Related Terms

• Activated C-protein, bacteria, bacterial infection, endotoxic shock, immune reaction, immune response, inflammation, inflammation reaction, inflammatory response, infection, sepsis, vasopressors.

Background

• Sepsis, also called systemic inflammatory response syndrome (SIRS), is a serious illness that occurs when the body is fighting an infection. As the immune system fights against the infection, inflammation occurs, causing an increased heartbeat, rapid breathing, and abnormal temperature.

• Without immediate treatment, sepsis can be life-threatening. Severe sepsis, also called septicemia, may cause inflammation and blood clotting throughout the entire body. As a result, one or more internal organs may stop working properly or fail. Sepsis may also lead to a dangerous drop in blood pressure called septic shock.

• Septic shock occurs most often in newborns, individuals who older than 50 years of age, and in those who have other long-term illnesses.

• Septic shock is a serious condition that requires immediate medical attention. Even with treatment, an estimated 30% of patients with septic shock die. The risk of death increases to 60-80% for newborns, the elderly, and individuals with underlying medical conditions. The patient's prognosis depends on the type of infection, as well as the amount of organ damage that has occurred. If organ damage occurs, it is usually irreversible, even if sepsis is successfully treated.

Causes

• Bacterial infections are the most common cause of sepsis. Any type of bacterial infection can cause sepsis. Less commonly, viruses may lead to sepsis, and in rare cases, a fungal infection may cause sepsis. The infection may be anywhere in the body. Sometimes the source of the infection is unknown.

• Once the infectious organism enters the body, the immune system launches an attack to prevent an infection. As a result, inflammation occurs to help the body repair damaged tissues. Normally, the body balances the chemical signals that start and stop the inflammatory response. However, in septic patients, the inflammatory response is not regulated properly. As a result, inflammation occurs throughout the entire body, rather than just the infected area.

• This widespread inflammation may lead to severe sepsis. The chemicals released during the inflammatory response stimulate tiny blood vessels to form clots throughout the body. As a result, the heart has to pump harder to pump blood, and the clots prevent enough oxygen from reaching tissues and organs. When the organs do not receive enough oxygen, they may become damaged or even fail. As the heart works extra hard to pump blood throughout the body, it starts to weaken and blood pressure drops. When blood pressure drops to dangerously low levels, the condition is called septic shock.

• The immune system chemicals may also harm body tissues. As the immune chemicals become overactive in an attempt to kill the disease-causing organism, they may also destroy healthy body tissues in the process.

• Individuals who have weakened immune systems have an increased risk of developing septic shock. This includes elderly and very young patients. It also includes patients with diseases that weaken the immune system, such as HIV/AIDS. Individuals who have long-term medical illnesses, such as diabetes, lymphoma, leukemia, or diseases of the genitourinary system or gastrointestinal system, also have an increased risk of developing septic shock. This is because these conditions make patients prone to developing infections. Individuals who have recently had an infection or recently underwent surgery or chemotherapy are also at risk for septic shock. Long-term use of antibiotics may lead to antibiotic resistance, which also increases the risk of septic shock.

Signs and Symptoms

• General: Septic shock is a medical emergency that requires immediate medical treatment. Individuals who experience symptoms of septic shock should be taken to the emergency room of the nearest hospital.

• Sepsis: Sepsis occurs in response to an infection in the body. Although the infection can be anywhere in the body, sepsis is often caused by an infection in the kidneys, lungs, abdomen, skin, or digestive tract. Symptoms of sepsis often develop suddenly. Initial symptoms may include rapid heartbeat, increased breathing, and fever or sometimes extremely low body temperature.

• Severe sepsis and septic shock: Symptoms that the condition may be progressing to severe sepsis or septic shock may include confusion, reduced mental alertness, skin rash or bleeding, warm and flushed skin, decreased urine production, and dizziness (caused by low blood pressure).

• Without immediate treatment, the organs will begin to fail. Symptoms of organ failure depend on the specific organ affected. For instance, if the lungs start to become dysfunctional, the patient may experience shortness of breath or difficulty breathing. If the kidneys start to fail, the patient may stop producing urine.

Diagnosis

• A blood test is performed to diagnose sepsis. The patient's blood will have high levels of white blood cells (a type of immune cell), decreased levels of oxygen, decreased levels of platelets, increased levels of lactic acid, and increased levels of metabolic waste products (such as nitrogen).

