Definition

Septic shock is a condition in which the circulatory system is unable to meet the oxygen demands of the body's organs as a result of sepsis. Sepsis is a condition in which the body overreacts to an infection. Septic shock has a very high mortality rate.

Causes

Sepsis may develop as a result of a bacterial, fungal, or viral infection. These infections can start anywhere, including at home or in the hospital (for example, while receiving inpatient care for another condition).

Sepsis is usually caused by abdomen or gastrointestinal tract infections, lung infections (pneumonia), urinary tract infections, or genital infections. If sepsis is not treated promptly, the patient may fall into septic shock.

Risk Factors

Risk factors for sepsis and septic shock are as follows:

• Extreme age (under 10 years or over 70 years)
• Presence of primary diseases such as hardening of the liver, alcoholism, diabetes mellitus, heart and lung problems, and solid and blood malignancies
• Immune system suppression, such as due to low white blood cell levels, immune suppression therapy given to post-organ transplant patients, long-term corticosteroid therapy, immune problems, and asplenia or absence of spleen
• Major or extensive surgery, injuries, and burns
• Invasive procedures such as the insertion of catheter tubes, devices inside blood vessels, prosthetic devices, dialysis tubes, or breathing tubes
• Previous history of antibiotic therapy
• Long-term hospitalization
• Genetic susceptibility
• Other factors such as childbirth, abortion or miscarriage, and malnutrition

Symptoms

Sepsis is a medical emergency, but the symptoms can be similar to those of other diseases, such as coughing and fever. If you or someone close to you has recently developed an infection that will not go away, the following symptoms may indicate sepsis:

• High fever and chills
• Extreme body pain
• Very fast pulse
• Rapid breathing
• Rash

While these symptoms may be associated with other conditions, you should consult your doctor about your or a loved one's condition.

Sepsis can quickly progress to septic shock, which increases the risk of death. Septic shock symptoms may include the following:

• A significantly reduced amount of urine or none at all
• Acute confusion and restlessness
• Dizziness
• Severe breathing problems
• Pale bluish skin discoloration (cyanosis)

People in septic shock also have extremely low blood pressure, which does not improve with intravenous fluids. In addition, septic shock patients have blood flow problems that can lead to organ failure.

Diagnosis

Septic shock is a medical emergency that must be treated immediately. Diagnosis is based on history and tests, such as blood pressure and blood oxygen levels (pulse oximetry). In addition, the doctor will run laboratory and imaging tests as necessary, which may include the following:

• Blood glucose levels
• Complete blood count
• Inflammatory markers such as C-reactive protein and procalcitonin
• Blood gas analysis
• Kidney and liver function
• Blood clotting
• Bilirubin (a substance that can cause the skin to be overly yellow)
• Lactate
• Blood culture (germ breeding on blood preparations) to identify the germs causing septic shock
• Lumbar puncture (collection of fluid outside the spinal cord) is performed if there is a suspicion of infection in the central nervous system, which should be done before any imaging

Imaging examinations may include plain radiographs, ultrasonography, CT scans, and MRI.

• Plain radiographs or X-rays may include the chest, abdomen, or limbs, depending on the suspected source of infection. When the source of infection is unknown, the priority is a chest X-ray, as the majority of sepsis patients have a lung infection (pneumonia)
• Ultrasonography (USG) is performed if an infection in the gallbladder or bile duct is suspected
• Biliary problems can be treated surgically or with endoscopic retrograde cholangiopancreatography (ERCP), a procedure that involves inserting a tube with a camera at the end
• Echocardiography can detect any heart problems associated with sepsis
• A CT scan is recommended to look for the source of the infection in the abdomen because it is quick and can reveal abdominal problems more clearly than an X-ray

Management

The treatment of septic shock aims to stabilize the circulatory system and eliminate the source of infection. As a result, several medications will be used in this management, including:

• Injectable antibiotics to fight infection
• Vasopressors are medications that constrict blood vessels and increase blood pressure
• Insulin is a hormone that regulates sugar, as sugar levels in septic shock patients are often unstable
• Corticosteroids suppress inflammatory reactions in the body

In addition to these medications, the doctor will administer a large amount of intravenous fluids to treat dehydration and increase blood pressure. This is necessary to maintain blood flow to the organs. If the hemoglobin (oxygen carrier in the blood) level is low, the doctor may recommend a blood transfusion. Additionally, the patient may require a breathing apparatus.

Other treatments may include surgery to remove the source of infection, such as draining pus from a pus-filled pocket (an abscess) or extracting dead or infected tissue.

Complications

The complications of septic shock are varied and life-threatening, including:

• Acute respiratory distress syndrome (ARDS) occurs when breathing fails to meet the body's oxygen requirements
• Acute or chronic renal failure resulting from oxygen deprivation
• Disseminated intravascular coagulation (DIC), a condition in which blood clots occur in large numbers throughout the body
• Mesenteric ischemia is a condition where the intestines are deprived of oxygen
• Acute liver failure due to lack of oxygen
• Heart muscle function issues
• Multiple organ failure

Prevention

To prevent septic shock, treat the infection as soon as possible before the patient develops sepsis. If you have a fever, cough, runny nose, shortness of breath, dental pain, painful urination, or abdominal pain, see a doctor right away.

Sepsis is typically preceded by common illnesses that are not properly treated. Therefore, prevention can begin with remaining vigilant and seeking treatment as soon as possible if you become infected. If your symptoms do not improve during treatment, you can consult with your doctor to discuss other treatments that may be more appropriate for you.

Cooperation between you as a patient and your doctor is very important to prevent sepsis shock from occurring.

When to See a Doctor?

If you have an infection that does not go away and you develop symptoms such as a high fever with chills, severe body aches, rapid pulse, and breathing, or a rash, see a doctor right away.

These symptoms can point to conditions other than sepsis, but sepsis is one of the most serious possibilities and should be treated as soon as possible. Septic shock, when treated promptly and appropriately, can improve the chances of complete recovery.

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