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* septic shock
  zo - 04/07/21 13:14
  what is the complication of septic shock ?  
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* Re:septic shock
  iniakin - 04/07/21 23:42
  In a nutshell, multi-organ failure. Septic shock, like any other type of shock, is like having hypoxia, but on the general body level.

Bacterial components (eg, endotoxins) and acute phase cytokines trigger production of free radicals that damage mitochondria and interfere with ETC (electron transport chain) -> mitochondrial dysfunction -> decreased oxidative phosphorylation -> loss of ATP production -> failure of ATP-dependent ion channels and pumps on the surface of the cells -> cells are dying -> complications:
- kidneys -> diffuse cortical necrosis -> renal failure;
- lungs -> acute respiratory distress syndrome -> non-cardiogenic pulmonary edema;
- coagulation system -> disseminated intravascular coagulation -> bleeding -> hypotension;

Since there`s a mitochondrial dysfunction, a compensatory bioenergetic shift towards glycolysis happens and results in lactic acidosis. Like any other acidosis, lactic acidosis leads to:
- decreased contractility of the heart;
- hyperkalemia -> life-threatening arrhythmias;

Of course, this is not a complete list of complications, but those are some obvious and, probably, most dangerous complications. Each of them alone potentially could kill a human, but when you`re having all of them together, it becomes extra-dangerous
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* Re:septic shock
  zo - 04/08/21 13:00
  thanks @ iniakin
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* Re:septic shock
  zo - 04/08/21 13:05
  A 17 -year-old girl is admitted to the hospital for purging behavior, weight loss, and
syncope. She is started on nasogastric feeds and her activities are restricted. On the
second day of admission, the patient complains of severe shortness of breath and has
recurrent episodes of nonsustained ventricular tachycardia. Her blood pressure is 82/55
mm Hg, heart rate is 112/min, and respirations are 22/min. Her body mass index is 14
kg/m2 Physical examination shows an emaciated girl with bibasilar crackles and jugular
venous distension. Serum chemistry results are as follows:
Sodium 138 mEq/L
Potassium 2.1 mEq/L
Chloride 92 mEq/L
Bicarbonate 28 mEq/L
Blood urea nitrogen 14 mg/dl
Creatinine 0.8 mg/dl
Calcium 8 mg/dL
Glucose 90 mg/dl
Magnesium 1 mg/dl
Phosphorus 0.9 mg/dl
A surge in which of the following hormones best explains this patient's deterioration?
0 A Aldosterone
0 B. Cortisol
0 C. Glucagon
0 D. Insulin
0 E. Triiodothyronine
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* Re:septic shock
  zo - 04/08/21 13:06
  what is the diagnosis and what is the ans ?
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* Re:septic shock
  iniakin - 04/08/21 14:25
  In solving these type of questions, first you have to make the right diagnosis.

Step 1 = initial diagnosis. Obviously, she has anorexia, because her BMI is
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* Re:septic shock
  iniakin - 04/08/21 14:37
  UPD: sorry, something went wrong and I had to send a new message :/

In solving these type of questions, first you have to make the right diagnosis.

Step 1 = initial diagnosis. Obviously, she has anorexia, because her BMI is less than 18.5 (anorexia patients also purge in 50% of cases and the easiest way to distinguish anorexia vs bulimia nervosa is via BMI, which will be higher than normal in bulimia patients).
Step 2 = something bad is happening in the hospital. Look at the chemistry panel and see that her phosphorus level is too low. Normal is between 3.5 to 4.5.
Step 3 = she has anorexia, recently she was admitted to the hospital and now something bad is happening. Since she has anorexia, probably they gave her dextrose IV-containing fluids, glucose or something like that. They didn`t tell us about that in the question, but we have to assume that it happened from the chemistry panel.
Step 4 = this is refeeding syndrome, which is common in anorexia patients, alcoholics and malnourished patients. Malnourishment results in the depletion of the phosphate, potassium and other electrolytes, although serum levels may remain normal due to transcellular shift.

To make it easier:
- normal range of some imaginary electrolyte = 500-1000
- healthy patient = 800 (inside the cells) and 800 (serum)
- malnourished patients = 100 (inside the cells) and 800 (serum)

So despite having the normal level of electrolyte in the serum, stores are depleted and this is the main reason why this patient is feeling fine. Reintroduction of carbohydrates increases insulin secretion, which stimulates redistribution of phosphate/potassium/other electrolytes from the serum into the muscle and hepatic cells for use during glycolysis. Remember that glycolysis generates more ATP than it costs, so you have to take this phosphate group somewhere to generate ATP from ADP and it comes from the serum. This leads to profound hypophosphatemia/hypokalemia/hypowhateveremia and results in refeeding syndrome (eg, muscular weakness, arrhythmias, congestive heart failure -> cardiogenic pulmonary edema and lung findings).
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* Re:septic shock
  zo - 04/09/21 10:37
  yea it is refeeding syndrome and ans is insulin  
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