SherbyNet - /page/wikibook/entry.mu

Micron Document

<!DOCTYPE html>

<title>Distributive shock</title>

</head>

<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Distributive shock</span></span>

</h1>

</header>

/* start https://en.wikipedia.org/ */

.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}

/* end https://en.wikipedia.org/ */

</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Distributive shock</th></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">

/* start https://en.wikipedia.org/ */

@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}

/* end https://en.wikipedia.org/ */

</style>

<p><b>Distributive shock</b> is a <a href="Medicine" title="Medicine">medical</a> condition in which abnormal distribution of <a href="Blood_flow" class="mw-redirect" title="Blood flow">blood flow</a> in the <a href="Microvessel" class="mw-redirect" title="Microvessel">smallest blood vessels</a> results in inadequate supply of blood to the body's <a href="Tissue_(biology)" title="Tissue (biology)">tissues</a> and <a href="Organ_(anatomy)" class="mw-redirect" title="Organ (anatomy)">organs</a>.<sup id="cite_ref-Kanaparthi_2013_1-0" class="reference"><a href="#cite_note-Kanaparthi_2013-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Elbers_2006_2-0" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It is one of four categories of <a href="Shock_(circulatory)" title="Shock (circulatory)">shock</a>, a condition where there is not enough <a href="Oxygen" title="Oxygen">oxygen</a>-carrying blood to meet the <a href="Metabolism" title="Metabolism">metabolic</a> needs of the <a href="Cell_(biology)" title="Cell (biology)">cells</a> which make up the body's tissues and organs.<sup id="cite_ref-Elbers_2006_2-1" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Distributive shock is different from the other three categories of shock in that it occurs even though the <a href="Cardiac_output" title="Cardiac output">output of the heart</a> is at or above a normal level.<sup id="cite_ref-Elbers_2006_2-2" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The most common cause is <a href="Sepsis" title="Sepsis">sepsis</a> leading to a type of distributive shock called <a href="Septic_shock" title="Septic shock">septic shock</a>, a condition that can be fatal.<sup id="cite_ref-Kanaparthi_2013_1-1" class="reference"><a href="#cite_note-Kanaparthi_2013-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="Types">Types</h2></div>

<p>Elbers and Ince have identified five classes of abnormal microcirculatory flow in distributive shock using side stream <a href="Dark_field_microscopy" class="mw-redirect" title="Dark field microscopy">dark field microscopy</a>.

</p>

<ul><li>Class I: all capillaries are stagnant when there is normal or sluggish venular flow.</li>

<li>Class II: there are empty capillaries next to capillaries that have flowing red blood cells.</li>

<li>Class III: there are stagnant capillaries next to capillaries with normal blood flow.</li>

<li>Class IV: hyperdynamic flow in capillaries adjacent to capillaries that are stagnant.</li>

<li>Class V: widespread hyperdynamic flow in the microcirculatory system.<sup id="cite_ref-Elbers_2006_2-3" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li></ul>

<p>According to the cause, there are 4 types of distributive shock:

</p>

<ul><li><a href="Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a>: Decreased sympathetic stimulation leading to decreased vessel tone.</li>

<li><a href="Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">Anaphylactic shock</a></li>

<li><a href="Septic_shock" title="Septic shock">Septic shock</a></li>

<li>Shock due to <a href="Adrenal_crisis" title="Adrenal crisis">adrenal crisis</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2></div>

<p>In addition to sepsis, distributive shock can be caused by <a href="Systemic_inflammatory_response_syndrome" title="Systemic inflammatory response syndrome">systemic inflammatory response syndrome</a> (SIRS) due to conditions other than <a href="Infection" title="Infection">infection</a> such as <a href="Pancreatitis" title="Pancreatitis">pancreatitis</a>, burns or <a href="Injury" title="Injury">trauma</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Other causes include <a href="Toxic_shock_syndrome" title="Toxic shock syndrome">toxic shock syndrome</a> (TSS), <a href="Anaphylaxis" title="Anaphylaxis">anaphylaxis</a> (a sudden, severe allergic reaction), <a href="Adrenal_insufficiency" title="Adrenal insufficiency">adrenal insufficiency</a>, reactions to <a href="Pharmaceutical_drug" class="mw-redirect" title="Pharmaceutical drug">drugs</a> or <a href="Toxin" title="Toxin">toxins</a>, <a href="Heavy_metal_(chemistry)" class="mw-redirect" title="Heavy metal (chemistry)">heavy metal</a> poisoning, hepatic (<a href="Liver" title="Liver">liver</a>) insufficiency and damage to the <a href="Central_nervous_system" title="Central nervous system">central nervous system</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-1" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-2" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2></div>

<p>The cause of inadequate tissue <a href="Perfusion" title="Perfusion">perfusion</a> (blood delivery to tissues) in distributive shock is a lack of normal responsiveness of <a href="Blood_vessel" title="Blood vessel">blood vessels</a> to <a href="Vasoconstriction" title="Vasoconstriction">vasoconstrictive</a> agents and direct <a href="Vasodilation" title="Vasodilation">vasodilation</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup>

