Septic shock is a form of shock associated with overwhelming infection, usually by gram-negative bacteria, although it may be caused by other bacteria, viruses or fungi. It is marked by hypotension, oliguria, tachycardia and confusion.
The signs and symptoms of shock include
- Hypotension (systolic blood pressure below 90 mmHg)
- Weak, rapid pulse
- Tachypnea (more than 20 breaths per minute) due to acidosis
- Flushing of skin due to vasodilation
- Tachycardia and palpitations (heart rate above 90 beats per minute)
- Low grade fever with rigor and chills
- Shortness of breath
- Confusion and light headedness
- Decreased urinary output
- Reduced platelet count
- Abdominal pain
- Multiple organ dysfunction syndrome (MODS): Dysfunction of two or more organs
Entire Body System
Antibiotic treatment was de-escalated after 21 days; 4 days later fever, leukocytosis, hypotension and acute renal failure relapsed. [ncbi.nlm.nih.gov]
Many view fever as the body's natural beneficial response to infection, whereas others contend that fever is harmful and should be controlled. [atsjournals.org]
Fever is a common symptom. The patient also feels difficulty in breathing and abdominal pain. Diagnosis of this condition is difficult. Such patients should be immediately treated and hospitalized. [symptoma.com]
Soon after, he developed fever, chills and a rash around the tattoo, according to a report in the British Medical Journal (BMJ). [thesun.co.uk]
It can impact any part of the body and some symptoms may include: High or very low temperatures Chills Rapid heart rate Shortness of breath Cool, pale extremities Restlessness, agitation, lethargy or confusion If you or someone you care for is experiencing [hospitals.jefferson.edu]
At first, people have a high (or sometimes low) body temperature, sometimes with shaking chills and weakness. As sepsis worsens, the heart beats rapidly, breathing becomes rapid, people become confused, and blood pressure drops. [msdmanuals.com]
This begins with weakness, chills, and a rapid heart and breathing rate. Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues. [zana.com]
Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations. [sepsis.org]
Post-sepsis symptoms can include insomnia, fatigue, depression, and cognitive decline. (9) One Last Thing on Preventing Sepsis and Avoiding Septic Shock If you suspect sepsis, it’s important that you go to the hospital immediately. [everydayhealth.com]
Signs and Symptoms Symptoms of sepsis are usually nonspecific and include fever, chills, and constitutional symptoms of fatigue, malaise, anxiety, or confusion. [atsu.edu]
[…] symptoms of shock vary depending on circumstances and may include: Cool, clammy skin Pale or ashen skin Bluish tinge to lips or fingernails (or gray in the case of dark complexions) Rapid pulse Rapid breathing Nausea or vomiting Enlarged pupils Weakness or fatigue [mayoclinic.org]
With reno-ocular manifestations, TINU syndrome is accompanied by symptoms such as fever, fatigue, malaise, anorexia, vomiting, and arthralgia. TINU syndrome is reported mainly in children or adolescent girls, and it is rare in adults. [kci.go.kr]
Acutely Ill Patient
Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med. 2006 ;34(3): 589 – 597. Google Scholar Crossref Medline ISI 5. Povoa, PR, Carneiro, AH, Ribeiro, OS. Influence of vasopressor agent in septic shock mortality. [doi.org]
Multiple organ dysfunction syndrome (MODS) - Altered function of more than one organ system in an acutely ill patient requiring medical intervention to maintain homeostasis 5/24/2014 INTRODUCTION 10. EPIDEMIOLOGY 4.6 cases/1000 persons in [slideshare.net]
Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, Artigas A, Ranieri VM; Sepsis Occurence in Acutely Ill Patients Investigators. [scielo.br]
All steroid drug classes possess biological plausibility to affect a beneficial clinical effect among children with septic shock, but none has undergone rigorous, prospective assessment in a large, high-quality pediatric interventional trial. [ncbi.nlm.nih.gov]
