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| {{DiseaseDisorder infobox |
| | #redirect:[[Sepsis]] |
| Name = Septic shock |
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| ICD10 = A41.9 |
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| ICD9 = {{ICD9|785.52}} |
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| }}
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| {{Sepsis}}
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| {{CMG}}
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| ==Overview==
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| '''Septic shock''' is a serious [[medicine|medical]] condition caused by decreased tissue perfusion and oxygen delivery as a result of [[infection]] and [[sepsis]]. It can cause [[multiple organ failure]] and [[death]]. Its most common victims are children, [[immunodeficiency|immunocompromised]] individuals, and the elderly, as their [[immune system]]s cannot cope with the infection as well as those of full-grown adults. The [[mortality rate]] from septic shock is approximately 50%.
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| ==[[Sepsis overview|Definitions]]==
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| ==Septic shock==
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| [[Septic shock]] is defined as [[sepsis]] with refractory arterial [[hypotension]]. Refractory arterial [[hypotension]] is further defined as:
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| * Mean systemic blood pressure (SBP) of < 60 mm Hg or < 80 mm Hg (in hypertensives) despite adequate fluid resuscitation.
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| ** Adequate fluid resuscitation is defined as infusion of following at the said rates:
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| *** 20 to 30 mL/kg of starch,
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| *** 40 to 60 mL/kg of saline solution
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| *** Measured [[pulmonary capillary wedge pressure]] - 12 to 20 mmHg
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| *** [[Central venous pressure]] of 8 to 12 mmHg
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| * Maintenance of the systemic mean blood pressure of >60 mmHg or >80 mmHg (in hypertensives) despite adequate fluid resuscitation requires
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| ** [[Dopamine]] > 5 mcg/kg/min
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| ** [[Norepinephrine]] < 0.25 mcg/kg/min
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| ** [[Epinephrine]] < 0.25 mcg/kg/min
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| ===Types===
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| A subclass of [[distributive shock]], shock refers specifically to decreased tissue [[perfusion]] resulting in end-organ dysfunction. [[Cytokines]] TNFα, IL-1β, IL-6 released in a large scale inflammatory response results in massive [[vasodilation]], increased [[capillary]] permeability, decreased systemic vascular resistance, and [[hypotension]]. Hypotension reduces tissue perfusion pressure and thus tissue [[Hypoxia (medical)|hypoxia]] ensues. Finally, in an attempt to offset decreased [[blood pressure]], [[ventricular]] dilatation and [[myocardium|myocardial]] dysfunction will occur.
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| ===Causes===
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| The process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. In rough order of severity, these are [[bacteremia]] or [[fungemia]]; [[septicemia]]; [[sepsis]], severe sepsis or sepsis syndrome; septic shock; refractory septic shock; [[multiple organ dysfunction syndrome]], and [[death]].
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| The condition develops as a response to certain [[microbe|microbial]] molecules which trigger the production and release of cellular mediators, such as [[tumor necrosis factors]] (TNF); these act to stimulate immune response. Besides [[Tumor necrosis factor-alpha|TNFα]], other [[cytokine]]s involved in the development of septic shock include [[interleukin]]-1β, and [[interferon]] γ.
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| ==[[Sepsis medical therapy|Medical therapy]]==
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| ==References==
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| {{reflist|2}}
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| ==See also==
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| *[[Anaphylactic shock]]
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| *[[Cardiogenic shock]]
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| *[[Neurogenic shock]]
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| *[[Sepsis]]
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| *[[Shock (medical)|Shock]]
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| *[[Systemic inflammatory response syndrome]] (SIRS)
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| [[Category:Medical emergencies]]
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| [[Category:Intensive care medicine]]
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| [[Category:Causes of death]]
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| [[Category:Infectious disease]]
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| [[Category:Emergency medicine]]
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| [[fr:Choc septique]]
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| [[pl:Wstrząs septyczny]]
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| [[sk:Septický šok]]
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| [[sv:Septisk chock]]
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| [[zh:敗血性休克]]
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