Septic Shock

Septic shock is the final, most severe form of sepsis and also the most difficult to treat. Patients in septic shock are often called the “sickest patients in the hospital,” as doctors, nurses, and other healthcare professionals work to save them from long-lasting complications or death.

People are more likely to develop sepsis in the community than in the hospital – up to 87% of cases start from infections people contracted at work, school, or home. Sepsis can start gradually, or the symptoms can come on very suddenly. Sepsis must be treated quickly and efficiently as soon as healthcare providers suspect it. If it isn’t recognized and treated quickly, sepsis can progress to severe sepsis and then to septic shock.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection or injury. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival. Septic shock disproportionately affects certain communities, increasing their disability and mortality rates. Black and Hispanic children are 25% more likely to die from severe sepsis or septic shock than non-Hispanic white children. American Indians and Alaskan Native people in the Indian Health Service area are 1.6 times more likely to die from sepsis than the national average.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumoniainfluenzaurinary tract infections, or even from a cut on the finger that becomes infected. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

When sepsis becomes septic shock

Sepsis treatment usually requires intravenous (IV) fluids and antibiotics. It is essential that the treatment begin as early as possible. The chance of sepsis progressing to severe sepsis and septic shock, causing death, rises by 4% to 9% for every hour treatment is delayed.

Severe sepsis occurs when one or more of your organs stop working effectively. For example, you could need a ventilator to help you breathe or dialysis to filter toxins from your blood. Any organ can be affected.

People with severe sepsis are already very ill, but if your blood pressure starts to drop, you become even sicker. You go into septic shock. The medical definition of “shock” is a drop or fall in blood pressure. When it is associated with sepsis, it is called septic shock.

 

Sepsis to septic shock

 

Why septic shock is dangerous

As your heart pumps blood throughout your body, it produces a certain amount of pressure to help push the blood through the blood vessels. The blood then delivers oxygen and nutrients to the organs and other body tissues. It also removes toxins. The average blood pressure for a healthy adult is around 120/80 mmHg. Hypotension, or low blood pressure, occurs when the blood pressure drops to below 90/60. If you are hypotensive, your blood does not have enough force behind it to circulate properly throughout your body. The tissues don’t get the nutrients they need.

Temporary hypotension, caused by dehydration, overheating, or even psychological shock can cause dizziness, nausea, and fainting. Usually, those situations resolve when the cause is treated, and the blood pressure and blood flow throughout the body return to normal. But when hypotension is extended, like in septic shock, the prolonged blood pressure drop can cause many complications.

Septic Shock Complications

One of the most serious septic shock complications is organ damage. In some cases, the damage may only be temporary. For example, a person in septic shock may develop acute kidney injury. The kidneys are not able to filter out the toxins from the blood. If this occurs, the patient may need dialysis, a procedure where a machine acts as the body’s kidneys to cleanse the blood. As the body heals, the kidneys may begin functioning again. But in many cases, organ damage is permanent.

Another serious septic shock complication is tissue death (gangrene) that leads to amputations. Not only does hypotension reduce the blood flow to the less vital parts of the body, like the feet and hands, people with severe sepsis or septic shock can develop tiny blood clots in the blood vessels. These clots can block blood that tries to reach the area, resulting in tissue death.

If too much of the tissue has died, a surgeon must remove it to prevent the dead tissue from spreading. Some septic shock survivors must have the tips of fingers and toes removed, while others lose one or both legs, or even all four limbs.

Accurate statistics regarding sepsis-related amputations are not easily available, but a study presented in 2019 looked at 1.5 million sepsis survivors in the United States and the researchers found that one out of every 100 survivors had an amputation within 90 days of their sepsis diagnosis. Most amputations were of the lower limbs.

Septic Shock Treatment

Treating septic shock focuses on increasing the blood pressure, eliminating the infection that triggered the sepsis, and providing support for the organs that are failing. Some treatments could include:

  • IV fluids to raise blood pressure.
  • Medications, including antimicrobials (antibiotics, antivirals), drugs to increase blood pressure, pain relievers, and any other medications to treat immediate issues.
  • Oxygen, either by mask or nasal cannula, or with a ventilator, to help raise oxygen levels in the blood.
  • Surgery, which may be necessary to remove the source of infection, such as gallstones or an inflamed appendix.