Hypotension (systolic blood pressure below 90 mmHg) Weak, rapid pulse Tachypnea (more than 20 breaths per minute) due to acidosis Flushing of skin due to vasodilation Tachycardia and palpitations (heart rate above 90 beats per minute) Low grade fever with rigor [symptoma.com]
"It has been almost two decades since a rigorous approach has been undertaken to better define sepsis and during that time a lot of new science has emerged examining the pathophysiology of sepsis, in particular how the body responds to it." [medpagetoday.com]
Immediately after, he developed chills and rigors but left the dental clinic. He was subsequently found collapsed outside the clinic. He had no other significant past medical or travel history. [casesjournal.biomedcentral.com]
[…] oliguria; or acute alteration in mental status Shock caused by infection; frequently caused by gram negative bacteria, although some cases have been caused by other bacteria, viruses, fungi, and protozoa; characterized by fever, chills, tachycardia, tachypnea [icd9data.com]
[derived from Glasgow Coma Score 13]) while SIRS (including tachycardia 90 and tachypnea 20) criteria is deleted. [medintensiva.org]
Organ dysfunction Tachypnea (PO2 and PCO2 decrease), restlessness, confusion, kidney and liver insufficiency, encephalopathy, respiratory insufficiency, myocardial insufficiency. [lecturio.com]
The signs and symptoms of shock include Hypotension (systolic blood pressure below 90 mmHg) Weak, rapid pulse Tachypnea (more than 20 breaths per minute) due to acidosis Flushing of skin due to vasodilation Tachycardia and palpitations (heart rate above [symptoma.com]
Components of SIRS include tachycardia, tachypnea, hyperthermia or hypothermia, and elevated white blood count. [medpagetoday.com]
Some clues to a septic event include: Fever or unexplained signs with malignancy or instrumentation Hypotension Oliguria or anuria Tachypnea or hyperpnea Hypothermia without obvious cause Bleeding Physical Examination A thorough physical exam is essential [atsu.edu]
(hyperlactatemia without refractory hypotension), and a typical group (both refractory hypotension and hyperlactatemia). [ncbi.nlm.nih.gov]
Scheeren Abstract Author Information Authors Article Metrics Metrics Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. [journals.lww.com]
A 74-year-old woman presenting with sepsis demonstrated AF tachycardia characterised by severe hypotension. [ncbi.nlm.nih.gov]
It is marked by hypotension, oliguria, tachycardia and confusion. [symptoma.com]
Fall in blood pressure, prolonged capillary refill time, tachycardia and tachypnoea occurring jointly or in various combinations provide an early clue. [academic.oup.com]
It is marked by hypotension and coldness of the skin, and often by tachycardia and anxiety. Untreated shock can be fatal. Called also circulatory collapse. Mechanisms of Circulatory Shock. [medical-dictionary.thefreedictionary.com]
Ketamine Drug of choice as it is relatively safe in hypotension and tachycardia. However, catecholamine depletion can cause refractory hypotension and result in worsening shock. [emergencymedicinecases.com]
Symptoms of shock include Confusion or lack of alertness Loss of consciousness Sudden and ongoing rapid heartbeat Sweating Pale skin A weak pulse Rapid breathing Decreased or no urine output Cool hands and feet Shock is a life-threatening medical emergency [medlineplus.gov]
References: Cardiogenic shock Definition: systolic BP 90 mm Hg with urine output 20 mL/hr and normal or elevated left ventricular filling pressure Pathophysiology: stroke volume Etiology Clinical features Weak pulse, tachycardia Cold, clammy [amboss.com]
spinal cord injury) Endocrinologic (Addison’s disease, myxedema) Hypotension (mean arterial bp Signs of intense peripheral vasoconstriction, with weak pulses and cold clammy extremities. [accessmedicine.mhmedical.com]
