Septic shock

Septic shock is a medical emergency that is a result of acute cases of infection and sepsis. Globally, the condition arises in as many as 20 million people every year with death occurring in even 50% of all cases in industrialized nations. Read and know all about Septic shock, its causes, symptoms, treatment, prognosis and more.

Septic shock Definition

It is a severe condition that arises when an overwhelming infection gives rise to fatally low blood-pressure in sufferers.

The condition is also known by various other names, such as:

• Septicemic shock
• Bacteremic shock
• Endotoxic shock
• Warm shock

Septic shock ICD9 Code

The ICD9 Code for the disorder is 785.52.

Septic shock Incidence

Over the last five decades, the incidence of Septic shock and Sepsis has been on the rise. Around 8.7% of every 1,000 admissions in hospital are for either of these two diseases. Around 2.26% of hospitalized sufferers develop nosocomial or hospital-acquired infections that cause Septic shock.

In the United States, the incidence of this disease is around 200,000 cases in every year.

Septic shock Symptoms

The condition may affect any region of the human body, including organs like:

• Brain
• Heart
• Kidneys
• Liver
• Intestines

The signs and symptoms exhibited by individuals affected by this disorder include the following:

• High or very low body temperature
• Cool, pale arms and legs
• Chills
• Palpitations
• Shortness of breath
• Lightheadedness
• Little or no urine
• Skin rash or discoloration
• Low blood pressure, especially when standing
• Rapid heart rate
• Restlessness, lethargy, agitation or confusion

Septic shock Causes

The disorder can occur due to varied causes. It often affects individuals who are very young or very old in age. It is also common in people suffering from ailments, particularly in case they have a weakened immunity.

The disease may arise due to any form of bacteria. Fungi, and even viruses in rare cases, may also give rise to this disorder. Toxins released by these microbes may lead to tissue damage and may cause low blood pressure as well as poor functioning of the various organs of the human body. According to some researchers, reduced blood flow and impaired organ functioning may occur as a result of blood clots in small arteries. The human body also shows a powerful inflammatory response to the toxins produced by the microbes. Such a response may contribute to the damage of the organs.

What Happens in Septic shock?

The disorder typically starts with an infection, which may occur at any region of the body. As the immune system tries to cure the infection, the process goes awry resulting in the spread of infection. The infection ultimately enters the bloodstream of sufferers. In an attempt to combat the infection, the immune system goes into an overdrive and secretes substances that expand the blood vessels along the way. With the dilation of the blood vessels, blood pressure decreases and the flow of blood to the body is reduced in a drastic manner. In the meantime, toxins from the infection flood the body of sufferers and results in further problems.

In the absence of proper amounts of oxygen, tissues begin to release lactic acid. An accumulation of lactic acid in the body makes the blood highly acidic in nature. As the infection continues to spread, the organs in the body start to fail due to reduced supply of blood and increase in the acidic level of bloodstream. When blood fails to flow in proper amounts to vital bodily organs like the brain and the heart, patients may enter into a comatose state or eventually die.

Septic shock Risk Factors

The risk factors for this disease include:

• Diabetes
• Leukemia
• Lymphoma
• Recent infection
• Conditions such as AIDS that weaken the immune system
• Disorders of the genitourinary system, intestinal system or biliary system
• Long-term use of antibiotics
• Recently conducted medical procedure or surgery
• Recent use of steroid medications
• Indwelling catheters (those kept for extended periods in place, especially urinary catheters and intravenous lines and plastic and metal stents that are used for drainage)

Septic shock Diagnosis

The diagnosis of this disease involves the following:

Consideration of medical history

People with this condition may report of non-specific or vague problems like chills, fever, confusion, anxiety or fatigue. In some cases, patients may be able to describe a particular region where they have sensations of discomfort or pain, such as the abdomen or the throat. Areas in which such problems are experienced may be the site of an underlying infection. Patients may report a recent ailment, operation or any other process that can give rise to the infection.

Physical examination

Alteration in mental functioning is the clinical problem that is most consistently detected during a physical examination of Septic shock sufferers. This may either be as moderate as mild disorientation or more acute in nature such as extreme agitation or even mental bluntness. Other common findings include Hyperventilation and rapid respiration (over 20 breaths per minute). The heart rate is generally elevated over 90 beats every minute. The body temperature may be abnormally low or high. In the early stages of sepsis, the skin may be dry, warm or flushed. However, the skin usually turns cool and mottled as the Septic shock progresses.

In the initial stages of Septic shock, the systolic blood pressure may be over 100 mmHg although it may reduce well below that level as the shock progresses and the heart weakens. The local signs and symptoms may point to the source of the underlying infection. In lung infections, a productive cough and chest pain may be detected. An infection in the intestines or the abdominal cavity may be indicated by the following problems:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain

Infection in the bone or soft tissues may be indicated by problems like noticeable redness, inflammation and pain. However, there is often an absence of localizing symptoms.

Medical tests

Doctors may conduct blood tests to check for the following problems:

• Infection
• Low blood oxygen level
• Disturbances in the acid-base balance of the body
• Poor organ functioning or organ failure

Blood tests may involve:

• CBC (Complete Blood Count) with differential
• Arterial blood gases (ABGs)
• Chemistry panel with renal and liver function studies
• Coagulation studies
• Blood cultures
• Additional Gram stains and cultures from any draining wounds or exudates

An x-ray examination of the chest may reveal problems like Pulmonary edema (fluid in the lungs) or Pneumonia. A urine sample analysis may show an underlying infection in sufferers.