Once the blood pressure is back up to normal levels and it stays there, the patient is no longer in septic shock. The patient is still very ill, but no longer with a too-low blood pressure.

After Septic Shock

Most often, you can be discharged from the ICU once your blood pressure is stable and supportive treatment, like a ventilator or dialysis, are no longer required. You will still be monitored and cared for, but in a lower-acuity ward or unit.

Recovering from septic shock can take longer than you may expect. Survivors may appear to be better, but many live with long-lasting effects from having been so ill. Up to 50% of sepsis survivors live with post-sepsis syndrome (PSS), which can be mild or severe. Signs of PSS can include:

  • Insomnia
  • Chronic pain
  • Chronic fatigue
  • Hair loss
  • Memory issues
  • Frequent infections

About one-third of sepsis survivors return to the hospital within three months of their discharge. The most common causes are repeat infection or sepsis. You can learn more from the Life After Sepsis Fact Sheet.

If you or someone you know shows any signs of sepsis, this is a medical emergency and you must seek medical help immediately to reduce the risk of septic shock.

 

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Septic Shock. 2023. https://www.sepsis.org/sepsisand/septic-shock/

Updated July 6, 2023.

Read Personal Stories of Sepsis and Septic Shock

Dennis S.

Survivor

After having a colonoscopy due to minor but long term bleeding, they found I had numerous tumors in my descending and transverse sections of my colon. Because they were in 2 of the 3, they said the whole colon had to be removed, the tumors would appear in the ascending portion within a year. Surgery was done, removed the colon, built a Hartman’s pouch and re- attached my intestine. Just 24hrs after surgery, something was wrong. (Sepsis and Surgery) They had placed me in a ICU unit in an induced coma. It took a couple days but found out 1 ... Read Full Story

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Joan Hatton

Survivor, Tribute

April is always a difficult month for me as it will be six years in the 27th that my mom succumbed to sepsis. What started out as a three-day hospital admission for RSV and an urinary tract infection that required IV antibiotics turned into a nightmare. Two separate IV antibiotics eventually cured the respiratory and urinary infections, but lead to severe abdominal pain and diarrhea. My concerns to medical staff was not taken seriously and what was supposed to be a home discharge day turned out to admission to the Intensive Care Unit for C-Diff. Delay in diagnosis and treatment ... Read Full Story

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Vala Hallgrimson

Survivor, Tribute, Survivor

Septic Shock put me in the hospital for a year. (Sepsis and Septic Shock) Hello – Vala H. here. When it comes to sepsis, remember it’s about TIME! Temperature – Infection – Mental Decline – Extremely ill. I wish I had known that when Sepsis overtook me. “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency.” January 21, 2018, I was feeling great during the day. I came home from a meeting at 8 p.m. and was cold and couldn’t get warm, so I went to bed. I slept for 24 hours without getting ... Read Full Story

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Mateo Rodriguez-Limon

Survivor, Tribute, Survivor, Survivor

My son Mateo went septic a month before his 2nd birthday. He complained of a pain in his knee and after a 6 hour visit to our local hospital with no outcome we took him to to the children’s hospital. They discovered osteomyelitis in his tibia and within hours he was in full septic shock.He had contracted strep A with no clue how he was not sick and he didn’t have any open wounds. (Sepsis and Group A Streptococcus, Sepsis and Septic Shock) He spent the next 5 weeks in the PICU where they did multiple different treatments to save ... Read Full Story

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Gail Guglietta

Survivor, Tribute, Survivor, Survivor, Tribute

My wife, Gail Guglietta died from septic shock in March 2020. She was 54 years old, having just celebrated her birthday the previous December. The sepsis was brought on by a ruptured colon, which was caused by undiagnosed diverticulitis. (Sepsis and Perforated Bowel, Sepsis and Septic Shock) Despite living a healthy lifestyle that included being active, eating and cooking healthy (she was an excellent cook), and exercising regularly, she dealt with digestive system issues her whole life. It caused her to downplay these problems, noting that these problems happened to her grandmothers. With that, she never got the right diagnosis ... Read Full Story

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Septic Shock

Septic shock is the final, most severe form of sepsis and also the most difficult to treat. Patients in septic shock are often called the “sickest patients in the hospital,” as doctors, nurses, and other healthcare professionals work to save them from long-lasting complications or death.

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