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ikipedia jump to content main menu main menu move to sidebar hide navigation main page contents current events random article about wikipedia contact us contribute help learn to edit community portal recent changes upload file special pages search search appearance donate create account log in personal tools donate create account log in contents move to sidebar hide top 1 types 2 causes 3 pathophysiology 4 treatment 5 prognosis 6 research directions 7 references 8 external links toggle the table of contents distributive shock 10 languages العربية español français հայերեն italiano नेपाल भाषा ଓଡ଼ିଆ srpskohrvatski српскохрватски српски srpski 中文 edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia insufficient blood flow due to abnormal distribution in the capillaries medical condition distributive shock specialty critical care medicine distributive shock is a medical condition in which abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body s tissues and organs 1 2 it is one of four categories of shock a condition where there is not enough oxygen carrying blood to meet the metabolic needs of the cells which make up the body s tissues and organs 2 distributive shock is different from the other three categories of shock in that it occurs even though the output of the heart is at or above a normal level 2 the most common cause is sepsis leading to a type of distributive shock called septic shock a condition that can be fatal 1 types edit elbers and ince have identified five classes of abnormal microcirculatory flow in distributive shock using side stream dark field microscopy class i all capillaries are stagnant when there is normal or sluggish venular flow class ii there are empty capillaries next to capillaries that have flowing red blood cells class iii there are stagnant capillaries next to capillaries with normal blood flow class iv hyperdynamic flow in capillaries adjacent to capillaries that are stagnant class v widespread hyperdynamic flow in the microcirculatory system 2 according to the cause there are 4 types of distributive shock neurogenic shock decreased sympathetic stimulation leading to decreased vessel tone anaphylactic shock septic shock shock due to adrenal crisis causes edit in addition to sepsis distributive shock can be caused by systemic inflammatory response syndrome sirs due to conditions other than infection such as pancreatitis burns or trauma 3 other causes include toxic shock syndrome tss anaphylaxis a sudden severe allergic reaction adrenal insufficiency reactions to drugs or toxins heavy metal poisoning hepatic liver insufficiency and damage to the central nervous system 3 causes of adrenal insufficiency leading to distributive shock include acute worsening of chronic adrenal insufficiency destruction or removal of the adrenal glands suppression of adrenal gland function due to exogenous steroids hypopituitarism and metabolic failure of hormone production 3 pathophysiology edit the cause of inadequate tissue perfusion blood delivery to tissues in distributive shock is a lack of normal responsiveness of blood vessels to vasoconstrictive agents and direct vasodilation 4 there are four types of distributive shock the most common septic shock is caused by an infection most frequently by bacteria but viruses fungi and parasites have been implicated 3 infection sites most likely to lead to septic shock are chest abdomen and genitourinary tract 3 in septic shock the blood flow in the microvasculature is abnormal with some capillaries underperfused and others with normal to high blood flow 5 the endothelial cells lining the blood vessels become less responsive to vasoconstrictive agents lose their glycocalyx normal coating and negative ionic charge become leaky and cause extensive over expression of nitric oxide 2 the coagulation cascade is also disrupted 4 tissue factor that initiates the clotting cascade is produced by activated monocytes and the endothelial cells lining the blood vessels while antithrombin and fibrinolysis are impaired 4 disseminated intravascular coagulation dic can result from the thrombin produced in the inflammatory response 4 the ability of red blood cells to change shape decreases and their tendency to clump together increases inhibiting their flow through the microvasculature 5 in anaphylactic shock low blood pressure is related to decreased systemic vascular resistance svr triggered primarily by a massive release of histamine by mast cells activated by antigen bound immunoglobulin e and also by increased production and release of prostaglandins 4 neurogenic shock is caused by the loss of vascular tone normally supported by the sympathetic nervous system due to injury to the central nervous system especially spinal cord injury 4 6 rupture of a hollow organ with