부산대학교 도서관

Septic shock can be defined as a severe sepsis with low blood pressure, prolonged over an hour, which does not respond to intravenous administration of fluids and requiring vasoactive substances management. The authors report the case of a scholar Ş.M. male patient, aged 10 years, who was admitted to the Intensive Care Department of Pediatric Clinic I Craiova presenting with coma, severe hypotension, occurred due to fever, vomiting and diarrhea emission. Laboratory investigations revealed: infectious anemia, leukopenia (2900/mm³), followed by leukocytosis (> 13000/mm³, six days), thrombocytopenia (<85000/mm³) which lasted for 7 days and altered coagulation, elevated serum ALT, AST (100-500u/l), hypoglycemia, metabolic acidosis and transient hyponatremia, hypokalemia. Being comatose, with O2 saturation (determined by pulse oximeter) of 76%, it has been required assisted ventilation for 5 days. Severe hypotension (40/30 mm Hg) in the second day of admission imposed both an adequate fluid rebalancing and proper administration of Dopamine 5μg/kc/min. These are antibiotics that were sequentially used: Sulcef, Meropenem, and Ceftriaxone associated with Metronidazole and Ciprofloxacinum. Clinical evolution was favorable, fever reducing gradually in 4 days. Five days later, he regained consciousness without disabling motor deficits. Due to mechanical ventilation, he presented subcutaneous emphysema as a transient incident. Because of the lesions diagnosed "dry gangrene" to toes, he has been transferred on the 14th day to Pediatric Surgery Department, where he received antibiotics, local treatment, being discharged on the 18th day from admission. In conclusion, our patient was admitted in the Emergency Room for septic shock, a redoubtable complication of sepsis, due to a gastroenteritis. His evolution was a favorable one, unto healing, but with disabling ischemic lesions in the legs caused by microcirculation disturbances in the context of a septic shock low blood pressure. The particularity of this case was a "restitutio ad integrum" healing of the organ damage and his complete recovery after septic shock with lifethreatening hypotension. [ABSTRACT FROM AUTHOR]