Septic Shock - Symptoms Risk Factors and Treatment Of This Deadly Infection
Many of the infections that patients acquire during hospitalization do not result in severe life-threatening illnesses that demand admission in the ICU. Several diseases such as urinary tract infections, pneumonias, and gastrointestinal bugs pass through clinics and hospitals everyday across the world without a thought.
Unfortunately, many people especially children develop a serious clinical syndrome called sepsis. Each year over 6,00,000 infants die because of sepsis and it’s the most common cause of death in people who are hospitalized. It is estimated that annually, there are over 18 million cases of sepsis worldwide.
What is septic shock?
Sepsis is a condition resulting from an infection. Severe cases of sepsis can lead to septic shock. Sepsis occurs when chemicals released by immune system into the bloodstream for fighting infection, starts a chain of reaction triggering uncontrolled inflammation. This causes a cascade of changes in the body making the organs of an infected person on the verge of failure and eventually death.
Experts so far have identified three stages of sepsis, the last one being septic shock.
- Sepsis - When the infection enters the bloodstream and causes inflammation of body organs
- Severe sepsis - When the infection is so severe that it affects the functioning of vital organs such as brain, heart and kidneys
- Septic shock - If severe sepsis progresses to septic shock, the blood pressure drops dramatically resulting in organ failures and even death.
What causes septic shock?
Septic shock occurs due to bacterial, viral or fungal infection. A person can catch infection from home or at the hospital undergoing treatment of some other condition. Sepsis can occur due to:
- Infections in the abdominal and digestive system
- Urinary tract infection
- Lung infections such as pneumonia
- Infection in the reproductive system
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Who gets septic shock?
There are several factors such as age and prior illness that can lead to septic shock. Newborns, pregnant women, older adults and those people with compromised immune system caused by HIV, rheumatoid arthritis, psoriasis etc. are vulnerable to sepsis. Other factors that raise the risk of getting septic shock are:
- Inflammatory bowel disease
- Long-term hospitalization due to major surgery
- Chronic illness such as diabetes
- Intravenous drug abuse
- Exposure to invasive devices such as breathing tubes, urinary catheters and intravenous catheters
- Artificial joint replacement
- Hospitalized patients that are already sick
- Anti-biotics abuse
What are the symptoms of septic shock?
The symptoms should not be ignored. Early symptoms of sepsis are:
- High fever usually 101 degree Fahrenheit
- Fast heart rate (higher than 90 beats per minute)
- Low body temperature
- Breathing problem or rapid breathing (more than 20 breaths per minute)
In case of severe sepsis, the important body organs such as kidneys, lungs and heart start facing serious impact.
- Significant reduction in urine output
- Sudden or unexpected change in mental status
- Severe difficulty in breathing
- Abnormal heart functioning
- Bluish lips (cyanosis)
To be diagnosed with septic shock, a person will show signs and symptoms of severe sepsis.
Which tests are used in diagnosis septic shock?
Diagnosing of sepsis can be very difficult as the signs and symptoms can indicate other disorders. Doctor would order a number of tests to pinpoint the infection. These are:
- Blood tests - For determining infection, impaired oxygen level, electrolyte balance and abnormal liver and kidney functions
- Lab tests for bodily fluids - Urine, wound secretions and respiratory or mucous secretions to find out the cause of infection
- Imaging scans - X-Ray, Ultrasound, CT scan and MRI to dig deep into body’s internal structures
Is there any treatment of septic shock?
Early diagnoses of sepsis increase the chances of survival. Once doctor is able to diagnose sepsis, the patient will be admitted to the ICU for the treatment. Following medications are usually given for septic shock:
- Anti-biotics which are given intravenously
- Low doses of corticosteroids
- Insulin to maintain stability in the blood glucose level
- Painkillers or sedatives
- Vasopressors medications are given when the blood pressure remains low even after getting intravenous fluids. These drugs constrict blood vessels and help improve blood pressure.
A respirator for breathing might also be administered. In some other cases, surgery might be needed to remove the source of infection such as removing the infected tissue or collection of pus.
Septic shock mortality rate
Septic shock is a deadly condition. According to an estimate, 20-35 percent people with severe sepsis and about 30-70 percent people with septic shock pass away. Chances of survival will depend on the severity of the infection, how much and how many organs it has affected and top of it, how early you have started the treatment.
Why cases of sepsis in India are rising?
According to a study by Lancet Global Health in 2016, more than 25 percent of newborn deaths in India occur due to sepsis. And in many cases, infection occurred in the gut. According to a nationwide study conducted by Indian Intensive Care Case Mix and Practice Patterns (INDICAPS), 1 out of 4 patients admitted in ICU (intensive care unit) have contracted sepsis. The study was based on 4,209 patients admitted to ICU wards of various hospitals across 17 states of the country.
The findings reveal that 1,094 patients (26 percent) out of 4,209 patients contracted sepsis. While the mortality rate among the infected people was 42 percent i.e. 459 patients died of sepsis. The mortality rates in the Indian hospitals can be anywhere between 20-50 percent.
But recently, doctors in Apollo children’s hospital in Chennai have developed a method to bring down mortality rates down to 8 percent. The method involves real-time monitoring of patients’ fluid levels, blood vessels, and organs. This study was published in two medical journals and has been gaining popularity among the doctors fraternity across the globe. Under the protocol, they ask a list of questions to the parents who visit the hospitals with complaints of fever such as:
- Temperature of the child
- Frequency of urination of the child i.e. at least 6 times in the past 24 hours
- If the child has good appetite
- If the child is active
All these measures adopted by the hospital saved lives of 90-100 children with sepsis and also reduced the days of stay in intensive care unit by almost half.
Recently, there was another breakthrough development by an Indian American doctor in this field. Dr. Pinaki Panigrahi, professor of epidemiology and pediatrics at the Child Health Research Institute and Center for Global Health at the University of Nebraska Medical Centre’s College of Public Health, led a team that developed a therapy, details of which was published in Nature Journal.
The therapy is being claimed to reduce the risk of sepsis infection by 40 percent. Moreover, it is inexpensive costing less than 1 dollar for a single course. It involves feeding the infant with good bacteria (probiotic) that will populate his gut and prevent the attack of harmful bacteria. This oral therapy is similar to the vaccination and should be started 2-4 days after birth. The trial was conducted on 4,556 people and was an outcome of 20 years of research.