Additional medical studies like blood cultures may not yield positive results for a number of days after the blood has been extracted or for several days after the development of the shock.

Septic shock Differential Diagnosis

The differential diagnosis of the disorder requires physicians to ensure that the symptoms exhibited by sufferers are not the result of the following conditions:

• Acute renal failure
• Anaphylaxis
• Arthritis
• Adrenal crisis
• Cardiogenic shock
• Heatstroke
• Diabetic ketoacidosis
• Myocardial infarction
• Pulmonary embolism
• Hyperthyroidism
• Hemorrhagic shock
• Viral enteritis
• Salicylate toxicity

Septic shock Treatment

This is a medical emergency and should always be treated as one. Patients are generally admitted to the ICU (Intensive Care Unit) of hospital. The treatment of the disease may involve the usage of the following curative options:

• Surgery
• Oxygen
• Dialysis
• Sedatives
• Breathing machine (mechanical ventilation)
• Directly administering fluids into a vein (intravenous administration)
• Medicines to cure low blood pressure, infection, or blood clotting

Some new medications are found to act against the acute inflammatory response observed in Septic shock patients. This may help reduce damage to the organs.

The pressure in the lungs and the heart may be checked by using a technique known as Hemodynamic monitoring. This can only be performed with intensive care nursing and special equipments.

Septic shock Management

The management of this disorder has as many as four aims:

Early recognition and resuscitation

Early recognition and initiation of treatment is the main determinant in the survival of sepsis patients as the disorder is readily reversible in such stages. Rapid administration of intravenous fluids helps restore and maintain blood pressure and is considered to be a mandatory first step in curing septic shock.

Re-establishment of circulation and blood pressure to the tissues

Individuals with septic shock or sepsis need intensive care monitoring including Continuous ECG along with the frequent assessment of the following:

• Blood pressure
• Respiratory rate
• Neurological status
• Color
• Body temperature
• Urine flow (generally by indwelling bladder catheter)

In individuals suffering from severe shock or shock of uncertain or mixed etiology, a catheter may be inserted into the right atrium (central venous pressure catheter) or into the pulmonary artery (pulmonary artery catheter) through the superior vena cava to constantly measure the performance and pressure in the heart. This can serve as a guide for doctors in the administration of fluids and the use of drugs to restore and support blood pressure (inotropes and vasoactive medications).

Provision of optimal supportive care

The following supportive care options are deemed as appropriate:

• Assisted ventilation
• Maintenance of organ function
• Administration of nutrition support (either through gastric tubes or in an intravenous manner)

Septic focus/Timely initiation of treatment

Septic focus aims to obliterate the source of infection. Eradicating the source of infection may include one or more of the following measures:

• Administration of antibiotics
• Drainage of abscesses or infected wounds
• Clearing of lung secretions (Bronchoscopy)
• Surgical resection of infected tissue (resection, removal or debridement)

Other supportive measures involve:

• Administration of H2 receptor inhibitors, to prevent stress ulcers
• Use of anticoagulants, in order to prevent deep vein thrombosis
• Administration of steroids, to compensate for endocrine effects

Acute cases of the disorder may need blood product transfusions or the administration of recombinant human activated protein C, which may help in reducing risks of death (due to the presence of anticoagulant and anti-inflammatory properties).

Septic shock Prognosis

The condition is associated with a high mortality rate. The mortality rate actually depends on various factors, such as:

• Age of patients
• Overall health condition of patients
• Cause of infection
• Number of organs that have suffered failure
• How promptly and aggressively medical therapy has been initiated

In spite of a concerted effort to bring about an improvement in the treatment options and outcome for the disorder, the death rate associated with this condition remains varying between 14.3 – 20%.

The condition has a poorer prognosis when it is related with problems like:

• Persistent low blood pressure
• Organ dysfunction
• Inadequate circulation to the tissues, proved by physical signs like lactic acid build-up, low urine output and changed mental status

Septic shock Complications

The possible complications of this disorder include:

• Cardiac failure
• Respiratory failure
• Central Nervous System (CNS) Dysfunction
• Liver failure
• Acute Renal Failure
• Failure of any other organ
• Tendency to bleed (Disseminated Intravascular Coagulation or DIC)
• Gangrene, possibly resulting in the amputation of a body part

Around 18% of sufferers of this condition develop Adult Respiratory Distress Syndrome (ARDS). DIC arises in approximately 38% of people with this disease. Renal failure occurs in around 50% of all sufferers of septic shock.

Septic shock Prevention

In the majority of cases, this condition cannot be prevented. However, quick curing of bacterial infections can helpful.

Septic shock Recovery

The time for recovery, accommodations and work limitations for sufferers depend on the underlying as well as whether or not there is any defect in the functioning of the organs.

Patients who exhibit symptoms of Septic shock should be immediately rushed to a hospital to seek quick treatment for them. As aforesaid, quick and proper medical cure can help prevent further complications of this disorder and safeguard the health and life of sufferers.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001689/

http://www.mdguidelines.com/septic-shock

http://en.wikipedia.org/wiki/Septic_shock

http://www.wisegeek.org/what-is-septic-shock.htm