Septic shock - Symptoms

Symptoms of septic shock are quite typical. The severity of individual symptoms depends on the phase of shock, the duration of its course, the degree of damage to various organs, and the disease against which the shock developed.

Septic shock occurs acutely, most often after operations or any manipulations at the site of infection, creating conditions for the “breakthrough” of microorganisms or their toxins into the patient’s bloodstream.

The development of shock is preceded by hyperthermia. The body temperature rises to 39-41 °C, lasts for 1-3 days, then falls critically by 2-4 °C to subfebrile, normal or subnormal figures, repeated chills are characteristic.

The main symptom of septic shock is a drop in blood pressure without previous blood loss or not corresponding to it. In the hyperdynamic, or "warm phase" of shock, systolic blood pressure drops to 10.6-12.0 kPa (80-90 mm Hg). Blood pressure does not stay at these values for long: from 15-30 minutes to 1-2 hours. Therefore, the hyperdynamic phase of shock is sometimes overlooked by doctors. The hypodynamic, or "cold" phase of septic shock is characterized by a sharper and longer drop in blood pressure (sometimes below critical values). Some patients may experience short-term remissions. This condition lasts from several hours to several days.

Along with the drop in blood pressure, pronounced tachycardia develops up to 120-140 beats/min. The shock index (the quotient of the pulse rate divided by the systolic blood pressure) usually exceeds 1.5 with the norm being 0.5. This fact indicates a fairly rapid decrease in the BCC.

Symptoms of septic shock are characterized by the early appearance of severe dyspnea from 30 to 60 respiratory movements per minute. Tachypnea indicates not only increasing tissue acidosis, but also the formation of a "shock" lung.

The following symptoms, which are usually found in all patients, are the most diverse manifestations from the central nervous system: euphoria, excitement, disorientation, delirium, auditory hallucinations, followed by lethargy and adynamia. Disturbances from the central nervous system appear early, often preceding a drop in blood pressure.

Hyperemia and dryness of the skin quickly give way to pallor, coldness, and sticky cold sweat. Herpes tabiatis often occurs. In the case of liver failure, the skin becomes jaundiced. Acrocytosis, petechial rash on the face, chest, abdomen, and on the flexor surfaces of the extremities appear at a later date.

Most women report pain of an inconstant nature and various localizations: in the epigastric region, in the lower abdomen, in the extremities, in the lumbar region, chest, headache. The occurrence of pain is associated with impaired blood supply and hemorrhages in different parts of the body, in muscles, in mucous membranes.

Almost half of the patients experience vomiting. As shock progresses, vomiting takes on the character of "coffee grounds" due to necrosis and hemorrhages in areas of the gastric mucosa.

The clinical picture of septic shock is often accompanied by symptoms of acute renal and respiratory failure, as well as bleeding due to the progression of DIC syndrome.

The most dangerous complication of shock is acute renal failure. Kidney function is impaired early in shock and manifests itself as oliguria: hourly diuresis is less than 30 ml. In the initial stage of acute renal failure, the filtration capacity of the glomeruli suffers due to spasm of the vessels of the cortex and general hypotension. Further progression of the pathological process (spasm of the vessels, stasis with the development of sludge syndrome, microthrombosis) leads to deepening of local hypoxia and damage to the nephron. The degree of damage to the nephron explains the development of oliguria or anuria. The most severe acute renal failure develops with necrosis of the renal cortex.

Clinically expressed symptoms of acute renal failure occur in half of patients with septic shock. In addition to oliguria, acute renal failure manifests itself by rapidly increasing azotemia, electrolyte imbalance (primarily signs of hyperkalemia) and changes in the acid-base balance (ABS) of the blood. Patients are lethargic, drowsy, inhibited. Pain in the heart area appears, shortness of breath increases, heart rhythm disturbances and sometimes bradycardia appear. Clonic seizures may join in. The greatest danger during this period is cardiac arrest. With a favorable outcome, the next stage of diuresis restoration occurs, during which electrolyte imbalance with hypokalemia is noted.

Another, no less formidable, complication of septic shock is acute respiratory failure. Disturbances in the respiratory function of the lungs accompany the course of shock in all patients. However, interstitial pulmonary edema does not have pronounced clinical manifestations. Existing dyspnea is usually assessed as a compensatory reaction to metabolic acidosis. Physical methods diagnose only an advanced process in the form of intraalveolar edema, which poses an immediate threat to the patient's life.

A very dangerous complication of septic shock can be uterine bleeding - as a manifestation of DIC syndrome in the phase of consumption coagulopathy.

In addition to the described "warm" and "cold" phases of septic shock, a third phase is distinguished - "irreversible" or "secondary" shock. The third phase is manifested by anuria, respiratory and cardiac failure and coma as a manifestation of prolonged cellular hypoxia and anaerobic glycolysis, expressed by metabolic acidosis and an increase in the level of lactate in the blood.

Septic shock is a mortal danger for the patient, so its timely, i.e. early, diagnosis is important. The time factor plays a decisive role in this type of shock, because irreversible changes in the body occur extremely early: within 6-8, less often 10-12 hours. The diagnosis is made mainly on the basis of the following clinical manifestations:

1. The presence of a septic focus in the body.
2. High fever with frequent chills, followed by a sharp drop in body temperature.
3. A drop in blood pressure that is not proportional to the hemorrhage.
4. Tachycardia.
5. Tachypnea.
6. Disorder of consciousness.
7. Pain in the abdomen, chest, limbs, lower back, headache.
8. Decreased diuresis up to anuria.
9. Petechial rash, necrosis of skin areas.

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