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Sepsis is a life-threatening condition that occurs when the body’s excessive response to an infection causes damage to its own tissues. Sepsis may progress to septic shock, a body-wide deficiency of blood supply that leads to oxygen deprivation, buildup of waste products, and eventual organ failure. Without timely treatment, mortality rates are high.
With sepsis, patients typically experience fever, weakness, sweating, and a rapid heart rate and breathing rate. As septic shock develops, blood pressure decreases, and signs of organ damage, such as confusion and reduced urine output, can be observed. The skin is initially warm or flushed, then becomes cold, sweaty, mottled or bluish.
While any infection can lead to sepsis, bacterial infections in the lungs, digestive and urinary organs, are the most common causes. Sepsis may also develop from a post-surgery infection or an infected catheter.
Septic shock occurs more often in newborns, the elderly and pregnant women. Other risk factors include having a compromised immune system or chronic diseases, extended hospital stays, having invasive devices, and overuse of antibiotics or corticosteroids.
The pathogenesis of septic shock is not fully understood. In most cases, the immune system is overwhelmed by an infection that gets out of control, and responds with a systemic cytokine release that causes widespread vasodilation and fluid leakage from capillaries. These cytokines also activate the coagulation process, producing tiny blood clots that clog blood vessels, reducing blood flow. Bleeding may also develop because excessive coagulation depletes clotting factors. Poor capillary flow reduces oxygen supply and impairs removal of carbon dioxide and waste products, resulting in organ dysfunction and eventually failure.
Diagnosis is primarily clinical but requires confirmation of an ongoing infection.
An elevated blood lactate level serves as an indicator of shock. This is because in the absence of oxygen, the body switches to anaerobic metabolism, which breaks down glucose only partially, producing lactic acid. Blood tests may also indicate signs of organ damage, and infection. Other specimens such as urine, respiratory or wound secretions, may be taken for culture to detect infection. Imaging tests may also help identify the source of infection. Other causes of shock should be ruled out.
Early and aggressive treatment is critical for survival. Treatments include:
– Intravenous fluids, and possibly vasopressors, to restore blood flow.
– Broad-spectrum antibiotics while waiting for culture results. Once the causative organism is identified, more specific antibiotics will be used.
– Other measures to control infection.
– Supportive care such as supplemental oxygen, and in case of organ failure, mechanical ventilation or dialysis.
