Septic shock

Definition:
Septic shock is a serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Vital organs, such as the brain, heart, kidneys, and liver may not function properly or may fail. Decreased urine output from kidney failure may be one manifestation.

Alternative Names:
Bacteremic shock; Endotoxic shock; Septicemic shock; Warm shock

Causes, incidence, and risk factors:

Septic shock occurs most often in the very old and the very young. It also occurs in people with underlying illnesses. Any bacterial organism can cause septic shock. Fungi and (rarely) viruses may also cause this condition. Toxins released by the bacteria or fungus may cause direct tissue damage, and may lead to low blood pressure and/or poor organ function. These toxins also produce a vigorous inflammatory response from the body which contributes to septic shock.

Risk factors include underlying illnesses, such as diabetes; hematologic cancers (lymphoma or leukemia); and other malignancies and diseases of the genitourinary system, liver or biliary system, and intestinal system. Other risk factors are recent infection, prolonged antibiotic therapy, and having had a recent surgical or medical procedure. See also:

Symptoms:

Some physical findings may be easily detected:

  • Rapid heart rate
  • Low blood pressure, especially when standing
  • Low urine output
Signs and tests:
  • Blood gases may reveal low oxygen concentration and acidosis
  • Blood cultures to detect infection
  • Blood pressure readings are low
  • Chest X-ray may reveal pneumonia or pulmonary edema
  • The blood count may reflect infection
  • Blood tests may reflect poor organ function or organ failure
Treatment:

Septic shock is a medical emergency, and patients are usually admitted to intensive care.

The objective of treatment is to:

  • Provide oxygen, and treat respiratory distress if present
  • Administer intravenous fluids to restore blood volume, and vasoactive drugs to treat low blood pressure
  • Treat underlying infections with antibiotics
  • Support any poorly functioning organs

Hemodynamic monitoring, to evaluate the pressures in the heart and lungs in treatment of shock, may be required. This can only be done with specialized equipment and intensive care nursing.

Expectations (prognosis):

Septic shock has a high death rate, exceeding 50%, depending on the type of organism causing the infection and the degree of organ failure.

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 infections caused by bacteria is helpful. However, many cases cannot be prevented.


Review Date: 1/25/2002
Reviewed By: David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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