Treatment of shock caused by bacterial infections.

Bacteremia caused by Gram-negative enteric organisms accounts for the majority of instances of shock complicating bacterial infection. Control of the infection and maintenance of normal blood volume constitute the primary considerations in immediate treatment. The use of three or four doses of corticosteroid agent over a period of 24 hours is regarded as advantageous for routine treatment. Conservative and selective use of isoproterenol and phentolamine are justified for management of patients who do not respond to the administration of bactericidal drugs and volume repletion. Levarterenol and metaraminol are rarely indicated. Intravascular coagulation complicated by bleeding diathesis may serve as an indication for anticoagulation. With more effective management of the hemodynamic defects, patients are now more likely to survive the shock state only to develop a fatal form of pulmonary failure which is yet poorly understood. Close attention to respiratory management is therefore advised.