A 68-year-old man with diabetes presents with pyelonephritis and gram-negative bacteremia. Despite ceftriaxone and gentamicin, he develops hypotension (BP 85/52), tachycardia (HR 118), tachypnea (RR 22), and warm erythematous skin. Laboratory studies show serum lactate 4.2 mg/dL and positive blood cultures for E. coli. Urinalysis reveals pyuria and bacteriuria. He denies chest pain. Which mechanism most directly accounts for his decreased systemic vascular resistance?
- A)Coronary plaque rupture with pump failure
- B)Massive vagal discharge causing bradycardia
- C)Rapid loss of intravascular volume from hemorrhage
- D)Autoimmune destruction of adrenal cortex
- E)Nitric oxide mediated systemic vasodilation from inflammatory cytokinesGABARITO
Explicação
In septic shock, microbial products trigger release of inflammatory cytokines such as TNF and IL 1, which induce nitric oxide synthase and widespread nitric oxide mediated vasodilation. The result is distributive shock with warm extremities early in the course... Ver explicação completa e trilha adaptativa →