is a serious
Medical condition causing such effects as
Multiple Organ Failure and death in response to
Infection and
Sepsis . Its most common victims are children and the elderly, as their
Immune System s cannot cope with the infection as well as those of full-grown adults, as well as
Immunocompromised individuals. The
Mortality rate from septic shock is approximately 50%.
To diagnose septic shock the following two criteria must be met:
# A proven source of infection, such as a positive
Blood Culture .
# Refractive
Hypotension - hypotension despite adequate
Fluid Resuscitation .
- In adults it is defined as a Systolic Blood Pressure < 90 MmHg , or a MAP < 60 mmHg, or a reduction of 40 mmHg in the systolic blood pressure from baseline.
- In children it is BP < 2 SD of the normal blood pressure.
In addition to the two criteria above, two or more of the following must be present:
- Heart Rate > 90 beats per minute.
- Body temperature < 36 or > 38°C.
- Hyperventilation (high respiratory rate) > 20 breaths per minute or, on Blood Gas , a PaCO2 less than 32 mmHg.
- White Blood Cell count < 4000 cells/mm3 or > 12000 cells/mm3 (< 4 x 109 or > 12 x 109 cells/L).
A subclass of
Distributive Shock , shock refers specifically to decreased tissue
Perfusion resulting in end-organ dysfunction.
Cytokines TNFα, IL-1β, IL-6 released in a large scale inflammatory response results in massive
Vasodilation , increased
Capillary permeability, decreased systemic vascular resistance, and
Hypotension . Hypotension reduces tissue perfusion pressure and and thus tissue
Hypoxia ensues. Finally, in an attempt to offset decreased
Blood Pressure ,
Ventricular Dilatation and
Myocardial dysfunction will occur.
The various shock conditions include: septic shock, systemic inflammatory response syndrome,
Toxic Shock Syndrome ,
Adrenal Insufficiency , and
Anaphylaxis .
The process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. In rough order of severity, these are
Bacteremia or
Fungemia ;
Septicemia ;
Systemic Inflammatory Response Syndrome (SIRS),
Sepsis , severe sepsis or sepsis syndrome; septic shock; refractory septic shock; multiple-organ dysfunction syndrome, and
Death .
The condition develops as a response to certain
Microbial molecules which trigger the production and release of cellular mediators, such as
Tumor Necrosis Factor (TNF); these act to stimulate immune response. Besides TNFα, other
Cytokine s involved in the development of septic shock include
Interleukin -1β, and
Interferon γ.
Treatment primarily consists of antimicrobial chemotherapy, removal of the source of
Infection , and haemodynamic, respiratory, and metabolic support. Antimediator agents may be of some limited use in certain clinical situations.
