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.

Sometimes incorrectly called blood poisoning, sepsis 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. 2022. https://www.sepsis.org/sepsisand/septic-shock/

Updated July 12, 2022.

Read Personal Stories of Sepsis and Septic Shock

Rosa M

Tribute

On February 3rd my mother died from septic shock due to a long battle with a urinary infection that was not treated on time. (Sepsis and Septic Shock, Sepsis and Urinary Tract Infections) On October 2021 my mom had a urinary infection and her primary care did not give her antibiotics until one month after. This caused that her infection spread throughout her bloodstream and she started developing signs of sepsis such as trouble breathing, fatigue, extreme confusion, and extremely low blood pressure. She went on and off out of the hospital. By the time she was treated and she ... Read Full Story

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Samantha Bullock

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February 8, 2013 I was 8 days out from having an emergency cervical cerclage to help save my baby. I went to sleep fine. I was approximately 17 weeks pregnant so I thought my tiredness and sickness was pregnancy related. (Sepsis and Pregnancy & Childbirth) I woke up in the middle of the night with a fever, I assumed I had the flu. My daughter and mom had it but I stayed away because I was pregnant. I felt like I was freezing to death. By the time we made it to the gas station about 15 minutes away I ... Read Full Story

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Vuyo Ndlovu

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I’m a 40 year old female nurse with 17 years post experience after 4-year nursing course training. My story begins as follows. It was on the 11.01.2022 and I was pregnant approaching end of my 2nd trimester, this was the most precious moment in our life. We were in love since 2002 and this was our second pregnancy, in 2019 I had miscarriage. I woke up feeling okay, but in the morning hours, I started having uncontrolled shivering and my colleagues forced me to visit our occupation health clinic. I agreed and after consultation I went to sleep and rest ... Read Full Story

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Dawn D.

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Hello, my name is Dawn I was 50 years old when it happened. On September 19, 2020 at around 10:00 pm I felt a terrible pain. This time I knew what the pain was a kidney stone. (Sepsis and Kidney Stones) I waited but after a few hours I was in the ED. After pain meds and a few tests, they sent me home. Late Monday the pain stopped which normally would mean that the kidney stone reach the bladder. By Wednesday night the stone had not appeared, and I was in bad shape. Not enough blankets to warm me ... Read Full Story

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Emma Moss

Tribute, Survivor, Survivor, Survivor, Survivor

I felt completely fine in the lead up to my diagnosis. Monday night I woke up with a pain that I can’t fully describe but I knew something was wrong and that I needed to go to the hospital. I got up and got dressed but felt too weak to go so I lay back down. After a while I woke my partner, who then brought me to hospital. Once there I did some blood tests and x-rays which came back clear so I was sent home with a high fever and a viral infection. (Sepsis and Viral Infections) The ... 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.