ConditionInfections
Septic Shock
Septic shock is the most severe form of sepsis: the body's overwhelming response to an infection causes blood pressure to fall so low that medicines are needed to keep it up, and cells cannot use oxygen properly. Organs such as the kidneys, lungs, liver and brain begin to fail. It usually starts from pneumonia, a urinary, abdominal or skin infection. Warning signs include confusion, fast breathing, a racing heart, cold or mottled skin and very little urine. It is a medical emergency with high mortality; every hour of delay in treatment matters.
Also called: Severe sepsis with shock, sepsis-induced shock, septicemic shock, vasodilatory shock
At a glance
- What it is
- Sepsis with circulatory collapse: low blood pressure requiring vasopressors and high lactate despite fluids.
- Common sources
- Pneumonia, urinary tract and kidney infections, abdominal infections, skin infections, catheters.
- Warning signs
- Confusion, fast breathing, fast heart rate, low blood pressure, cold or mottled skin, little urine.
- Who is at risk
- Older adults, babies, people with chronic illness or weakened immunity, recent surgery or hospital stay.
- Treatment
- Immediate antibiotics, IV fluids, vasopressors, source control and ICU support.
- Outlook
- Hospital mortality is high, often around 30 to 40% or more; survivors may have lasting effects.
When to get help
Call 911 or go to the ER
- Signs of sepsis with a known or suspected infection: confusion or drowsiness, very fast breathing, a racing heart, shivering or very high or low temperature, cold, clammy or mottled skin, no urine for a day, or feeling like you might die: call 911 or your local emergency number and say "I think this is sepsis"
- Fainting or dizziness with very low blood pressure during an infection
- A rash that does not fade under pressure, with fever
- In babies and young children: fast breathing, a floppy or unresponsive baby, blue or pale skin, or not feeding
See a doctor within a day or two
- An infection that is getting worse despite antibiotics
- Fever in someone on chemotherapy, without a spleen, or with weakened immunity
Sepsis vs septic shock
Sepsis is life-threatening organ dysfunction caused by the body's dysregulated response to infection. Septic shock is a subset of sepsis in which circulation and metabolism are so disturbed that the risk of death rises substantially. Doctors define septic shock as sepsis requiring vasopressor medicines to maintain a mean arterial blood pressure of at least 65 mm Hg, with a blood lactate above 2 mmol/L despite adequate fluids.
| Infection | Sepsis | Septic shock | |
|---|---|---|---|
| Body response | Local | Widespread, damaging organs | Circulatory and cellular failure |
| Blood pressure | Normal | May be low | Low despite fluids; needs vasopressors |
| Care setting | Home or clinic | Hospital | Intensive care |
How septic shock happens
The immune system releases large amounts of inflammatory chemicals to fight infection. These make blood vessels widen and leak, so blood pressure falls and fluid escapes into tissues. Small blood clots form, blood flow to organs drops, and cells struggle to use oxygen, producing lactate. The heart may also weaken. Without rapid treatment, organs fail one after another.
Causes
- lung infections: pneumonia, the most common source
- urinary tract and kidney infections: see urinary tract infection
- abdominal infections: perforated bowel, peritonitis, gallbladder infection
- skin and soft tissue infections: cellulitis, abscess, necrotizing fasciitis
- bloodstream infections from IV lines and catheters
- meningitis and meningococcal disease
- toxic shock syndrome
Bacteria cause most cases, but viruses (including influenza and COVID-19) and fungi can also cause septic shock.
Risk factors
- age over 65 or under 1
- diabetes, cancer, chronic kidney, liver or lung disease
- weakened immunity from chemotherapy, steroids, transplant medicines or HIV
- no spleen
- recent surgery, invasive devices or hospital stay
- previous sepsis
Symptoms
- confusion, disorientation or extreme sleepiness
- fast breathing and shortness of breath
- fast heart rate
- fever with shivering, or a low body temperature
- low blood pressure, dizziness or fainting
- cold, clammy, pale or mottled skin; bluish lips or fingers
- little or no urine
- extreme pain or discomfort
- in some infections, a rash
Diagnosis
Doctors recognize septic shock from the clinical picture and act immediately. Tests include:
- blood pressure monitoring, often with an arterial line
- blood lactate level
- blood cultures, ideally before antibiotics
- blood count, kidney and liver function, clotting tests
- urine tests, chest X-ray, and CT or ultrasound to find the source
Treatment
Treatment follows the Surviving Sepsis Campaign guidelines and begins in the ER:
- Antibiotics within 1 hour: broad-spectrum IV antibiotics, narrowed once the organism is identified.
- IV fluids: rapid infusion of crystalloid fluids to restore circulation.
- Vasopressors: norepinephrine is first-line to raise blood pressure; vasopressin or others may be added.
- Source control: draining abscesses, removing infected catheters, or surgery for perforated bowel or dead tissue.
- Steroids: hydrocortisone for shock that needs ongoing vasopressors.
- Organ support: oxygen and mechanical ventilation, dialysis for kidney failure, blood transfusions, blood sugar control, and prevention of blood clots and stress ulcers.
Outlook and recovery
Septic shock carries a high risk of death, with hospital mortality often around 30 to 40% or more, depending on age, health and how quickly treatment starts.
Survivors often face post-sepsis syndrome: fatigue, muscle weakness, sleep problems, memory and concentration difficulties, anxiety, depression and PTSD. Some have lasting kidney damage or, after severe infections, limb loss. Recovery may take months; rehabilitation, follow-up clinics and support groups help. Survivors are at higher risk of another sepsis episode.
Prevention
- stay up to date with vaccines: flu, COVID-19, pneumococcal, and others
- treat infections promptly, and finish prescribed antibiotics
- clean and care for wounds
- wash hands regularly
- manage chronic conditions such as diabetes
- know the signs of sepsis and act quickly
Frequently asked questions
What is the difference between sepsis and septic shock?
Sepsis is a life-threatening reaction to infection that damages organs. Septic shock is its most severe stage, where blood pressure stays dangerously low despite IV fluids and medicines are needed to raise it, with signs of cellular failure such as high lactate.
What are the signs of septic shock?
Signs include confusion, fast breathing, a racing heart, very low blood pressure, cold, clammy or mottled skin, and little or no urine, usually in someone with an infection. It requires emergency treatment.
What is the survival rate of septic shock?
Hospital survival is roughly 60 to 70%, though mortality varies widely with age, health conditions, the source of infection and how quickly treatment starts. Early recognition and antibiotics within the first hour improve survival.
What causes septic shock?
It is caused by an infection that triggers an overwhelming immune response. The most common sources are pneumonia, urinary tract and kidney infections, abdominal infections and skin infections. Bacteria are most often responsible, but viruses and fungi can also cause it.
Sources
This guide was written from current patient and clinical guidance, including:
- Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock
- CDC: About sepsis
- Sepsis-3: Third International Consensus Definitions for Sepsis and Septic Shock (JAMA)
- National Institute of General Medical Sciences: Sepsis fact sheet
- Sepsis Alliance: Septic shock
- MedlinePlus: Septic shock