Symptoms of all types of shock include: Rapid, shallow breathing Cold, clammy skin Rapid, weak pulse Dizziness or fainting Weakness Depending on the type of shock the following symptoms may also be observed: Eyes appear to stare Anxiety or agitation Seizures [medicinenet.com]
They may also check for: low blood pressure weak pulse rapid heartbeat Once they’ve diagnosed shock, their first priority is to provide lifesaving treatment to get blood circulating through the body as quickly as possible. [healthline.com]
You may have fever, fast breathing, dizziness, or a fast heart rate if your infection has spread in your body. Care Agreement You have the right to help plan your care. [drugs.com]
In addition to the symptoms of sepsis and severe sepsis, symptoms of septic shock can include Rapid pulse Dizziness or light-headedness Lower than normal body temperature Rapid breathing You may have a higher risk of going into septic shock if you have [sepsis.org]
[…] diabetes, Cirrhosis or kidney failure people with lowered immune systems, such as those with HIV or AIDS or those receiving chemotherapy Symptoms of septic shock Symptoms of septic shock include: low blood pressure (hypotension) that makes you feel dizzy [zana.com]
These can include: lightheadedness (dizziness) a change in mental state – such as confusion or disorientation diarrhoea feeling sick and vomiting slurred speech severe muscle pain severe shortness of breath producing less urine – for example, not peeing [nhs.uk]
Altered Mental Status
CASE REPORT Our case involves an elderly man presenting with altered mental status of unknown etiology, in addition to hemodynamic instability, presumably due to septic shock, without any overt signs of bleeding. [ncbi.nlm.nih.gov]
Signs of septic shock include low blood pressure, a rapid heart rate, altered mental status, and the need for a ventilator. Septic shock is life-threatening and requires immediate attention. [verywellhealth.com]
mental status Renal - decreased urine output Pulm - acute lung injury or ARDS Heme - DIC or thrombocytopenia (plts GI - elevated bilirubin ( 4) - due to poor perfusion of liver and cytokines Septic Shock Sepsis Hypotension refractory to fluids 2) Pathogenesis [errolozdalga.com]
On ICU 10th day, however, he experienced septic shock, with tachycardia, fever and a stuporous mental state. His blood pressure decreased despite receiving vasopressor and inotropic agents. [doi.org]
- Pulse oxymetry
- Blood and sputum cultures for microbes
- Liver function tests (LFTs)
- Renal function tests (RFTs)
- Radiography of the chest
- Computerized tomography (CT) scans
- Magnetic resonance imaging (MRI)
Furthermore, nosocomial infections such as invasive aspergillosis and Pseudomonas aeruginosa occurred during hospitalization. [ncbi.nlm.nih.gov]
[…] anaerobic Septic shock acute organ dysfunction, Escherichia coli Septic shock acute organ dysfunction, gram negative Septic shock acute organ dysfunction, meningococcal Septic shock acute organ dysfunction, MRSA Septic shock acute organ dysfunction, Pseudomonas [icd9data.com]
Pseudomonas aeruginosa Escherichia coli Klebsiella sp. Staphylococcus sp. [atsu.edu]
The treatment of septic shock consists of the following:
- Immediate hospitalization
- Breathing should be stabilized by oxygen therapy.
- Endotracheal intubation should be done, if necessary.
- Intravenous fluids to maintain blood pressure (volume resuscitation). Continuous monitoring of blood pressure should be done.
- Vasopressor drugs (like dopamine or norepinephrine) for maintenance of blood pressure.
- Inotropic drugs (for example, dobutamine) to increase the heart rate .
- Antibiotics (wide spectrum) for treatment of concomitant infection.
- Empirical antimicrobial therapy 
- Unfractionated heparin or low-molecular-weight heparin (LMWH) for management of disseminated intravascular coagulation.
- Corticosteroids for reducing inflammation 
- Protein C 
- Insulin therapy for blood sugar level maintenance.
- Excision and drainage surgery for collection of pus in case of infections.
