Septic shock

Alternative names 
Bacteremic shock; Endotoxic shock; Septicemic shock; Warm 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 symptom.

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 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, biliary system, or intestinal system. Other risk factors are recent infection, prolonged antibiotic therapy, and having had a recent surgical or medical procedure. See also:

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

Symptoms

     
  • High or very low temperature, chills  
  • Lightheadedness  
  • Shortness of breath  
  • Palpitations  
  • Cool, pale extremities  
  • Restlessness, agitation, lethargy, or confusion

Some physical findings may be easily detected:

     
  • Rapid heart rate  
  • Low blood pressure, especially when standing  
  • Low urine output

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, and patients are usually admitted to intensive care.

The objective of treatment is to:

     
  • Provide oxygen, and relieve 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 - 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. There are new drugs that act against the hyperinflammatory response seen in septic shock. These may help limit the damage to vital organs.

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.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.