Septic Shock

http://sciencewithsusanna.com has diagrams, notes, and practice questions.
Sepsis, or blood-poisoning, can progress to septic shock.

Septic shock is a dangerous drop in blood pressure that may lead to hypoperfusion of tissues, cell damage, and multiple organ failure. It has about a 50% mortality rate.

It is most common in the elderly and the very young, or the immunocompromised.

Urinary tract infections, peritonitis, pneumonia, or skin wounds or cellulitis are the most typical infections that may progress to septic shock.

Gram negative or Gram positive bacteria can cause septic shock if their toxins overstimulate host white blood cells.

Endotoxin from Gram negative cell walls, and superantigen exotoxins from Gram positive bacteria can overstimulate host leukocytes. In particular, monocytes and T cells that are overstimulated start a cytokine storm that causes massive vasodilation (leaky blood vessels) and disseminated intravascular clotting (DIC). In this situation, blood pressure plummets from lack of fluid, and tiny clots form throughout the body. To make matters worse, the clotting factors are then "used up", and internal bleeding occurs.

Treatment involves stabilizing blood pressure as much as possible using IV fluids, aggressive antimicrobial treatment, and vasopressors such as NE, vasopressin, and possibly dopamine. Steroids may be given in some cases. Even those that survive septic shock often have brain damage and cognitive impairment from the hypoperfusion during the crisis.