</p><p>There are four types of distributive shock. The most common, <a href="Septic_shock" title="Septic shock">septic shock</a>, is caused by an infection, most frequently by <a href="Bacteria" title="Bacteria">bacteria</a>, but <a href="Virus" title="Virus">viruses</a>, <a href="Fungus" title="Fungus">fungi</a> and <a href="Parasite" class="mw-redirect" title="Parasite">parasites</a> have been implicated.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-3" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Infection sites most likely to lead to septic shock are chest, <a href="Abdomen" title="Abdomen">abdomen</a> and <a href="Genitourinary_system" title="Genitourinary system">genitourinary tract</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-4" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In septic shock the blood flow in the microvasculature is abnormal with some <a href="Capillary" title="Capillary">capillaries</a> underperfused and others with normal to high blood flow.<sup id="cite_ref-Ince_2005_5-0" class="reference"><a href="#cite_note-Ince_2005-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The <a href="Endothelium" title="Endothelium">endothelial</a> cells lining the blood vessels become less responsive to vasoconstrictive agents, lose their <a href="Glycocalyx" title="Glycocalyx">glycocalyx</a> (normal coating) and negative <a href="Ion" title="Ion">ionic</a> charge, become leaky and cause extensive over-expression of <a href="Nitric_oxide" title="Nitric oxide">nitric oxide</a>.<sup id="cite_ref-Elbers_2006_2-4" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The <a href="Coagulation" title="Coagulation">coagulation</a> cascade is also disrupted.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-1" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> <a href="Tissue_factor" title="Tissue factor">Tissue factor</a> that initiates the clotting cascade is produced by activated <a href="Monocyte" title="Monocyte">monocytes</a> and the endothelial cells lining the blood vessels while <a href="Antithrombin" title="Antithrombin">antithrombin</a> and <a href="Fibrinolysis" title="Fibrinolysis">fibrinolysis</a> are impaired.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-2" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> <a href="Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">Disseminated intravascular coagulation</a> (DIC) can result from the <a href="Thrombin" title="Thrombin">thrombin</a> produced in the <a href="Inflammation" title="Inflammation">inflammatory</a> response.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-3" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> The ability of red blood cells to <a href="Erythrocyte_deformability" title="Erythrocyte deformability">change shape</a> decreases and their tendency to <a href="Erythrocyte_aggregation" title="Erythrocyte aggregation">clump together</a> increases, inhibiting their flow through the microvasculature.<sup id="cite_ref-Ince_2005_5-1" class="reference"><a href="#cite_note-Ince_2005-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup>

</p><p>In <a href="Anaphylaxis#Diagnosis" title="Anaphylaxis">anaphylactic shock</a> low blood pressure is related to decreased <a href="Vascular_resistance" title="Vascular resistance">systemic vascular resistance</a> (SVR) triggered primarily by a massive release of histamine by mast cells activated by <a href="Antigen" title="Antigen">antigen</a>-bound <a href="Immunoglobulin_E" title="Immunoglobulin E">immunoglobulin E</a> and also by increased production and release of <a href="Prostaglandin" title="Prostaglandin">prostaglandins</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-4" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup>

</p><p><a href="Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a> is caused by the loss of vascular <a href="Muscle_tone" title="Muscle tone">tone</a> normally supported by the <a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> due to injury to the central nervous system especially <a href="Spinal_cord_injury" title="Spinal cord injury">spinal cord injury</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-5" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Weaver_2012_6-0" class="reference"><a href="#cite_note-Weaver_2012-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Thus, in neurogenic shock, there is decreased systemic vascular resistance, CVP is typically decreased, CO decreased or normal, and PAOP decreased.<sup id="cite_ref-Elbers_2006_2-5" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

</p><p>Distributive shock associated with <a href="Adrenal_crisis" title="Adrenal crisis">adrenal crisis</a> results from inadequate steroid hormones.

</p>

<div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div>

/* start https://en.wikipedia.org/ */

.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}

/* end https://en.wikipedia.org/ */

</style>

<div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2></div>

<p>The main goals of treatment in distributive shock are to reverse the underlying cause and achieve <a href="Hemodynamics" title="Hemodynamics">hemodynamic</a> stabilization.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Approach_Considerations_9-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Approach_Considerations-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Immediate treatment involves <a href="Fluid_replacement" title="Fluid replacement">fluid resuscitation</a> and the use of <a href="Vasoactive" class="mw-redirect" title="Vasoactive">vasoactive</a> drugs, both <a href="Vasoconstriction" title="Vasoconstriction">vasopressors</a> and <a href="Inotrope" title="Inotrope">inotropes</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation_10-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Hydrocortisone is used for people whose hypotension does not respond to fluid resuscitation and vasopressors.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Corticosteroids_11-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Corticosteroids-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Elbers_2006_2-6" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Elbers_2006_2-7" class="reference"><a href="#cite_note-Elbers_2006-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