• A sample of blood is also analyzed to detect a bacteria, virus, or fungi. The blood may be analyzed under a microscope to detect pathogens. A blood culture may also be performed. During this procedure a sample of the patient's blood is taken and placed in a medium where disease-causing microorganisms will grow if they are present.

• The patient's urine, saliva, stool, or other secretions may also be analyzed for the presence of bacteria or fungi.

• A healthcare provider may monitor the level of oxygen in the patient's blood with a fingertip sensor.

Treatment

• General: Septic shock is a medical emergency. Patients with septic shock are typically admitted to the intensive care unit (ICU) of the hospital. Prompt treatment increases the patient's prognosis.

• Antibiotics: High doses of intravenous antibiotics are the first line of treatment for sepsis. Until the laboratory tests detect the specific type of infection, patients typically receive a combination of two broad spectrum antibiotics such as meropenem (Merrem®) or imipenem/cilastatin (Primaxin®). This increases the likelihood that the infection will be treated. Once doctors know what type of infection the patient has, the type of medication may be switched.

• Fluids: Large amounts of fluid are immediately given intravenously to increase the blood pressure.

• Vasopressors: If the patient's blood pressure is still low after intravenous fluids are given, medications, called vasopressors, may be used. Vasopressors, such as ephedrine (Ephedrine Sulfate®), constrict the blood vessels in order to increase blood pressure.

• Activated protein C: Patients with severe sepsis who have a high risk of dying may receive a new drug called activated C protein (Xigris®). This medication helps stop the immune system's inflammatory response. However, it is only recommended in severe, life-threatening cases because it may cause serious bleeding. For this reason, it should be avoided in patients with bleeding disorders. Because activated protein C is new, it is an expensive treatment.

• Oxygen: Patients often require supplemental oxygen when they are first admitted to the hospital. If the lungs fail, the patient may need a mechanical ventilator to help them breath.

• Surgery: Surgery may need to be performed to remove any dead tissue, such as tissue that is infected with gangrene.

Integrative Therapies

• Note: Septic shock is a serious medical condition that requires immediate medical treatment. Although some evidence suggests that certain integrative therapies may be helpful for septic shock, these therapies should not replace or delay treatment with more proven techniques or therapies. Integrative therapies should not be used as the sole treatment for septic shock.

• Unclear or conflicting scientific evidence:

• DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Unclear scientific evidence exists surrounding the safety or effectiveness of DHEA supplementation in septic patients. At this time, more proven therapies are recommended.

• Avoid if allergic to DHEA. Use cautiously with adrenal or thyroid disorders, depression, panic disorder, bipolar disorder, psychotic disorders, heart disorders, polycystic ovary syndrome, anovulatory infertility, steroid 21-hydroxylase deficiency, gynecomastia, overactive thyroid, bacterial infections, or diabetes. Use cautiously if at risk for prostate cancer, liver cancer, breast cancer, or ovarian cancer. Use cautiously in HIV patients with Kaposi's sarcoma or in patients who have received flu shots. Use cautiously if taking alprazolam, amlodipine, anastrozole, benfluorex, beta-adrenergic antagonists, calcium channel blockers, canrenoate, danazol, diltiazem, growth hormone, methylphenidates, metopirone, nitrendipine, or hormones or dietary supplements with hormone-like effects (e.g. chromium picolinate). Avoid if pregnant or breastfeeding.

• Ephedra: Chemicals in ephedra can stimulate the heart, increase heart rate, and raise blood pressure. Ephedrine, a component of ephedra, is sometimes used in hospitals to help control blood pressure. However, the effects of over-the-counter ephedra supplements taken by mouth are not well described in this area.

• Ephedra is considered unsafe for humans. Serious reactions, including heart attack, stroke, seizure, and death have occurred. Therefore, ephedrine, which is made from ephedra, should only be used under the strict supervision of a healthcare provider. Avoid if pregnant or breastfeeding.

• Rhubarb: Rhubarb is an herb that is commonly used in traditional Chinese medicine (TCM). One study indicates that rhubarb may be helpful in treating systemic inflammation reaction syndrome (SIRS). However, more high-quality studies are needed to confirm this hypothesis.

