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Sepsis Quiz
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Which mechanism is primarily responsible for the profound hypotension seen in sepsis?
- A Widespread vasodilation caused by inflammatory cytokines You picked ✓
- B Loss of intravascular volume from increased capillary permeability You picked ✕
- C Isolated failure of autonomic sympathetic outflow You picked ✕
- D Reduced myocardial contractility due to primary cardiac ischaemia You picked ✕
- E Obstruction of major arteries by large thromboemboli You picked ✕
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Incorrect
The answer is A: Widespread vasodilation caused by inflammatory cytokines
Explanation
Why A is correct
See Pathophysiology of Sepsis. Option A is correct because sepsis causes widespread cytokine-mediated vasodilation, which produces distributive shock. Cytokines are chemical messengers released by immune cells. In sepsis, endotoxins from bacteria in the bloodstream trigger a massive immune response with widespread cytokine release. The cytokines make blood vessels dilate (widen) throughout the body, so systemic vascular resistance (the resistance the vessels offer to blood flow) falls and the blood pressure drops, even though the volume of blood may be normal. This is called distributive shock because the blood is spread out over a much larger, widened vascular space. Organs then receive too little blood and oxygen, leading to dysfunction and, if untreated, death. The picture is made worse by disseminated intravascular coagulation (DIC), in which clots form throughout the small vessels and use up clotting factors, leading to organ ischaemia. Septic shock is defined as persisting hypotension despite fluid resuscitation. Memory aid: in sepsis the pipes widen, so the same amount of fluid cannot fill them.
- Mechanism: widespread cytokine-mediated vasodilation.
- Effect: systemic vascular resistance falls, so blood pressure drops.
- Type of shock: distributive shock, because the blood is spread over a much larger vascular space.
- Septic shock: persisting hypotension despite fluid resuscitation.
Why the other options are incorrect
- B. Loss of intravascular volume from increased capillary permeability: Capillary leak can reduce circulating volume in sepsis, but it is a secondary contributor. The main cause of the profound fall in blood pressure is widespread vasodilation, so this option is not the primary mechanism. Your answer
- C. Isolated failure of autonomic sympathetic outflow: Autonomic failure is not the central driver of the pressure fall in sepsis. The inflammatory mediators act directly on the blood vessels. Your answer
- D. Reduced myocardial contractility due to primary cardiac ischaemia: Sepsis can depress heart function, but a primary heart attack is not what causes the early fall in blood pressure. The cause is vasodilation. Your answer
- E. Obstruction of major arteries by large thromboemboli: Large emboli block individual arteries and cause local ischaemia. They do not explain generalised hypotension in sepsis. Your answer
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1
For an adult with suspected sepsis who requires initial resuscitation, which action should be included in the first hour of management?
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2
Which statement best describes the fundamental problem that defines sepsis?
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