</p><p>People with septic shock are treated with <a href="Antimicrobial" title="Antimicrobial">antimicrobial</a> drugs to treat the causative infection.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Antimicrobial_Treatment_12-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Antimicrobial_Treatment-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Some sources of infection require surgical intervention including <a href="Necrotizing_fasciitis" title="Necrotizing fasciitis">necrotizing fasciitis</a>, <a href="Ascending_cholangitis" title="Ascending cholangitis">cholangitis</a>, <a href="Abscess" title="Abscess">abscess</a>, <a href="Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">intestinal ischemia</a>, or infected <a href="Medical_device" title="Medical device">medical devices</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Surgical_Control_of_Shock_Sources_13-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Surgical_Control_of_Shock_Sources-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup>

</p><p>Anaphylactic shock is treated with <a href="Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a>.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Treatment_of_Anaphylaxis_14-0" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Treatment_of_Anaphylaxis-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> The use of <a href="Vasopressin" title="Vasopressin">vasopressin</a> together with <a href="Norepinephrine" title="Norepinephrine">norepinephrine</a> rather than norepinephrine alone appears to decrease the risk of <a href="Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a> but with few other benefits.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div>

<p>Septic shock is associated with significant mortality and is the leading non-cardiac cause of death in <a href="Intensive_care_unit" title="Intensive care unit">intensive care units</a> (ICUs).<sup id="cite_ref-Kanaparthi_2013_1-2" class="reference"><a href="#cite_note-Kanaparthi_2013-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="Research_directions">Research directions</h2></div>

<p>The choice of fluids for resuscitation remains an area of research, the <a href="Surviving_Sepsis_Campaign" title="Surviving Sepsis Campaign">Surviving Sepsis Campaign</a> an international consortium of experts, did not find adequate evidence to support the superiority of <a href="Volume_expander#Crystalloids" title="Volume expander">crystalloid</a> fluids versus <a href="Volume_expander#Colloids" title="Volume expander">colloid</a> fluids.<sup id="cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation_10-1" class="reference"><a href="#cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Drugs such as pyridoxalated hemoglobin polyoxyethylene, which scavenge nitric oxide from the blood, have been investigated,<sup id="cite_ref-Kinasewitz_2008_16-0" class="reference"><a href="#cite_note-Kinasewitz_2008-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Jang_2013_17-0" class="reference"><a href="#cite_note-Jang_2013-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup>

</p>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

/* start https://en.wikipedia.org/ */

.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}

/* end https://en.wikipedia.org/ */

</style><div class="reflist">

/* start https://en.wikipedia.org/ */

.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("./mw/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("./mw/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("./mw/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("./mw/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}

/* end https://en.wikipedia.org/ */

</style><cite id="CITEREFKanaparthi_et_al.2013" class="citation cs2">Kanaparthi, Lalit K.; Klaus-Dieter, Lessnau; Peralta, Ruben (12 February 2013), Pinsky, Michael R. (ed.), <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="http://emedicine.medscape.com/article/168689">"Distributive Shock: Overview: Background"</a></span>, <i>Medscape Reference</i>, <a href="Medscape" title="Medscape">Medscape</a><span class="reference-accessdate">, retrieved <span class="nowrap">2014-04-28</span></span>.</cite></span>

</li>

<li id="cite_note-Elbers_2006-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Elbers_2006_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Elbers_2006_2-7"><sup><i><b>h</b></i></sup></a></span> <span class="reference-text"><cite id="CITEREFElbers_&_Ince2006" class="citation journal cs1">Elbers, Paul W.G.; Ince, Can (19 July 2006). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750971">"Mechanisms of critical illness--classifying microcirculatory flow abnormalities in distributive shock"</a>. <i><a href="Critical_Care_(journal)" title="Critical Care (journal)">Critical Care</a></i>. <b>10</b> (4): 221. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fcc4969">10.1186/cc4969</a></span>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750971">1750971</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16879732">16879732</a>.</cite></span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Etiology_3-4"><sup><i><b>e</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Overview: Etiology.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Overview:_Pathophysiology_4-5"><sup><i><b>f</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Overview: Pathophysiology.</span>

</li>

<li id="cite_note-Ince_2005-5"><span class="mw-cite-backlink">^ <a href="#cite_ref-Ince_2005_5-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Ince_2005_5-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite id="CITEREFInce2005" class="citation journal cs1">Ince, Can (25 August 2005). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226164">"The microcirculation is the motor of sepsis"</a>. <i><a href="Critical_Care_(journal)" title="Critical Care (journal)">Critical Care</a></i>. <b>4</b> (Supp 4): S13-9. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fcc3753">10.1186/cc3753</a></span>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226164">3226164</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16168069">16168069</a>.</cite></span>

</li>

<li id="cite_note-Weaver_2012-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-Weaver_2012_6-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFWeaverFlemingMathiasKrassioukov2012" class="citation book cs1">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.). <i>Spinal Cord Injury</i>. Handbook of Clinical Neurology. Vol. 109. pp. <span class="nowrap">213–</span>33. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FB978-0-444-52137-8.00013-9">10.1016/B978-0-444-52137-8.00013-9</a>. <a href="ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <bdi>9780444521378</bdi>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23098715">23098715</a>.</cite></span>