Mortality rate due to septic shock is very high due to delay in management and treatment of septic shock. Almost 50% of the patients of septic shock die. The mortality rate is about 40% in adults and approximately 25% in children. With immediate medical care, about 95% of the patients can recover but most die due to difficulty in recognizing the symptoms of shock and establishing a diagnosis.
The causes of septic shock include the following  :
- Microbial infections causing septicemia (bacteremia or viremia)
The risk factors for the development of sepsis include:
- Immunocompromised states (diabetes mellitus, AIDS, leukemia, organ transplant, etc.)
- Urinary tract infections (UTIs)
- Respiratory infections
- Gastrointestinal infections
- Long term catheterization
- Long term use of antibiotics and steroids
- Recent surgery
- Burn injuries
- Chronic illnesses (for example, cirrhosis, renal disease, etc.)
- Open wounds and fractures
More than 20 million cases of septic shock are registered per year. Elderly, children and immunocompromised patients are more susceptible due to weak immune systems as compared to healthy adults who are better equipped to fight systemic infections.
Men have been shown to be more susceptible to the complications of sepsis as compared to women. Higher incidence of sepsis and thereby, septic shock has been found among the Black populations.
Hemodynamic changes are the basic mechanism involved in pathogenesis of the disease. The endotoxins and microbial products activate multiple pathways that include the following  :
- Activation of complement system product C3a which leads to endothelial activation. Endothelial activation causes the activation of procoagulant factors (tissue factor), nitric oxide (NO), reactive oxygen species and various cytokines (IL-6, IL-8, platelet activating factor (PAF)). All these factors lead to vasodilation and increased capillary permeability. Inadequate organ perfusion results leading to multiorgan failure.
- Activation of procoagulant factor XII and antifibrinolytic factors (plasminogen activator inhibitor, PAI-1) cause widespread disseminated intravascular coagulation (DIC) that causes thrombosis. As a result, inadequate tissue perfusion and tissue ischemia ensue.
- Activation of monocyte-neutrophil system causing the release of tumor necrosis factor (TNF) and various cytokines like interleukin-1 (IL-1) and high mobility group box 1 protein (HMGB1). These cytokines cause release of IL-10 and secondary inflammatory mediators that lead to apoptosis and ultimately cause immunosuppression. These cytokines also result in systemic manifestations like fever, metabolic abnormalities and decreased myocardial contractility.
The disease occurs in 3 stages:
- Non-progressive phase: Compensatory mechanisms are activated during this stage. The perfusion of vital organs is, however, maintained.
- Progressive stage: Circulatory and metabolic imbalances occur. Tissue hypo perfusion worsens during this stage.
- Irreversible stage: Irreversible tissue injury occurs and death is inevitable.
- Immediate treatment of bacterial and viral infections can help prevent sepsis and thereby, the septic shock.
- Long-term catheterization should be avoided to prevent nosocomial infections.
- Prophylactic therapy after surgeries can help prevent secondary infections.
- Surgeries should be avoided if they can be.
- Strict septic protocol should be followed during the surgical procedures.
- Vaccination against streptococcal and pneumococcal strains can help prevent septic shock that develops secondary to these infections.
- Open wounds should be properly washed and cleansed with antiseptic.
Septic shock is a condition in which body-wide infection occurs leading to involvement and failure of more than one organ. Marked hypotension can even lead to death if prompt treatment is not given. Sepsis or septic shock is most common in patients who are immunocompromised, have bacterial or viral infections or in children and elderly due to weakened immune mechanisms.
Early signs and symptoms of the disease include lowering of blood pressure, increased respiratory and heart rate, confusion and agitation. Fever is a common symptom. The patient also feels difficulty in breathing and abdominal pain.
Diagnosis of this condition is difficult. Such patients should be immediately treated and hospitalized. Blood pressure, breathing and heart rate should be stabilized. With care, patient can recover but delay in the treatment can lead to death of the patient.
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