Exams and Tests

• White blood cell count that is low or high
• Platelet count that is low
• Blood culture that is positive for bacteria
• Blood gases that reveal acidosis
• Kidney function tests that are abnormal (early in the course of disease)

Treatment

Septic patients usually require monitoring in an intensive care unit (ICU). "Broad spectrum" intravenous antibiotic therapy should be initiated as soon as sepsis is suspected.

The number of antibiotics administered may be decreased when the results of blood cultures become available and the causative organism is identified. The source of the infection should be discovered, if possible, which may mean further diagnostic testing. Sources such as infected intravenous lines or surgical drains should be removed, and sources such as abscesses should be surgically drained.

Supportive therapy with oxygen, intravenous fluids, and medications that increase blood pressure may be required for a good outcome. Dialysis may be necessary in the event of kidney failure, and mechanical ventilation is often required if respiratory failure occurs.

Outlook (Prognosis)

The death rate can be as high as 60% for people with underlying medical problems. Mortality is less (but still significant) in individuals without other medical problems.

Possible Complications

• Septic shock
• Impaired blood flow to vital organs (brain, heart, kidneys)
• Disseminated intravascular coagulation

Septic shock

Definition

Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. The brain, heart, kidneys, and liver may not work properly or may fail.

Alternative Names

Bacteremic shock; Endotoxic shock; Septicemic shock; Warm shock

Causes

Septic shock occurs most often in the very old and the very young. It also occurs in people who have other illnesses.

Any type of bacteria can cause septic shock. Fungi and (rarely) viruses may also cause the condition. Toxins released by the bacteria or fungus may cause tissue damage, and may lead to low blood pressure and poor organ function. Many researchers believe that abnormal blood clots in small arteries cause the lack of blood flow and poor organ function.

The toxins also cause a strong inflammatory response from the body, which contributes to septic shock.

Risk factors for septic shock include:

• Diabetes
• Diseases that weaken the immune system such as AIDS
• Diseases of the genitourinary system, biliary system, or intestinal system
• Leukemia
• Long-term use of antibiotics
• Lymphoma
• Recent infection
• Recent surgery or medical procedure.

Symptoms

• Cool, pale extremities
• High or very low temperature, chills
• Lightheadedness
• Low blood pressure, especially when standing
• Low urine output (due to kidney failure)
• Palpitations
• Rapid heart rate
• Restlessness, agitation, lethargy, or confusion
• Shortness of breath

Exams and Tests

Blood tests may be done to check for infection, low blood oxygen level, disturbances in the body's acid-base balance, or poor organ function or organ failure.

A chest x-ray may show pneumonia or pulmonary edema.

Treatment

Septic shock is a medical emergency. Patients are usually admitted to the intensive care unit of the hospital.

Treatment may include:

• Drugs to treat low blood pressure, infection, or blood clotting
• Fluids by a vein (intravenously)
• Oxygen
• Surgery
• Support for any poorly functioning organs

There are new drugs that act against the hyperinflammatory response seen in septic shock. These may help limit the damage to vital organs.

Hemodynamic monitoring -- the evaluation of the pressures in the heart and lungs -- may be required. This can only be done with specialized equipment and intensive care nursing.

Outlook (Prognosis)

Septic shock has a high death rate. The death rate depends on the cause of the infection, how many organs have failed, and how quickly and aggressively medical therapy is started.

Possible Complications

Respiratory failure, cardiac failure, or any other organ failure can occur.

When to Contact a Medical Professional

Go directly to an emergency department if you or a loved one have symptoms of septic shock

Prevention

Prompt treatment of bacterial infections is helpful. However, many cases of septic shock cannot be prevented.