Disseminated Shock

There are a number of disorders, including cancer and shock, in which the concentrations of plasminogen activators increase. In addition, the antiplasmin activities contributed by tti-antitrypsin and a2-antiplas-min may be impaired in diseases such as cirrhosis. Since certain bacterial products, such as streptokinase, are capable of activating plasminogen, they may be responsible for the diffuse hemotthage sometimes observed in patients with disseminated bacterial infections. 

Suggested Alternatives for Differential Diagnosis Scarlet fever, cellulitis, cat scratch disease, gas gangrene, necrotizing fasciitis, tick-borne diseases such as Rocky Mountain spotted fever, pneumonia, septic shock, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation. 

Progression of uncontrolled sepsis leads to evidence of organ dysfunction, which may include oliguria, hemodynamic instability with hypotension or shock, lactic acidosis, hyperglycemia or hypoglycemia, possibly leukopenia, disseminated intravascular coagulation, thrombocytopenia, acute respiratory distress syndrome, GI hemorrhage, or coma. 

The initial symptoms are often non-specific, but pulmonary involvement characterized by cough, fever, malaise and weight loss - and confirmed by radiological evidence of pulmonary interstitial infiltrates - can be prominent. Nausea, vomiting and diarrhoea are common. Haematogenous dissemination ultimately results in terminal septic shock. 

Hemorrhagic Illness. The viral hemorrhagic fevers include diseases caused by a number of different viruses. The clinical manifestations are characteristically severe, including shock, disseminated intravascular coagulation (Die), and other signs of increased vascular permeability (Borio et al., 2002 Franz et al., 1997). A macular or petechial rash is also typical for many of the viral hemorrhagic fevers. 

Comments about the prestability and finished product stability profiles should be presented as an overview of the new product s chemical stability. This will support the anticipated shelf life of the formula and its ability to withstand the process shocks normally encountered during production scale-ups. The toxicity of the finished product should be discussed. This information ensures that a decision regarding the handling of the formula has been made based on generated data and experience. A draft or tentative material safety data sheet may be one route to disseminate this information. 

Cardiogenic shock can occur in parallel with disseminated intravascular coagulation (5). In these circumstances heparin is thought to act as a hapten in a heparin-protein interaction that stimulates antibody production and an antigen-antibody reaction associated with release of platelet and vasoactive compounds. 

Most severe reactions to contrast media are associated with cardiovascular manifestations, causing hypotensive shock and in some cases ventricular fibrillation and cardiac arrest these events are reversible in most cases in which prompt treatment is given. In a case of hypotensive collapse reported in 1977, and followed by a small number of others, there was disseminated intravascular coagulation (50). In milder cases there is only hypotension, which can be transient and symptomless in some cases there is bradycardia (due apparently to vagal overactivity) rather than tachycardia. 

In another case of acute systemic allergy to quinine, which mimicked septic shock, with little hemolysis or renal involvement, the patient presented twice with a virtually identical clinical picture sudden fever, rigors, and back pain, followed by hypotension, metabolic acidosis, granulocytopenia, and disseminated intravascular coagulation. On each occasion chnical and laboratory indices recovered spontaneously within 36 hours. A retrospective analysis of the patient s serum showed the presence of neutrophil-specific, quinine-dependent antibodies. 

Gram-negative bacteremic shock (early diagnosis) Gram-positive bacteremia disseminated cytomegalovirus infection... 

Initial local infection in skin or lungs with intracellular multiplication may become disseminated via bloodstream, with septic shock... 

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