Septic-shock syndrome

Some patients fail to recover from trauma because they develop multiple organ failure (MOF), also known as multiple systems failure (MSF). It is estimated to kill almost 200000 patients each year in the USA. The name arises from the fact that several organs are involved and they are distant from the site of trauma. Since it can arise in septic patients, it is also known as septic shock syndrome . It can occur in any condition that induces a major inflammatory response. The time between the insult and the malfunction of the organs is variable and may run into weeks. As expected, the larger the number of organs involved, the greater the risk of death (Box 18.1). 

Dinarello, C.A. The proinflammatory cytokines interleukin-1 and tumor necrosis factor and treatment of the septic shock syndrome. J Infect Dis 163 (1991) 1177-1184. 

Ali A, Walentik C, Mantych GJ, Sadiq HE, Keenan WJ, Noguchi A. Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome two case reports. Pediatrics 2003 112(1 Pt l) e70-2. 

The location of these gly can molecules on the bacterial outer membrane makes them an important component in the pathogenesis of endotoxemia and septic shock syndromes, and in the survival and overall biological functions of the bacterium. Moreover, LPSs with differences in chemical stmctures of the 0-chains often provide a molecular basis for serological classifications within the same genus. " ... 

M35. Miller Graziano, C. L., Szabo, G., Kodys, K., and Griffey, K. Aberrations in post-trauma monocyte (MO) subpopulation Role in septic shock syndrome. J. Trauma 30, S86-S96 (1990). 

MMP-8 and MMP-9 are stored in the granules of polymorphonuclear leukocytes. These cells are key effectors in inflammatory and infectious processes. A role for these MMPs in shock is supported by studies in MMP-9 deficient mice that were shown to be resistant to endotoxic shock. Dubois et al. (D4) proposed that specific MMP-9 inhibition constitutes a potential approach for the treatment of septic shock syndromes. 

Inflammatory and immune diseases Autoimmune disease (A,I), asthma (A), osteoarthritis (I), rheumatoid arthritis (I), septic shock (A,I), infections (A,I), familial cold auto-inflammatory syndrome (I), Muckle Wells syndrome (I), chronic infantile neurological cutaneous and articular syndrome/neonatal onset multisystemic inflammatory disease (CINCA/NOMID) (I), Crohn s disease (I), gout (I), acute renal failure (A,l)... 

Sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion with widespread tissue injury.1 The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions to utilize for sepsis (Table 79—l).2 They provide physiologic parameters categorizing patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ-dysfunction syndrome (MODS).2 Standardized definitions have been developed for infections in critically ill patients.3... 

Septic shock Sepsis with hypotension, despite fluid resuscitation, along with the presence of perfusion abnormalities. Patients who are on inotropic or vasopressor agents may not be hypotensive at the time perfusion abnormalities are measured. Multiple-Organ Dysfunction Syndrome (MODS) Presence of altered organ function requiring intervention to maintain homeostasis. 

According to the patient s parameters what does he have (i.e., systemic inflammatory response syndrome, sepsis, or septic shock) ... 

Fig. 1. Main steps in the pathogenesis of sepsis, leading to septic shock and/or multiple organ dysfunction syndrome (MODS).

F15. Fourrier, F., Jallot, A., Leclerc, L., Jourdain, M., Racadot, A., Chagnon, J. L., Rime, A., and Chopin, C., Sex steroid hormones in circulatory shock, sepsis syndrome, and septic shock. Circ. Shock 43, 171-178(1994). 

H6. Hack, C. E., Ogilvie, A. C., Eisele, B., Jansen, P. M Wagstaff, J., and Thijs, L. G Initial studies on the administration of Cl-esterase inhibitor to patients with septic shock or with a vascular leak syndrome induced by interleukin-2 therapy. Prog. Clin. Biol. Res. 388, 335-357 (1994). 

Damage to connective caused by leakage of elastases leads to damage associated with inflammatory diseases, such as pulmonary emphysema, adult respiratory distress syndrome, septic shock, cystic fibrosis, carcinogenesis, chronic bronchitis, and rheumatoid arthritis. Compounds that directly inhibit elastase or its release from human neutrophils are of enormous pharmaceutical and cosmetological interest in the development of new anti-inflammatory drugs. A possible source for elastase inhibitors are the medicinal Asteraceae and Droseraceae, particularly those used as traditional medicine in Asia. 

Suggested Alternatives for Differential Diagnosis Bronchitis, pneumonia, meningitis, gastroenteritis, septic shock, congestive heart failure and pulmonary edema, pleural effusion, costochondritis, prostatitis, adult respiratory distress syndrome (ARDS), HIV infection and AIDS, and Q fever. 

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. 

Suggested Alternatives for Differential Diagnosis Acute respiratory distress syndrome, congestive heart failure, pulmonary edema, AIDS, pneumonia, cardiogenic shock, septic shock, phosgene toxicity, phosphine toxicity, salicylate toxicity with pulmonary edema, influenza, plague, tularemia, and anthrax. 

Chronic Health Evaluation II >25, sepsis-induced multiple organ failure, septic shock, or sepsis-induced acute respiratory distress syndrome)... 

Possible adverse reactions include fever lupus-like syndrome rise in BUN myalgia septic shock-like syndrome headache asthenia weakness dizziness symptoms of... 

Systemic infections are those that have microorganisms (bacteria, viruses, yeasts, parasites) spread, usually via the bloodstream, beyond the portal of entry or original site of localized infection to multiple compartments of the body. When infections, either localized or systemic, are accompanied by signs and symptoms of a systemic inflammatory response (fever, rapid pulse, increase in white blood cells) the syndrome is called sepsis. Severe sepsis is defined by the additional occurrence of organ failure (either kidney, liver, brain, lungs), and is a potentially fatal condition (mortality around 50%). If there is hypotension not responding on fluid resuscitation it is called septic shock and the mortally is even higher (60-70%). 

For parenteral therapy, nafciUin and oxacillin offer comparable efficacy and antimicrobial spectra of activity. Although both drugs undergo hepatic metabolism, only nafcillin requires dose adjustment in patients with combined hepatic and renal insufficiency. Other pharmacokinetic data for nafcillin and oxacillin appear in Table 45.1. Indications for nafcillin or oxacillin include severe staphylococcal infections like cellulitis, empyema, endocarditis, osteomyelitis, pneumonia, septic arthritis, and toxic shock syndrome. 

Unlabeled Uses Diabeticneuropathy gangrene, hemodialysis shunt thrombosis, septic shock, sickle cell syndrome, vascular impotence... 

The use of vasopressin and terlipressin for the management of septic shock has been reviewed a maximum dose of 0.04 U/minute is recommended (5). Vasopressin 0.23 U/minute in patients with hepatorenal syndrome did not appear to be associated with the adverse effects that occur at the lower doses that are used to treat other critically ill patients (6). 

Hypothermia is known to cause cardiac dysfunction, particularly arrhythmias (36,37). Careful temperature control and optimal antiar-rhythmic therapy can minimize this problem. However, to avoid severe circulatory dysfunction, knowledge of arrhythmias is required. Hypothermia may be associated with a suppression of the immunological system, which exposes patients to the danger of severe infections. Schwab et al. reported that 7 of 25 stroke patients undergoing hypoth-ermiatherapy suffered a septic syndrome (17). In our hypothermic study, none of the 13 patients who underwent hypothermia therapy for 3-7 d developed severe infectious diseases. However, the remaining patient, who underwent 10 d of hypothermia because of massive cerebral edema, developed septic shock on the 10th day of hypothermia treatment. The immunosuppressive effect appears to be correlated with the depth and... 

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