glasgow Coma Score (GCS) ≤ 11, or
altered mental status with drop in GCS of 3 or more points in a person with developmental delay/intellectual disability
Hematologic dysfunction
platelet count < 80,000/mm3 or 50% drop from maximum in chronically thrombocytopenic, or
international normalized ratio (INR) > 2
Disseminated intravascular coagulation
Kidney dysfunction
serum creatinine ≥ 2 times the upper limit of normal for age or 2-fold increase in baseline creatinine in people with chronic kidney disease
Liver dysfunction (only applicable to infants > 1 month)
total serum bilirubin ≥ 4 mg/dL, or
alanine aminotransferase (ALT) ≥ 2 times the upper limit of normalConsensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience.
Chlorzoxazone (INN) is a centrally acting muscle relaxant used to treat muscle spasm and the resulting pain or discomfort. It can also be administered for acute pain in general and for tension headache (muscle contraction headache). It acts on the spinal cord by depressing reflexes. It is sold under the brand names Lorzone, Paraflex and Muscol and in combination form as Parafon Forte, a combination of chlorzoxazone and acetaminophen (paracetamol). Possible side effects include dizziness, lightheadedness, malaise, nausea, vomiting, and liver dysfunction. Used with acetaminophen it has added risk of hepatotoxicity,. Like metaxalone, its mechanism of action is still in question. It is believed that metaxalone works by altering serotonin levels and acting as a mild MAO inhibitor. The mechanism of action of chlorzoaxazone is thought to act on Gaba-A & B receptors and voltage-gated calcium channels to a degree. General central nervous system depression is the only currently accepted aspect to its medical benefits. Elucidation of the exact mechanism of action is ongoing but there is limited study due to the existence of more effective, safe muscle relaxants (ex. diazepam, cyclobenzaprine, tizanidine), greatly limiting the potential benefit of identifying novel compounds which share chlorzoxazones mechanism of action. See also
Zoxazolamine

References
Further reading
External links
"Chlorzoxazone". Drug Information Portal. U.S. National Library of Medicine. Chloroxazone Safety Data Sheet Archived 2019-07-12 at the Wayback Machine
D.F. Marsh, U.S. Patent 2,895,877 (1959)