</li>

<li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text"><cite id="CITEREFDe-Giorgio_F,_Lodise_M,_Pascali_VL,_Spagnolo_AG,_d'Aloja_E,_Arena_V2015" class="citation journal cs1">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". <i>Journal of Forensic Sciences</i>. <b>60</b> (1): <span class="nowrap">240–</span>2. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2F1556-4029.12665">10.1111/1556-4029.12665</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25388056">25388056</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:1458157">1458157</a>.</cite><span class="cs1-maint citation-comment"><code class="cs1-code">{{cite journal}}</code>: CS1 maint: multiple names: authors list (link)</span></span>

</li>

<li id="cite_note-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-8">^</a></b></span> <span class="reference-text">Civetta, Taylor, & Kirby's Critical Care, 4th Edition. Chapter 59 Neurogenic Shock. Lippincott Williams & Wilkins 2009</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Approach_Considerations-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Approach_Considerations_9-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Approach Considerations.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation-10"><span class="mw-cite-backlink">^ <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation_10-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Resuscitation_10-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Resuscitation.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Corticosteroids-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Corticosteroids_11-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Corticosteroids.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Antimicrobial_Treatment-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Antimicrobial_Treatment_12-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Antimicrobial Treatment.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Surgical_Control_of_Shock_Sources-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Surgical_Control_of_Shock_Sources_13-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Surgical Control of Shock Sources.</span>

</li>

<li id="cite_note-FOOTNOTEKanaparthi_et_al.2013Treatment:_Treatment_of_Anaphylaxis-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-FOOTNOTEKanaparthi_et_al.2013Treatment:_Treatment_of_Anaphylaxis_14-0">^</a></b></span> <span class="reference-text"><a href="#CITEREFKanaparthi_et_al.2013">Kanaparthi et al. 2013</a>, Treatment: Treatment of Anaphylaxis.</span>

</li>

<li id="cite_note-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-15">^</a></b></span> <span class="reference-text"><cite id="CITEREFMcIntyreUmAlhazzaniLengyel2018" class="citation journal cs1">McIntyre, WF; Um, KJ; Alhazzani, W; Lengyel, AP; Hajjar, L; Gordon, AC; Lamontagne, F; Healey, JS; Whitlock, RP; Belley-Côté, EP (8 May 2018). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583502">"Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock: A Systematic Review and Meta-analysis"</a>. <i>JAMA</i>. <b>319</b> (18): <span class="nowrap">1889–</span>1900. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.2018.4528">10.1001/jama.2018.4528</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583502">6583502</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29801010">29801010</a>.</cite></span>

</li>

<li id="cite_note-Kinasewitz_2008-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-Kinasewitz_2008_16-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFKinasewitzPrivalleImmSteingrub2008" class="citation journal cs1">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". <i><a href="Critical_Care_Medicine" class="mw-redirect" title="Critical Care Medicine">Critical Care Medicine</a></i>. <b>36</b> (7): <span class="nowrap">1999–</span>2007. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2FCCM.0b013e31817bfe84">10.1097/CCM.0b013e31817bfe84</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18552688">18552688</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:30123186">30123186</a>.</cite></span>

</li>

<li id="cite_note-Jang_2013-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-Jang_2013_17-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFJangNelsonHoffman2013" class="citation journal cs1">Jang, D.H.; Nelson, L.S.; Hoffman, R.S. (September 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770994">"Methylene blue for distributive shock: A potential new use of an old antidote"</a>. <i><a href="Journal_of_Medical_Toxicology" title="Journal of Medical Toxicology">Journal of Medical Toxicology</a></i>. <b>9</b> (3): <span class="nowrap">242–</span>9. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs13181-013-0298-7">10.1007/s13181-013-0298-7</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770994">3770994</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23580172">23580172</a>.</cite></span>

</li>

</ol></div></div>

<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

<ul><li><a rel="nofollow" class="external text" href="http://www.survivingsepsis.org">Surviving Sepsis Campaign</a></li></ul>

/* start https://en.wikipedia.org/ */

.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul ol,.mw-parser-output .hlist ul ul{display:inline}.mw-parser-output .hlist .mw-empty-li{display:none}.mw-parser-output .hlist dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}

