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Septic shock
Second only to cardiogenic shock as the leading cause of shock-related death, septic shock involves inadequate tissue perfusion, abnormalities of oxygen supply and demand, metabolic changes, and circulatory collapse. It typically occurs among hospitalized patients, usually as a result of bacterial infection. About 25% of patients who develop gram-negative bacteremia go into shock. Unless vigorous treatment begins promptly, preferably before symptoms fully develop, septic shock rapidly progresses to death (in many cases within a few hours) in up to 80% of these patients. Septic shock is the most common cause of death in acute care units in the United States.
CAUSES AND INCIDENCE
In two-thirds of patients, septic shock results from infection with the gram-negative bacteria Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, or Bacteroides; in a minority of patients, it results from the gram-positive bacteria Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, or Actinomyces. Infections with viruses, rickettsiae, chlamydiae, and protozoa may be complicated by shock.
These organisms produce septicemia in people whose resistance is already compromised by an existing condition; infection also results from translocation of bacteria from other areas of the body through surgery, I.V. therapy, and catheters. Septic shock commonly occurs in patients hospitalized for primary infection of the genitourinary, biliary, GI, or gynecologic tract. Other predisposing factors include immunodeficiency, advanced age, trauma, burns, diabetes mellitus, cirrhosis, and disseminated cancer.
SIGNS AND SYMPTOMS
Signs and symptoms of septic shock vary according to the stage of shock, the organism causing it, and the patient’s immune response and age. In the early stage, they include oliguria, sudden fever (over 101° F [38.3° C]), chills, tachypnea, tachycardia, full bounding pulse, hyperglycemia, nausea, vomiting, diarrhea, and prostration. In the late stage, they include restlessness, apprehension, irritability, thirst from decreased cerebral tissue perfusion, hypoglycemia, hypothermia, and anuria. Hypotension, an altered level of consciousness, and hyperventilation may be the only signs among infants and the elderly.
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