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Rapid Hemodynamic Deterioration and Death due to Acute Severe Refractory Septic Shock.

Dhoble A, Chung W - J Clin Med Res (2009)

Bottom Line: He also had infiltrates on chest radiograph.He expired within fifteen hours of presenting to the emergency department.This case also highlights the fact that despite optimized treatment, this entity has very high mortality rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA.

ABSTRACT

Unlabelled: Despite emergence of early goal directed therapy, septic shock still carries a high mortality. Gram negative septicemia is notorious for rapid deterioration due to endotoxin release. Multi-organ damage due to septic shock carries poor prognosis, and such patients should be managed aggressively with multidisciplinary approach. We present a fatal case of a patient with gram negative septicemia who rapidly deteriorated, and died due to acute refractory severe septic shock. This patient probably developed urosepsis secondary to severe urinary tract infection. He also had infiltrates on chest radiograph. He expired within fifteen hours of presenting to the emergency department. This case emphasizes the importance of early recognition and management of septic shock. Early goal directed therapy has shown to improve mortality. Broad spectrum antibiotics should be started within one hour depending on local immunity of organisms. This case also highlights the fact that despite optimized treatment, this entity has very high mortality rates.

Keywords: Hemodynamic deterioration; Refractory septic shock; Gram negative septicemia.

No MeSH data available.


Related in: MedlinePlus

Pathogenesis of sepsis
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Figure 1: Pathogenesis of sepsis

Mentions: Bloodstream infection is associated with high mortality rates. When bacteremia is associated with severe septic shock, gram negative and gram positive bacteria have comparable outcomes [4]. Dysregulation of anti and pro-inflammatory modulators is currently believed to be the center of pathogenesis of sepsis syndrome. Excessive spill of pro-inflammatory cytokines results in vasodilatation, increased endothelial permeability, leukocyte accumulation and neutrophils degranulation; leading to chain of events ensuing extensive tissue injury [5]. Cellular injury also plays an important role in the pathogenesis of sepsis through local hypoxia, apoptosis of injured cells, and direct cytotoxic effects [6]. Combination of excessive inflammation and cellular injury gives rise to full blown picture of sepsis syndrome (Fig. 1).


Rapid Hemodynamic Deterioration and Death due to Acute Severe Refractory Septic Shock.

Dhoble A, Chung W - J Clin Med Res (2009)

Pathogenesis of sepsis
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3318852&req=5

Figure 1: Pathogenesis of sepsis
Mentions: Bloodstream infection is associated with high mortality rates. When bacteremia is associated with severe septic shock, gram negative and gram positive bacteria have comparable outcomes [4]. Dysregulation of anti and pro-inflammatory modulators is currently believed to be the center of pathogenesis of sepsis syndrome. Excessive spill of pro-inflammatory cytokines results in vasodilatation, increased endothelial permeability, leukocyte accumulation and neutrophils degranulation; leading to chain of events ensuing extensive tissue injury [5]. Cellular injury also plays an important role in the pathogenesis of sepsis through local hypoxia, apoptosis of injured cells, and direct cytotoxic effects [6]. Combination of excessive inflammation and cellular injury gives rise to full blown picture of sepsis syndrome (Fig. 1).

Bottom Line: He also had infiltrates on chest radiograph.He expired within fifteen hours of presenting to the emergency department.This case also highlights the fact that despite optimized treatment, this entity has very high mortality rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA.

ABSTRACT

Unlabelled: Despite emergence of early goal directed therapy, septic shock still carries a high mortality. Gram negative septicemia is notorious for rapid deterioration due to endotoxin release. Multi-organ damage due to septic shock carries poor prognosis, and such patients should be managed aggressively with multidisciplinary approach. We present a fatal case of a patient with gram negative septicemia who rapidly deteriorated, and died due to acute refractory severe septic shock. This patient probably developed urosepsis secondary to severe urinary tract infection. He also had infiltrates on chest radiograph. He expired within fifteen hours of presenting to the emergency department. This case emphasizes the importance of early recognition and management of septic shock. Early goal directed therapy has shown to improve mortality. Broad spectrum antibiotics should be started within one hour depending on local immunity of organisms. This case also highlights the fact that despite optimized treatment, this entity has very high mortality rates.

Keywords: Hemodynamic deterioration; Refractory septic shock; Gram negative septicemia.

No MeSH data available.


Related in: MedlinePlus