/* end https://en.wikipedia.org/ */

</style><style data-mw-deduplicate="TemplateStyles:r1236075235">

/* start https://en.wikipedia.org/ */

.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output .navbox-list{line-height:1.5em;border-color:#fdfdfd}.mw-parser-output .navbox-list-with-group{text-align:left;border-left-width:2px;border-left-style:solid}.mw-parser-output tr+tr>.navbox-abovebelow,.mw-parser-output tr+tr>.navbox-group,.mw-parser-output tr+tr>.navbox-image,.mw-parser-output tr+tr>.navbox-list{border-top:2px solid #fdfdfd}.mw-parser-output .navbox-title{background-color:#ccf}.mw-parser-output .navbox-abovebelow,.mw-parser-output .navbox-group,.mw-parser-output .navbox-subgroup .navbox-title{background-color:#ddf}.mw-parser-output .navbox-subgroup .navbox-group,.mw-parser-output .navbox-subgroup .navbox-abovebelow{background-color:#e6e6ff}.mw-parser-output .navbox-even{background-color:#f7f7f7}.mw-parser-output .navbox-odd{background-color:transparent}.mw-parser-output .navbox .hlist td dl,.mw-parser-output .navbox .hlist td ol,.mw-parser-output .navbox .hlist td ul,.mw-parser-output .navbox td.hlist dl,.mw-parser-output .navbox td.hlist ol,.mw-parser-output .navbox td.hlist ul{padding:0.125em 0}.mw-parser-output .navbox .navbar{display:block;font-size:100%}.mw-parser-output .navbox-title .navbar{float:left;text-align:left;margin-right:0.5em}body.skin--responsive .mw-parser-output .navbox-image img{max-width:none!important}@media print{body.ns-0 .mw-parser-output .navbox{display:none!important}}

/* end https://en.wikipedia.org/ */

</style></div><div role="navigation" class="navbox" aria-labelledby="Shock112" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><style data-mw-deduplicate="TemplateStyles:r1239400231">

/* start https://en.wikipedia.org/ */

.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}

/* end https://en.wikipedia.org/ */

</style><div id="Shock112" style="font-size:114%;margin:0 4em"><a href="Shock_(circulatory)" title="Shock (circulatory)">Shock</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Septic_shock" title="Septic shock">Septic shock</a></li>

<li><a href="Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a></li>

<li><a href="Anaphylactic_shock" class="mw-redirect" title="Anaphylactic shock">Anaphylactic shock</a></li>

<li><a href="Toxic_shock_syndrome" title="Toxic shock syndrome">Toxic shock syndrome</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Obstructive_shock" title="Obstructive shock">Obstructive</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Abdominal_compartment_syndrome" title="Abdominal compartment syndrome">Abdominal compartment syndrome</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Low-volume</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Hemorrhage" class="mw-redirect" title="Hemorrhage">Hemorrhage</a></li>

<li><a href="Hypovolemia" title="Hypovolemia">Hypovolemia</a>

<ul><li><a href="Osmotic_shock" title="Osmotic shock">Osmotic shock</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic</a></li>

<li><a href="Spinal_shock" title="Spinal shock">Spinal shock</a></li>

<li><a href="Cryptic_shock" title="Cryptic shock">Cryptic shock</a></li>

<li><a href="Vasodilatory_shock" title="Vasodilatory shock">Vasodilatory shock</a></li></ul>

</div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Intensive_care_medicine321" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Intensive_care_medicine321" style="font-size:114%;margin:0 4em"><a href="Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></div></th></tr><tr><td class="navbox-abovebelow" colspan="2"><div>

<ul><li><a href="Outline_of_health_sciences" title="Outline of health sciences">Health science</a></li>

<li><a href="Medicine" title="Medicine">Medicine</a></li>

<li><a href="Medical_specialty" title="Medical specialty">Medical specialities</a></li>

<li><a href="Respiratory_therapy" class="mw-redirect" title="Respiratory therapy">Respiratory therapy</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General terms</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Intensive_care_unit" title="Intensive care unit">Intensive care unit</a> (ICU)</li>

<li><a href="Neonatal_intensive_care_unit" title="Neonatal intensive care unit">Neonatal intensive care unit</a> (NICU)</li>

<li><a href="Pediatric_intensive_care_unit" title="Pediatric intensive care unit">Pediatric intensive care unit</a> (PICU)</li>

<li><a href="Coronary_care_unit" title="Coronary care unit">Coronary care unit</a> (CCU)</li>

<li><a href="Critical_illness_insurance" title="Critical illness insurance">Critical illness insurance</a></li>

<li><a href="Geriatric_intensive-care_unit" title="Geriatric intensive-care unit">Geriatric intensive-care unit</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Conditions</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Organ system failure</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<dl><dt>Shock sequence</dt>

<dd><a href="Sepsis" title="Sepsis">Sepsis</a></dd>

<dd><a href="Sepsis#Definitions" title="Sepsis">Severe sepsis</a></dd>

<dd><a href="Septic_shock" title="Septic shock">Septic shock</a></dd>

<dd><a href="Multiple_organ_dysfunction_syndrome" title="Multiple organ dysfunction syndrome">Multiple organ dysfunction syndrome</a></dd></dl>

<dl><dt>Other <a href="Shock_(circulatory)" title="Shock (circulatory)">shock</a></dt>

<dd><a href="Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic shock</a></dd>

<dd><a href="Anaphylaxis" title="Anaphylaxis">Anaphylaxis</a></dd>

<dd><a href="Obstructive_shock" title="Obstructive shock">Obstructive shock</a></dd>

<dd><a href="Neurogenic_shock" title="Neurogenic shock">Neurogenic shock</a></dd>