subsequent evacuation of contents in the peritoneal cavity could also determine neurogenic shock a subtype of distributive shock this happens due to the widespread peritoneal irritation by the ruptured viscus contents as in peptic ulcer perforation with consequent strong vagal activation and generalized extensive peripheral vasodilation and bradycardia 7 8 thus in neurogenic shock there is decreased systemic vascular resistance cvp is typically decreased co decreased or normal and paop decreased 2 distributive shock associated with adrenal crisis results from inadequate steroid hormones treatment edit the main goals of treatment in distributive shock are to reverse the underlying cause and achieve hemodynamic stabilization 9 immediate treatment involves fluid resuscitation and the use of vasoactive drugs both vasopressors and inotropes 10 hydrocortisone is used for people whose hypotension does not respond to fluid resuscitation and vasopressors 11 opening and keeping open the microcirculation is a consideration in the treatment of distributive shock as a result limiting the use of vasopressors has been suggested 2 control of inflammation vascular function and coagulation to correct pathological differences in blood flow and microvascular shunting has been pointed to as a potentially important adjunct goal in the treatment of distributive shock 2 people with septic shock are treated with antimicrobial drugs to treat the causative infection 12 some sources of infection require surgical intervention including necrotizing fasciitis cholangitis abscess intestinal ischemia or infected medical devices 13 anaphylactic shock is treated with epinephrine 14 the use of vasopressin together with norepinephrine rather than norepinephrine alone appears to decrease the risk of atrial fibrillation but with few other benefits 15 prognosis edit septic shock is associated with significant mortality and is the leading non cardiac cause of death in intensive care units icus 1 research directions edit the choice of fluids for resuscitation remains an area of research the surviving sepsis campaign an international consortium of experts did not find adequate evidence to support the superiority of crystalloid fluids versus colloid fluids 10 drugs such as pyridoxalated hemoglobin polyoxyethylene which scavenge nitric oxide from the blood have been investigated 16 as well as methylene blue which may inhibit the nitric oxide cyclic guanosine monophosphate no cgmp pathway which has been suggested to play a significant role in distributive shock 17 references edit 1 2 3 kanaparthi lalit k klaus dieter lessnau peralta ruben 12 february 2013 pinsky michael r ed distributive shock overview background medscape reference medscape retrieved 2014 04 28 1 2 3 4 5 6 7 8 elbers paul w g ince can 19 july 2006 mechanisms of critical illness classifying microcirculatory flow abnormalities in distributive shock critical care 10 4 221 doi 10 1186 cc4969 pmc 1750971 pmid 16879732 1 2 3 4 5 kanaparthi et al 2013 overview etiology 1 2 3 4 5 6 kanaparthi et al 2013 overview pathophysiology 1 2 ince can 25 august 2005 the microcirculation is the motor of sepsis critical care 4 supp 4 s13 9 doi 10 1186 cc3753 pmc 3226164 pmid 16168069 weaver lynne c fleming jennifer c mathias christopher j krassioukov andrie v 2012 ch 13 disordered cardiovascular control after spinal cord injury in verhaagen joost mcdonald john w eds spinal cord injury handbook of clinical neurology vol 109 pp 213 33 doi 10 1016 b978 0 444 52137 8 00013 9 isbn 9780444521378 pmid 23098715 de giorgio f lodise m pascali vl spagnolo ag d aloja e arena v 2015 an unusual case showing fatal rupture of a gastric ulcer or gastromalacia the importance role of histology for differential diagnosis journal of forensic sciences 60 1 240 2 doi 10 1111 1556 4029 12665 pmid 25388056 s2cid 1458157 cite journal cs1 maint multiple names authors list link civetta taylor kirby s critical care 4th edition chapter 59 neurogenic shock lippincott williams wilkins 2009 kanaparthi et al 2013 treatment approach considerations 1 2 kanaparthi et al 2013 treatment resuscitation kanaparthi et al 2013 treatment corticosteroids kanaparthi et al 2013 treatment antimicrobial treatment kanaparthi et al 2013 treatment surgical control of shock sources kanaparthi et al 2013 treatment treatment of anaphylaxis mcintyre wf um kj alhazzani w lengyel ap hajjar l gordon ac lamontagne f healey js whitlock rp belley côté ep 8 may 2018 association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock a systematic review and meta analysis jama 319 18 1889 1900 doi 10 1001 jama 2018 4528 pmc 6583502 pmid 29801010 kinasewitz gary t privalle christopher t imm amy steingrub jay s et al july 2008 multicenter randomized placebo controlled study of the nitric oxide scavenger pyridoxalated hemoglobin polyoxyethylene