Septic shock: symptoms

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

Septic shock occurs acutely, most often after surgery or any manipulation in the focus of infection, creating the conditions for the "breakthrough" of microorganisms or their toxins into the bloodstream of the patient.

Hyperthermia precedes the development of shock. The body temperature rises to 39-41 ° C, holds 1-3 days, then falls critically by 2-4 ° C to subfebrile, normal or subnormal digits, characterized by repeated chills.

The main feature of septic shock is the drop in blood pressure without previous blood loss or not corresponding to it. In the hyperdynamic, or "warm phase" of shock, systolic blood pressure is reduced to 10.6-12.0 kPa (80-90 mm Hg). On these figures, blood pressure does not last long: from 15-30 minutes to 1-2 hours. Therefore, the hyperdynamic phase of shock is sometimes seen by doctors. The hypodynamic, or "cold", phase of septic shock is characterized by a more abrupt and prolonged drop in blood pressure (sometimes below critical figures). Some patients may experience short-term remissions. This state lasts from a few hours to several days.

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

Symptoms of septic shock are characterized by the early appearance of pronounced dyspnea from 30 to 60 respiratory movements per minute. Tachypnea indicates not only the growing 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 of the central nervous system: euphoria, agitation, disorientation, delirium, auditory hallucinations, followed by lethargy and adynamia. Disorders from the central nervous system manifest early, they often precede the fall of blood pressure.

Hyperemia and dry skin are quickly replaced by pallor, cold, sticky cold sweat. Herpes tabiatis often occurs. In case of adherence to hepatic insufficiency, the skin becomes icteric. Acrociaiosis, a petechial rash of the face, chest, abdomen, on the flexing surfaces of the limbs appear in later terms.

Most women report pain of a non-permanent nature and different localization: in the epigastric region, in the lower abdomen, in the extremities, in the lumbar region, chest, headache. The emergence of pain is associated with impaired blood flow and hemorrhages in different parts of the body, in the muscles, in the mucous membranes.

Almost half of the patients experience vomiting. With the progression of shock, vomiting becomes a "coffee grounds" in connection with necrosis and hemorrhages and areas of the gastric mucosa.

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

The most dangerous complication of shock is acute renal failure. The function of the kidney in shock is disturbed early and manifests itself in the form of an oliguria: an hourly diuresis is less than 30 ml. In the initial stage of acute renal failure, the filtration capacity of the glomerulus suffers because of spasm of the vessels of the cortical layer and general hypotension. Further progression of the pathological process (vasospasm, stasis with the development of the sludge syndrome, microthrombosis) leads to a deepening of local hypoxia and nephron damage. The degree of nephron damage is explained by the development of oliguria or anuria. The most severe acute renal failure develops with necrosis of the cortical layer of the kidneys.

Clinically expressed symptoms of acute renal failure are manifested in half of patients with septic shock. In addition to oligoanuria, acute renal failure manifests itself rapidly with increasing azotemia, a violation of the electrolyte balance (primarily, signs of hyperkalemia) and changes in the acid-base state (CBS) of the blood. Patients are sluggish, sleepy, inhibited. There are pains in the region of the heart, dyspnea increases, there are heart rhythm disturbances and sometimes bradycardia. Clonic convulsions can be attached. The greatest danger in this period is cardiac arrest. With a favorable outcome, the next stage of recovery of diuresis occurs, at which violations of electrolyte balance with hypokalemia are 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 a pronounced clinic. Existing dyspnea is usually regarded as a compensatory reaction to metabolic acidosis. Physicaped methods diagnose only a far-reaching process in the form of intra-alveolar edema, which poses an immediate threat to the life of the patient.

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

In addition to the described "warm" and "cold" phases of septic shock, the third phase is identified as "irreversible," or "secondary," shock. The third phase is manifested by anuria, respiratory and cardiac insufficiency and coma as a manifestation of prolonged cell 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 timely, that is, early diagnosis, is important. The time factor for this type of shock plays a decisive role, because irreversible changes in the body occur extremely early: within 6-8, less often 10-12 hours. Diagnosis is mainly based on the following clinical manifestations:

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

[1], [2], [3], [4], [5]