<dd><a href="Spinal_shock" title="Spinal shock">Spinal shock</a></dd>

<dd><a href="Vasodilatory_shock" title="Vasodilatory shock">Vasodilatory shock</a></dd></dl>

<dl><dt><a href="Organ_dysfunction" title="Organ dysfunction">Organ failure</a></dt>

<dd><a href="Acute_kidney_injury" title="Acute kidney injury">Acute renal failure</a></dd>

<dd><a href="Acute_respiratory_distress_syndrome" title="Acute respiratory distress syndrome">Acute respiratory distress syndrome</a></dd>

<dd><a href="Acute_liver_failure" title="Acute liver failure">Acute liver failure</a></dd>

<dd><a href="Respiratory_failure" title="Respiratory failure">Respiratory failure</a></dd>

<dd><a href="Multiple_organ_dysfunction_syndrome" title="Multiple organ dysfunction syndrome">Multiple organ dysfunction syndrome</a></dd></dl>

<ul><li><a href="Neonatal_infection" title="Neonatal infection">Neonatal infection</a></li>

<li><a href="Polytrauma" title="Polytrauma">Polytrauma</a></li>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Complications</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Critical_illness_polyneuropathy" title="Critical illness polyneuropathy">Critical illness polyneuropathy</a> / myopathy</li>

<li><a href="Critical_illness%E2%80%93related_corticosteroid_insufficiency" title="Critical illness–related corticosteroid insufficiency">Critical illness–related corticosteroid insufficiency</a></li>

<li><a href="Pressure_ulcer" title="Pressure ulcer">Decubitus ulcers</a></li>

<li><a href="Fungemia" title="Fungemia">Fungemia</a></li>

<li><a href="Stress_hyperglycemia" title="Stress hyperglycemia">Stress hyperglycemia</a></li>

<li><a href="Stress_ulcer" title="Stress ulcer">Stress ulcer</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Iatrogenesis" title="Iatrogenesis">Iatrogenesis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Methicillin-resistant_Staphylococcus_aureus" title="Methicillin-resistant Staphylococcus aureus">Methicillin-resistant <i>Staphylococcus aureus</i></a></li>

<li><a href="Oxygen_toxicity" title="Oxygen toxicity">Oxygen toxicity</a></li>

<li><a href="Refeeding_syndrome" title="Refeeding syndrome">Refeeding syndrome</a></li>

<li><a href="Ventilator-associated_lung_injury" title="Ventilator-associated lung injury">Ventilator-associated lung injury</a></li>

<li><a href="Ventilator-associated_pneumonia" title="Ventilator-associated pneumonia">Ventilator-associated pneumonia</a></li>

<li><a href="Hemodialysis#Complications" title="Hemodialysis">Dialytrauma</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Diagnosis</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Arterial_blood_gas_test" title="Arterial blood gas test">Arterial blood gas</a></li>

<li><a href="Catheter" title="Catheter">Catheter</a>

<ul><li><a href="Arterial_line" title="Arterial line">Arterial line</a></li>

<li><a href="Central_venous_catheter" title="Central venous catheter">Central venous catheter</a></li>

<li><a href="Pulmonary_artery_catheter" title="Pulmonary artery catheter">Pulmonary artery catheter</a></li></ul></li>

<li><a href="Blood_culture" title="Blood culture">Blood cultures</a></li>

<li><a href="Screening_cultures" title="Screening cultures">Screening cultures</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Life_support" title="Life support">Life-supporting treatments</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Airway_management" title="Airway management">Airway management</a> and <a href="Mechanical_ventilation" title="Mechanical ventilation">mechanical ventilation</a>

<ul><li><a href="Tracheal_intubation" title="Tracheal intubation">Tracheal intubation</a></li></ul></li>

<li>Cardiac devices

<ul><li><a href="Intra-aortic_balloon_pump" title="Intra-aortic balloon pump">Intra-aortic balloon pump</a></li>

<li><a href="Ventricular_assist_device" title="Ventricular assist device">Ventricular assist device</a></li></ul></li>

<li><a href="Chest_tube" title="Chest tube">Chest tube</a></li>

<li><a href="Kidney_dialysis" title="Kidney dialysis">Kidney dialysis</a></li>

<li><a href="Early_goal-directed_therapy" title="Early goal-directed therapy">Early goal-directed therapy</a></li>

<li><a href="Induced_coma" title="Induced coma">Induced coma</a></li>

<li>Nutritional supplementation

<ul><li><a href="Feeding_tube" title="Feeding tube">Enteral feeding</a></li>

<li><a href="Parenteral_nutrition" title="Parenteral nutrition">Total parenteral nutrition</a></li></ul></li>

<li><a href="Targeted_temperature_management" title="Targeted temperature management">Therapeutic hypothermia</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Drugs</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Analgesic" title="Analgesic">Analgesics</a></li>

