Sepsis can start off mild but may quickly progress to higher levels of severity, explains Keith Roach, MD, an internist at NewYork-Presbyterian Weill Cornell Medical Center in New York City. “Septic shock is a late stage of sepsis where the ability of the body to provide adequate blood flow to organs is compromised, to the point that blood pressure is low,” he says. Septic shock is a serious medical condition with a poor prognosis. It has a mortality rate of about 40 percent. (2)
Faster breathingLow urine outputConfusionDizzinessUnusual skin color
Septic shock is diagnosed when you have the above symptoms of severe sepsis and a dangerously low blood pressure that doesn’t respond to fluid replacement. (2) Low blood pressure is a reading lower than 90 millimeters of mercury (mm Hg) (systolic) over 60 mm Hg (diastolic). (3) It’s important to note that other conditions can cause low blood pressure, too. These include pregnancy, heart problems, dehydration, blood loss, and lack of nutrients. (3) Because some medications also result in low blood pressure (including diuretics and antidepressants), septic shock can be difficult to diagnose. Doctors will make this diagnosis, however, when low blood pressure is accompanied by symptoms of severe sepsis or an infection. (4) Low blood pressure decreases blood flow and makes it difficult for oxygen to reach your organs, hence the urgency of seeking medical help. Infections that most often lead to septic shock include urinary tract infections (UTI), pneumonia, gastrointestinal infections, and skin infections. Keep in mind that other types of infections can also progress to septic shock. (4) The risk for septic shock is higher if you have a weakened immune system. This makes it harder for your body to fight off infections. So while someone with a stronger immune system can take an antibiotic and quickly eliminate a urinary tract infection, someone with a weaker immune system may have trouble fighting the same type of infection. As a result, the infection may spread to other parts of their body, and their immune system triggers widespread inflammation in response to the infection. (1) People at greater risk for septic shock include: (5)
Newborns and infantsThe elderlyPregnant womenPeople who have had organ transplants
A chronic illness diagnosis also raises the risk for septic shock because chronic illnesses put a lot of stress on the immune system, making it harder for the body to defend itself against infections, says Kimberly Brown, MD, MPH, an ER doctor in Memphis, Tennessee. (5) Chronic illnesses that increase the risk of septic shock include: (5)
DiabetesLiver diseaseCancerAIDS/HIVKidney diseaseHeart diseaseLung disease
There’s also the risk of septic shock if your immune system is weak because of medications like chemotherapy and corticosteroids. (6) Because of the severity of septic shock, this condition isn’t treatable at home. You will need to be admitted to the ICU. Here, you will continue to receive medication to fight the infection, which you’ll receive intravenously so it gets into your bloodstream quicker. (7) When you’re diagnosed with sepsis, you’ll likely receive a broad-spectrum antibiotic that is effective against a variety of organisms. Once your doctor identifies the bacteria causing the infection, you’ll receive a more targeted antibiotic. (7) Treatment differs when bacteria isn’t the cause of an infection. If your doctor determines that septic shock is the result of an underlying fungal or viral infection, you’ll receive an antifungal or possibly an antiviral medication, respectively. Because septic shock causes extremely low blood pressure, treatment also focuses on increasing blood volume and blood pressure to avoid permanent organ damage. Therefore, septic shock treatment often involves receiving large amounts of intravenous fluids. Fluid not only helps increase blood pressure and blood flow, it can also prevent dehydration. (8) Along with large amounts of fluid, your doctor may also give you a corticosteroid to lessen inflammation in your body. Sometimes, vasopressor medications are administered. This medication constricts blood vessels and helps raise blood pressure. (8) Septic shock can also cause insulin resistance. You may receive insulin therapy while in the hospital to help your body maintain a healthy blood sugar level. (7) Impaired breathing is also common with septic shock, but, Dr. Brown says, “patients in septic shock are often placed on mechanical ventilators to give their lungs and body rest and the ability to heal.” You may require oxygen therapy through a face mask or a tube placed down your throat. Even though medication and fluids are the standard treatments for severe sepsis and septic shock, surgery is sometimes necessary. (7) Your doctor will conduct multiple tests to identify the source of the infection. This may include a urinalysis to check for urinary tract infections, a wound secretion test, and a mucus secretion test. Similarly, you may have an X-ray, CT scan, ultrasound, or MRI to check for abnormalities and signs of infection in various parts of your body. (7) Surgery can remove an abscess if it’s the source of the infection, or repair a hole that forms in the gastrointestinal tract because of an ulcer, diverticulitis, or another inflammatory condition. Surgery may be needed for other infectious complications as well. While severe sepsis can limit organ function, septic shock leads to complete organ failure when inflammation and low blood pressure aren’t controlled. Between severe inflammation triggering blood clots and low blood pressure causing inadequate blood flow, your organs may not receive sufficient oxygen or blood to function properly. (2) Kidney failure, heart dysfunction, respiratory failure, and multiple organ failure are all complications of sepsis and septic shock, notes Brown. “Patients may need dialysis temporarily or long-term if their kidneys are shutting down, and death can occur if multiple organ systems become dysfunctional and shut down.” She further relates the dangerous effect of low blood pressure on the brain, stating the increased likelihood of stroke when blood can’t circulate to all areas of the brain. In addition to possible organ failure, septic shock can lead to amputation of a limb. The risk for amputation increases when blood clots form in the body. Blood clots prevent the passage of blood. And when parts of the body are deprived of blood and oxygen long-term, body tissue starts to die. (2) Sometimes, the damage is reparable. When too much of your body tissue dies, the only option is to remove the dead tissue. This may involve removal of a finger, toe, foot, arm, or leg. (4) Even if you recover from septic shock, you may live with post-sepsis symptoms for weeks or months. (9) “Recently, we are starting to recognize how sepsis can cause patients to be debilitated for long periods of time, and very weak after they leave the hospital,” explains Brown. “The combination of being hospitalized, fighting off an infection, and being immobile can cause significant wear and tear on the body.” Post-sepsis symptoms can include insomnia, fatigue, depression, and cognitive decline. (9)
One Last Thing on Preventing Sepsis and Avoiding Septic Shock
If you suspect sepsis, it’s important that you go to the hospital immediately. The longer you wait, the greater the risk of the infection progressing into a life-threatening emergency. Unfortunately many people diagnosed with septic shock don’t survive. And because this condition strains the immune system, there’s also the risk of recurrent infections after leaving the hospital. (2) Therefore, learning how to recognize symptoms and thus get early treatment is your best chance of survival.
