Sepsis vs Septic shock
How to tell Sepsis and Septic shock apart when a board question makes them look alike.
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Need for vasopressors after fluid resuscitation is the branch point to septic shock.
Side by side
Suspected infection with organ dysfunction but preserved blood pressure after fluids fits sepsis.
Persistent hypotension requiring vasopressors after adequate fluid resuscitation with lactate above 2 mmol/L defines septic shock.
Dysregulated host response to infection causes endothelial injury and organ dysfunction.
Severe vasoplegia and microcirculatory failure cause refractory hypoperfusion despite fluids.
Sepsis commonly shows lactate elevation, leukocytosis or leukopenia, creatinine rise, bilirubin elevation, or thrombocytopenia with suspected infection source.
Septic shock is defined by vasopressor need to maintain MAP at least 65 mm Hg after at least 30 mL/kg crystalloid and lactate above 2 mmol/L.
The trap
Delaying vasopressor initiation while giving repeated unbounded fluids worsens edema and organ failure. Once adequate bolus is given and MAP remains low, start norepinephrine promptly.
The repair move
Next best step: give broad-spectrum IV antibiotics within 1 hour, complete initial 30 mL/kg crystalloid, then start norepinephrine infusion to maintain MAP at least 65 mm Hg if hypotension persists, and obtain source control urgently. Add vasopressin if escalating norepinephrine requirements continue.
Try a free question
CoreA patient with urosepsis receives 30 mL/kg crystalloid and remains at MAP 58 mm Hg with lactate 3.8 mmol/L. What is the next best step in management?
Show answer and explanation
Answer: A. Start norepinephrine infusion. Persistent hypotension after adequate fluids indicates septic shock and requires vasopressor support.
Why the other choices are tempting
- B. Wrong. Excess unstructured fluids can worsen edema without restoring perfusion.
- C. Wrong. Culture data should not delay life-saving shock treatment.
- D. Wrong. Oral therapy is inadequate in shock.
- E. Wrong. Ongoing shock is incompatible with outpatient care.
Flashcards
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What finding upgrades sepsis to septic shock in current criteria?
Persistent hypotension needing vasopressors after adequate fluids plus lactate above 2 mmol/L.
What is the first-line vasopressor in septic shock?
Norepinephrine infusion.
Quick answers
What is the fastest way to tell Sepsis from Septic shock?
Need for vasopressors after fluid resuscitation is the branch point to septic shock.
What is the key clue for Sepsis?
Suspected infection with organ dysfunction but preserved blood pressure after fluids fits sepsis.
What is the key clue for Septic shock?
Persistent hypotension requiring vasopressors after adequate fluid resuscitation with lactate above 2 mmol/L defines septic shock.
What is the common trap with Sepsis vs Septic shock?
Delaying vasopressor initiation while giving repeated unbounded fluids worsens edema and organ failure. Once adequate bolus is given and MAP remains low, start norepinephrine promptly.