<li><a href="Antibiotic" title="Antibiotic">Antibiotics</a></li>

<li><a href="Antithrombotic" title="Antithrombotic">Antithrombotics</a></li>

<li><a href="Inotrope" title="Inotrope">Inotropes</a></li>

<li><a href="Intravenous_therapy" title="Intravenous therapy">Intravenous fluids</a></li>

<li><a href="Neuromuscular-blocking_drug" title="Neuromuscular-blocking drug">Neuromuscular-blocking drugs</a></li>

<li><a href="Drotrecogin_alfa" title="Drotrecogin alfa">Recombinant activated protein C</a></li>

<li><a href="Sedative" title="Sedative">Sedatives</a></li>

<li><a href="Stress_ulcer_prevention" class="mw-redirect" title="Stress ulcer prevention">Stress ulcer prevention</a> drugs</li>

<li><a href="Antihypotensive_agent" class="mw-redirect" title="Antihypotensive agent">Vasopressors</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Medical_scoring" title="Medical scoring">ICU scoring systems</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="APACHE_II" title="APACHE II">APACHE II</a></li>

<li><a href="Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale</a></li>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Physiology</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Hemodynamics" title="Hemodynamics">Hemodynamics</a></li>

<li><a href="Hypotension" title="Hypotension">Hypotension</a></li>

<li><a href="Altered_level_of_consciousness" title="Altered level of consciousness">Level of consciousness</a></li>

<li><a href="Acid%E2%80%93base_disorder" title="Acid–base disorder">Acid–base imbalance</a></li>

<li><a href="Electrolyte_imbalance" title="Electrolyte imbalance">Water-electrolyte imbalance</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organisations</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Society_of_Critical_Care_Medicine" title="Society of Critical Care Medicine">Society of Critical Care Medicine</a></li>

<li><a href="Surviving_Sepsis_Campaign" title="Surviving Sepsis Campaign">Surviving Sepsis Campaign</a></li>

<li>European Society of Paediatric and Neonatal Intensive Care</li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related specialties</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Anesthesiology" title="Anesthesiology">Anesthesiology</a></li>

<li><a href="Internal_medicine" title="Internal medicine">Internal medicine</a>

<ul><li><a href="Cardiology" title="Cardiology">Cardiology</a></li>

<li><a href="Neurology" title="Neurology">Neurology</a></li>

<li><a href="Pulmonology" title="Pulmonology">Pulmonology</a></li></ul></li>

<li><a href="Pediatrics" title="Pediatrics">Pediatrics</a></li>

<li><a href="Surgery" title="Surgery">Surgery</a></li>

<li><a href="Traumatology" title="Traumatology">Traumatology</a></li></ul>

</div></td></tr></tbody></table></div>

<div class="navbox-styles"></div><div role="navigation" class="navbox" aria-labelledby="Signs_and_symptoms_relating_to_the_circulatory_system180" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Signs_and_symptoms_relating_to_the_circulatory_system180" style="font-size:114%;margin:0 4em"><a href="Signs_and_symptoms" title="Signs and symptoms">Signs and symptoms</a> relating to the <a href="Circulatory_system" title="Circulatory system">circulatory system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Chest_pain" title="Chest pain">Chest pain</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Referred_pain" title="Referred pain">Referred pain</a></li>

<li><a href="Angina" title="Angina">Angina</a>

<ul><li><a href="Levine's_sign" title="Levine's sign">Levine's sign</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Auscultation" title="Auscultation">Auscultation</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Heart_sounds" title="Heart sounds">Heart sounds</a>

<ul><li><a href="Split_S2" title="Split S2">Split S2</a></li>

<li><a href="Gallop_rhythm" title="Gallop rhythm">Gallop rhythm</a></li></ul></li>

<li><a href="Heart_murmur" title="Heart murmur">Heart murmur</a>

<ul><li><a href="Systolic_heart_murmur" title="Systolic heart murmur">Systolic</a>

<ul><li><a href="Functional_murmur" title="Functional murmur">Functional murmur</a></li>

<li><a href="Still's_murmur" title="Still's murmur">Still's murmur</a></li></ul></li>

<li><a href="Diastolic_heart_murmur" title="Diastolic heart murmur">Diastolic</a>

<ul><li><a href="Pulmonary_insufficiency" class="mw-redirect" title="Pulmonary insufficiency">Pulmonary insufficiency</a></li>

<li><a href="Graham_Steell_murmur" title="Graham Steell murmur">Graham Steell murmur</a></li></ul></li>

<li><a href="Continuous_murmurs" title="Continuous murmurs">Continuous</a></li>

<li><a href="Carey_Coombs_murmur" title="Carey Coombs murmur">Carey Coombs murmur</a></li>

<li><i><a href="Mitral_insufficiency" class="mw-redirect" title="Mitral insufficiency">Mitral insufficiency</a></i>

<ul><li><a href="Presystolic_murmur" title="Presystolic murmur">Presystolic murmur</a></li></ul></li></ul></li>

<li><a href="Pericardial_friction_rub" title="Pericardial friction rub">Pericardial friction rub</a></li>

