From a microbiologic standpoint, infections due to bacteria (possibly that the patient is already colonized with) are common causes of septic shock. But many other organisms including fungi, parasites, and higher-order bacteria can also cause septic shock. Signs and symptoms may be specific to the etiology (pneumonia, intra-abdominal sources, urinary sources, etc). Generally, patients may present with fever or hypothermia, tachycardia, tachypnea, and leukocytosis. Delirium and oliguria may be seen. Laboratory evaluation commonly reveals signs of organ hypoperfusion including elevated lactate, elevated creatinine, and abnormal liver function tests.
Rapid administration of appropriate anti-microbial therapy is the most important factor for patient survival. Supportive therapy with fluid resuscitation and pressor support is necessary. Elimination of a local site of infection (by draining an abscess or removing an infected intravenous catheter) is also frequently required for patient recovery.
R65.21 – Severe sepsis with septic shock
76571007 – Septic shock
Differential Diagnosis & Pitfalls
- Pancreatitis – Patients may have evidence of systemic inflammation fever, tachycardia, tachypnea, and elevated white blood cell (WBC) count.
- Burn patients – May have evidence of systemic inflammation fever, tachycardia, tachypnea, and elevated WBC count.
- Cardiogenic shock – Patients may complain of chest pain or have a history of recent major myocardial infarction or cardiac arrest.
- Hemorrhagic shock – Patients may have history of trauma or a recent procedure (eg, kidney or liver biopsy).
- Anaphylactic shock – Patient may report a history of exposure to a known allergen (eg, food or insect sting).
- Toxin-induced shock – Some infections are associated with toxic shock. See toxic shock syndrome.
- Neurogenic shock – May occur following spinal cord injury.
- Adrenal insufficiency – Patients may present with fever and hypotension.
- Pulmonary embolism – Patients may present with fever and hypotension.
Drug Reaction Data