Septic shock

Definition

Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. The brain, heart, kidneys, and liver may not work properly or may fail.

• Meningococcemia
• Waterhouse-Friderichsen syndrome
• DIC (disseminated intravascular coagulation)
• Multiple organ dysfunction syndrome (MODS)
• ARDS

Causes, incidence, and risk factors

Septic shock occurs most often in the very old and the very young. It also occurs in people who have other illnesses.

Any type of bacteria can cause septic shock. Fungi and (rarely) viruses may also cause the condition. Toxins released by the bacteria or fungus may cause tissue damage, and may lead to low blood pressure and poor organ function. Many researchers believe that abnormal blood clots in small arteries cause the lack of blood flow and poor organ function.

The toxins also cause a strong inflammatory response from the body, which contributes to septic shock.

Risk factors for septic shock include: 

• Diabetes  
• Diseases that weaken the immune system such as AIDS
• Lymphoma
• Leukemia
• Diseases of the genitourinary system, biliary system, or intestinal system
• Recent infection
• Long-term use of antibiotics
• Recent surgery or medical procedure.

Symptoms

• High or very low temperature, chills
• Lightheadedness
• Shortness of breath
• Palpitations
• Cool, pale extremities
• Restlessness, agitation, lethargy, or confusion
• Rapid heart rate
• Low blood pressure, especially when standing
• Low urine output (due to kidney failure)

Signs and tests

• Blood gases revealing low oxygen concentration and acidosis
• Blood cultures or blood count detecting infection
• Low blood pressure
• Chest x-ray revealing pneumonia or pulmonary edema
• Blood tests detecting poor organ function or organ failure

Treatment

Septic shock is a medical emergency. Patients are usually admitted to the intensive care unit of the hospital.

The goal of treatment is to:

• Provide oxygen, and relieve respiratory distress (if present)
• Give fluids by I.V. to restore blood volume
• Give vasoactive drugs to treat low blood pressure
• Treat underlying infections with antibiotics and surgery, if needed
• Support any poorly functioning organs
• Reverse abnormal blood clotting with drugs

There are new drugs that act against the hyperinflammatory response seen in septic shock. These may help limit the damage to vital organs.

Hemodynamic monitoring -- the evaluation of the pressures in the heart and lungs -- may be required. This can only be done with specialized equipment and intensive care nursing.

Expectations (prognosis)

Septic shock has a high death rate. The death rate depends on the cause of the infection and how many organs have failed.

Complications

Respiratory failure, cardiac failure, or any other organ failure can occur.

Calling your health care provider

Go to the emergency room if symptoms of septic shock are present. You may need to call an ambulance if you have no means of transportation, or if you feel like you are unable to drive.

Prevention

Prompt treatment of bacterial infections is helpful. However, many cases of septic shock cannot be prevented.

References

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1957.

Rakel P, ed. Conn’s Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:71.

Page Content:

Bacteremic shock; Endotoxic shock; Septicemic shock; Warm shock ; endotoxic shock