| Mr. Ibrahem/Septic shock | |
|---|---|
 | |
| The Sick Girl by Gabriël Metsu | |
| Specialty | Infectious disease |
| Symptoms | Early: Temperature > 38 °C (100.4 °F), fast heart rate, narrow pulse pressure[1][2] Worsens: Confusion, bluish skin[2] |
| Complications | Acute respiratory distress syndrome, multiple organ dysfunction syndrome[2] |
| Causes | Infection[2] |
| Risk factors | Diabetes, cancer, liver or kidney problems, corticosteroid use, burns, poor immune function, extremes of age[2] |
| Diagnostic method | Based on MAP < 65 mmHg and lactate < 2 mmol/L despite fluids[3] |
| Differential diagnosis | Other types of shock, disseminated intravascular coagulation, adrenal crisis, drug overdose[1][2] |
| Treatment | Antibiotics, removing infected tissue, intravenous fluids, norepinephrine[2] |
| Deaths | Risk > 40%[4] |
Septic shock is a severe form of sepsis in which blood pressure remains low and lactate is greater than 2 mmol/L (>18 mg/dL) despite sufficient intravenous fluids.[4][3] Initial symptoms may include a temperature greater than 38 °C (100.4 °F) or less than 36 °C (96.8 °F), fast heart rate, narrow pulse pressure, and increased respiratory rate.[1][2] More severe symptoms may include confusion and bluish skin.[2] Complications can include acute respiratory distress syndrome and multiple organ dysfunction syndrome.[2]
The most common type of infection is bacterial, with gram-negative bacterial infections present in 62% of cases and gram-positive bacterial infections present in 47% of cases.[2] In less than 5% of cases viruses or parasites are involved.[2] The most common locations of infections are the lungs (42%), blood (21%), and urine (10%), though in a third of cases the location is unclear.[2] Risk factors for sepsis include diabetes, cancer, liver or kidney problems, corticosteroid use, burns, poor immune function, and extremes of age.[2] It is a type of distributive shock.[5]
Treatment involves early goal-directed therapy, with the use of antibiotics, removing infected tissue, intravenous fluids, and vasoactive agents such as norepinephrine.[2] Other measures may include mechanical ventilation and corticosteroids.[2] Severe sepsis occurs in about 750,000 people (300 per 100,000) a year in the United States.[6][7] The risk of death is greater than 40% and some who survive are left with long term disability.[4][7]