Background: patient has chronic kidney disease and is admitted to the hospital with acute kidney injury and a urinary tract infection.

The blood pressure is low at 78/52. The heart rate is 114, and the temperature is 101.3.

Please answer the following True or False questions:

In septic shock, hypotension alone is considered diagnostic of end-organ hypoperfusion.
True or False?

False

Glucocorticoids are routinely recommended for all patients with septic shock.
True or False?

False

Early resuscitation with intravenous fluids is crucial in the treatment of distributive (also called vasodilatory) shock.
True or False?

True

Patients in septic shock who achieve a systolic blood pressure of at least 90 mm Hg by other measures should receive hydrocortisone for survival advantage.
True or False?

False

Vasopressor therapy should be administered before adequate volume replacement in patients with sepsis.
True or False?

False

Discussion:

Treatment of Septic Shock

Septic Shock Treatment Overview

Septic shock requires prompt treatment to restore tissue perfusion. Administering a fluid bolus is the initial step to maintain tissue perfusion in vasodilatory shock caused by an overwhelming infection.

Assessment and Diagnosis

Shock is characterized by inadequate tissue perfusion. Hypotension alone is not diagnostic; consider other signs like lethargy, confusion, mottled extremities, and anion-gap lactic acidosis.

Treatment Options

Fluid Bolus: Initial treatment to maintain tissue perfusion in distributive shock.

Hydrocortisone: Not routinely recommended unless profound, refractory shock is present.

Vasopressor Therapy: Consider norepinephrine, vasopressin, or epinephrine if a fluid challenge fails.

Packed Red Blood Cells: Reserved for patients with tissue hypoperfusion, active bleeding, or coronary artery disease.

Specific Treatment Considerations

Hydrocortisone is not recommended if systolic blood pressure is at least 90 mm Hg with fluids and vasopressors. Vasopressor therapy should follow adequate volume replacement. Packed red blood cells are indicated for specific conditions, like active bleeding or profound anemia.

Overall, treatment of septic shock should be tailored to the underlying cause and individual patient.

Inspiration: ACP, MKSAP 19

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