in distributive shock critical care medicine 36 7 1999 2007 doi 10 1097 ccm 0b013e31817bfe84 pmid 18552688 s2cid 30123186 jang d h nelson l s hoffman r s september 2013 methylene blue for distributive shock a potential new use of an old antidote journal of medical toxicology 9 3 242 9 doi 10 1007 s13181 013 0298 7 pmc 3770994 pmid 23580172 external links edit surviving sepsis campaign v t e shock distributive septic shock neurogenic shock anaphylactic shock toxic shock syndrome obstructive abdominal compartment syndrome low volume hemorrhage hypovolemia osmotic shock other cardiogenic spinal shock cryptic shock vasodilatory shock v t e intensive care medicine health science medicine medical specialities respiratory therapy general terms intensive care unit icu neonatal intensive care unit nicu pediatric intensive care unit picu coronary care unit ccu critical illness insurance geriatric intensive care unit conditions organ system failure shock sequence sirs sepsis severe sepsis septic shock multiple organ dysfunction syndrome other shock cardiogenic shock distributive shock anaphylaxis obstructive shock neurogenic shock spinal shock vasodilatory shock organ failure acute renal failure acute respiratory distress syndrome acute liver failure respiratory failure multiple organ dysfunction syndrome neonatal infection polytrauma coma complications critical illness polyneuropathy myopathy critical illness related corticosteroid insufficiency decubitus ulcers fungemia stress hyperglycemia stress ulcer iatrogenesis methicillin resistant staphylococcus aureus oxygen toxicity refeeding syndrome ventilator associated lung injury ventilator associated pneumonia dialytrauma diagnosis arterial blood gas catheter arterial line central venous catheter pulmonary artery catheter blood cultures screening cultures life supporting treatments airway management and mechanical ventilation tracheal intubation cardiac devices intra aortic balloon pump ventricular assist device chest tube kidney dialysis early goal directed therapy induced coma nutritional supplementation enteral feeding total parenteral nutrition therapeutic hypothermia drugs analgesics antibiotics antithrombotics inotropes intravenous fluids neuromuscular blocking drugs recombinant activated protein c sedatives stress ulcer prevention drugs vasopressors icu scoring systems apache ii glasgow coma scale pim2 saps ii saps iii sofa physiology hemodynamics hypotension level of consciousness acid base imbalance water electrolyte imbalance organisations society of critical care medicine surviving sepsis campaign european society of paediatric and neonatal intensive care related specialties anesthesiology internal medicine cardiology neurology pulmonology pediatrics surgery traumatology v t e signs and symptoms relating to the circulatory system chest pain referred pain angina levine s sign auscultation heart sounds split s2 s3 s4 gallop rhythm heart murmur systolic functional murmur still s murmur diastolic pulmonary insufficiency graham steell murmur continuous carey coombs murmur mitral insufficiency presystolic murmur pericardial friction rub heart click bruit carotid pulse tachycardia bradycardia pulsus paradoxus doubled pulsus bisferiens pulsus bigeminus pulsus alternans other palpitations apex beat cœur en sabot jugular venous pressure cannon a waves hyperaemia shock cardiogenic obstructive hypovolemic distributive see further template shock cardiovascular disease aortic insufficiency collapsing pulse de musset s sign duroziez s sign müller s sign austin flint murmur mayne s sign other endocardium endocarditis roth s spot janeway lesion osler s node bracht wachter bodies pericardium cardiac tamponade pericardial effusion beck s triad ewart s sign other rheumatic fever anitschkow cell aschoff body ekg j wave gallavardin phenomenon vascular disease arterial aortic aneurysm cardarelli s sign oliver s sign pulmonary embolism right heart strain radial artery sufficiency allen s test pseudohypertension thrombus lines of zahn adson s sign arteriovenous fistula nicoladoni branham sign venous friedreich s sign caput medusae kussmaul s sign trendelenburg test superior vena cava syndrome pemberton s sign retrieved from https en wikipedia org w index php title distributive_shock oldid 1325357791 category medical emergencies hidden categories articles with short description short description is different from wikidata cs1 maint multiple names authors list this page was last edited on 2 december 2025 at 17 27 utc page was rendered with parsoid text is available under the creative commons attribution sharealike 4 0 license additional terms may apply by using this site you agree to the terms of use and privacy policy wikipedia is a registered trademark of the wikimedia foundation inc a non 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