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Septic shock

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VOL: 102, ISSUE: 04, PAGE NO: 25

 

WHAT IS IT?
- Septic shock is the result of an overwhelming infection in the blood. It usually follows severe injury or is experienced by immunocompromised patients.

- Endotoxins or exotoxins are released from bacteria in the blood causing vasodilation, which results in a dramatic fall in blood pressure. Vital organs such as the brain, heart, kidneys and liver may cease functioning.

CAUSES
- Septic shock is most prevalent in older people and the very young.

- It can be caused by any bacterium but the most common are Gram negative enteric bacilli, such as Escherichia coli, pseudomonas and Gram positive staphylococcal infections.

- Fungi and in rare instances viruses can cause septic shock.

- All these organisms release toxins that can cause direct damage to tissue and result in reduced organ function. The effect is mainly on the walls of the smaller blood vessels, causing interstitial fluid leak, increased vascular permeability and vasodilation.

- Any inflammatory response may contribute to the overall shock.

- The eventual result of septic shock is reduced circulation, lowered blood pressure and high cardiac output.

- Those with underlying illnesses, for example diabetes, haematologic cancers and diseases of the genitourinary system, are at increased risk of septic shock.

- Other risk factors include recent infection, long-term courses of antibiotics, recent surgery and severe burns.

- Bacterial toxins can also result in disseminated intravascular coagulation, which is potentially fatal if it is not treated immediately.

SYMPTOMS
Symptoms include:

- Extremes of temperature;

- Shortness of breath;

- Lightheadedness;

- Palpitations;

- Lowered temperature in the extremities;

- Agitation;

- Lethargy;

- Confusion;

- Increased heart rate;

- Reduced blood pressure, especially when standing;

- Reduced urine output.

DIAGNOSIS
There are various diagnostic tests for septic shock, including:

- Blood cultures - can identify infection;

- Blood gases - can identify low oxygen concentration and acidosis;

- Chest X-rays - can identify pneumonia or pulmonary oedema;

- Blood tests - can identify poor organ function or failure.

TREATMENT
Septic shock is a medical emergency and must be treated immediately. Treatment includes:

- Antibiotics to address underlying infection;

- Intravenous fluids to restore blood volume;

- Oxygen therapy to relieve respiratory distress;

- Medication to treat hypotension;

- Haemodynamic monitoring;

- Medication to counter inflammatory response, limiting the damage to vital organs.

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