• Avoid if allergic to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction, ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anticoagulants, anti-psychotic drugs, or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding

• Selenium: Selenium is a mineral found in soil, water, and some foods. Study results of selenium supplementation in septic patients are mixed. Further research is warranted in this area.

• Avoid if allergic to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

• Traditional or theoretical uses lacking sufficient evidence:

• Andrographis: The leaves of Andrographis paniculata, an annual herb, have been commonly used in Indian folk medicine and Ayurveda for centuries. Animal studies suggest that andrographis may help treat shock. However, more evidence is needed to determine if this is safe and effective.

• Andrographis appears to be safe at recommended doses. Side effects reported in studies are mild and not frequent. However, most trials have been brief (two weeks or less), and the safety of long-term use is unclear. Avoid if allergic to andrographis. Use cautiously if taking drugs that alter blood sugar, drugs that affect blood pressure, anticoagulants, or anti-platelet agents. Avoid if pregnant, trying to become pregnant, or if breastfeeding.

• Beta-glucan: Beta-glucan is a fiber that comes from the cell walls of algae, bacteria, fungi, yeast, and plants. It has been suggested that beta-glucan may help prevent sepsis and treat symptoms of shock. However, only a few laboratory studies have been performed in this area. Additional studies are needed before a firm conclusion can be made.

• Avoid if allergic to beta-glucan. When taken by mouth, beta-glucans are generally considered safe. Use cautiously with HIV or AIDS. Avoid using insoluble (particulate) beta-glucan. Avoid if pregnant or breastfeeding due to a lack of safety evidence.

• Echinacea: Echinacea is a perennial herb that has been used to treat a variety of medical conditions. Although echinacea has been suggested as a possible treatment for sepsis, scientific studies are lacking.

• Avoid if allergic to plants in the Asteraceae or Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Avoid echinacea injections. Avoid with a history of liver disease or if taking amoxicillin. Avoid in transplant patients. Use cautiously if driving or operating heavy machinery. Use cautiously with a history of asthma, diabetes, conditions affecting the immune systems (such as lupus, tuberculosis, or HIV/AIDS), or rheumatologic conditions (such as rheumatoid arthritis). Avoid if pregnant or breastfeeding. Tinctures may contain large amounts of alcohol.

• Ginkgo biloba: Ginkgo biloba has been used medicinally for thousands of years. It has been suggested, but not proven, that ginkgo may help treat sepsis. Additional studies are warranted in this area.

• Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or poison oak, or cashews, then allergy to ginkgo is possible. Avoid if taking anticoagulants due to an increased risk of bleeding. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

Prevention

• Many cases of septic shock cannot be prevented. However, it is recommended that all infections are quickly treated.

• Patients with weakened immune systems, such as HIV patients, the elderly, infants, or patients undergoing chemotherapy, should take steps to prevent infections. Avoiding close contact with individuals who have contagious illnesses may help reduce the risk of acquiring infections. Practicing good hygiene and regularly washing the hands with soap and warm water may help reduce the risk of acquiring infections

• Patients who are at risk of developing septic shock should know the symptoms. Receiving quick medical care for septic care is important to prevent death.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Delaloye J, Baumgartner JD, Calandra T. Severe sepsis and septic shock. Article in French. Rev Med Suisse. 2006 Apr 5;2(60):896-8, 900-2. View Abstract

2. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004 Mar;32(3):858-73. View Abstract

3. Dries DJ. Cardiovascular support in septic shock. Air Med J. 2007 Sep-Oct;26(5):240-7. View Abstract

4. National Institutes of Health (NIH). www.nih.gov.

5. Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com.

6. Nguyen HB, Rivers EP, Abrahamian FM, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med. 2006 Jul;48(1):28-54. Epub 2006 May 2. View Abstract

7. Nobre V, Sarasin FP, Pugin J. Prompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock. Curr Opin Crit Care. 2007 Oct;13(5):586-91. View Abstract

8. O'Brien JM Jr, Abraham E. New approaches to the treatment of sepsis. Clin Chest Med. 2003 Dec;24(4):521-48,v. View Abstract

9. Patel GP, Gurka DP, Balk RA. New treatment strategies for severe sepsis and septic shock. Curr Opin Crit Care. 2003 Oct;9(5):390-6. View Abstract