Pathophysiology and treatment of septic shock
Article Abstract:
Septic shock involves a severe depression of bodily functioning brought on by bacterial infection that pervades the whole body. Between 40 and 60 percent of patients who suffer septic shock die. The infection usually occurs after the body's defense systems have been compromised. Gram-negative bacteria cause the most cases of septic shock. They possess a substance called endotoxin in their outer membranes that is thought to be a mediator of septic shock. Infection usually originates in the genital/urinary or respiratory tracts. Initial symptoms include fever and a rapid heart rate. Septic shock is often identified when the patient's blood pressure decreases to low levels. Laboratory findings include leukocytosis (an increased number of white blood cells) and neutropenia (a decrease in the number of neutrophils, a type of white blood cell). Hyperglycemia, high blood sugar, may occur in the early stages, while the opposite condition may occur in advanced stages. Changes in blood flow are also seen. Depression of the heart muscle's activity occurs early on and coronary blood flow is increased. Cardiac output may increase in the early stages and then decrease later on. The tissues eventually suffer from a lack of oxygen as circulation becomes depressed. The metabolic rate increases as energy requirements increase. Skeletal muscle may begin to breakdown, in order to provide the body with protein as an energy source. Death usually results from multiple organ failure or cardiac failure. The shock eventually causes injury to the blood vessels supplying the organs, which results in organ failure. The liver and the kidneys often fail late in the disease. Treatment involves replacing lost fluids and supporting cardiac output and oxygen delivery throughout the body. A number of drugs may be given if fluid replacement alone is ineffective. Antibiotic therapy is extremely important. Antibiotics should be chosen on the basis of the organism involved and the location of the major site of infection. Steroids can be used to decrease inflammation. Research on immunologic therapies for treating septic shock are underway. Septic shock is a very grave condition, but prompt actions can help increase the chances for survival. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Role of early fluid resuscitation in pediatric septic shock
Article Abstract:
Septic shock occurs when an infection enters the blood stream and toxic substances (endotoxins) are released by dying bacteria. Part of the recommended treatment of sepsis includes aggressive fluid resuscitation, which means the infusion of large amounts of fluid over rather short periods. Although this approach is effective in adults, its effects in children have not been studied extensively. To learn more about this issue, the outcomes of 34 pediatric sepsis cases (median age, 13.5 months) were compared according to the amount of fluid administered. The criteria for diagnosing sepsis are presented. Patients who received the greatest volume of fluid after arrival in the emergency department were more likely to survive than those who received less. There was only one death among the nine patients who received the maximum dose, compared with 15 deaths among the 25 patients in the other two groups. Survivors received more fluid than nonsurvivors at one hour but similar quantities at six hours. Rapid fluid resuscitation with volumes in excess of 40 milliliters per kilogram in the first hour after the patient arrives in the emergency department led to the best outcome. Until recently, treatment of pediatric shock called for fluid administration of 10 to 20 milliliters per kilogram, but improvements in treating sepsis make it possible to infuse more fluid. No increase in complications was noted with this more aggressive approach. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin
Article Abstract:
A short corticotropin stimulation test may indicate a poor prognosis in patients with septic shock. Septic shock occurs when the cardiovascular system and other organs fail following an infection. Researchers gave a corticotropin stimulation test to 189 patients with septic shock. This test measures how quickly blood levels of cortisol increase in response to corticotropin. A short test means cortisol levels increase relatively quickly. Patients whose cortisol levels at baseline were higher than normal and whose cortisol levels increased quickly following the test had the highest mortality rates.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2000
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