<li><a href="Heart_click" title="Heart click">Heart click</a></li>

<li><a href="Bruit" title="Bruit">Bruit</a>

<ul><li><a href="Carotid_bruit" title="Carotid bruit">carotid</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Pulse" title="Pulse">Pulse</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Tachycardia" title="Tachycardia">Tachycardia</a></li>

<li><a href="Bradycardia" title="Bradycardia">Bradycardia</a></li>

<li><a href="Pulsus_paradoxus" title="Pulsus paradoxus">Pulsus paradoxus</a></li>

<li><i>doubled</i>

<ul><li><a href="Pulsus_bisferiens" title="Pulsus bisferiens">Pulsus bisferiens</a></li>

<li><a href="Pulsus_bigeminus" class="mw-redirect" title="Pulsus bigeminus">Pulsus bigeminus</a></li></ul></li>

<li><a href="Pulsus_alternans" title="Pulsus alternans">Pulsus alternans</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Palpitations" title="Palpitations">Palpitations</a>

<li><a href="C%C5%93ur_en_sabot" title="Cœur en sabot">Cœur en sabot</a></li>

<li><a href="Jugular_venous_pressure" title="Jugular venous pressure">Jugular venous pressure</a>

<ul><li><a href="Cannon_A_waves" title="Cannon A waves">Cannon A waves</a></li></ul></li>

<li><a href="Hyperaemia" title="Hyperaemia">Hyperaemia</a></li>

</ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Shock_(circulatory)" title="Shock (circulatory)">Shock</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Cardiogenic_shock" title="Cardiogenic shock">Cardiogenic</a></li>

<li><a href="Obstructive_shock" title="Obstructive shock">Obstructive</a></li>

<li><a href="Hypovolemia" title="Hypovolemia">Hypovolemic</a></li>

<li>See further Template:Shock</li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">Aortic insufficiency</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Collapsing_pulse" title="Collapsing pulse">Collapsing pulse</a></li>

<li><a href="De_Musset's_sign" title="De Musset's sign">De Musset's sign</a></li>

<li><a href="Duroziez's_sign" title="Duroziez's sign">Duroziez's sign</a></li>

<li><a href="M%C3%BCller's_sign" title="Müller's sign">Müller's sign</a></li>

<li><a href="Austin_Flint_murmur" title="Austin Flint murmur">Austin Flint murmur</a></li>

<li><a href="Mayne's_sign" title="Mayne's sign">Mayne's sign</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other <a href="Endocardium" title="Endocardium">endocardium</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i><a href="Endocarditis" title="Endocarditis">endocarditis</a>:</i> <a href="Roth's_spot" title="Roth's spot">Roth's spot</a></li>

<li><a href="Janeway_lesion" title="Janeway lesion">Janeway lesion</a>/<a href="Osler's_node" title="Osler's node">Osler's node</a></li>

<li><a href="Bracht%E2%80%93Wachter_bodies" title="Bracht–Wachter bodies">Bracht–Wachter bodies</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Pericardium" title="Pericardium">Pericardium</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i><a href="Cardiac_tamponade" title="Cardiac tamponade">Cardiac tamponade</a>/<a href="Pericardial_effusion" title="Pericardial effusion">Pericardial effusion</a>:</i> <a href="Beck's_triad_(cardiology)" title="Beck's triad (cardiology)">Beck's triad</a></li>

<li><a href="Ewart's_sign" title="Ewart's sign">Ewart's sign</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i><a href="Rheumatic_fever" title="Rheumatic fever">rheumatic fever</a>:</i></li>

<li><a href="Anitschkow_cell" title="Anitschkow cell">Anitschkow cell</a></li>

<li><a href="Aschoff_body" title="Aschoff body">Aschoff body</a></li>

<li><a href="Gallavardin_phenomenon" title="Gallavardin phenomenon">Gallavardin phenomenon</a></li></ul>

</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Vascular_disease" title="Vascular disease">Vascular disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Artery" title="Artery">Arterial</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><i><a href="Aortic_aneurysm" title="Aortic aneurysm">aortic aneurysm</a></i>

<ul><li><a href="Cardarelli's_sign" title="Cardarelli's sign">Cardarelli's sign</a></li>

<li><a href="Oliver's_sign" title="Oliver's sign">Oliver's sign</a></li></ul></li>

<li><i><a href="Pulmonary_embolism" title="Pulmonary embolism">pulmonary embolism</a></i>

<ul><li><a href="Right_heart_strain" title="Right heart strain">Right heart strain</a></li></ul></li>

<li><i><a href="Radial_artery" title="Radial artery">radial artery sufficiency</a></i>

<ul><li><a href="Allen's_test" title="Allen's test">Allen's test</a></li></ul></li>

<li><i><a href="Pseudohypertension" title="Pseudohypertension">pseudohypertension</a></i></li>

<li><i><a href="Thrombus" title="Thrombus">thrombus</a></i>

<ul><li><a href="Lines_of_Zahn" title="Lines of Zahn">Lines of Zahn</a></li></ul></li>

<li><a href="Adson's_sign" title="Adson's sign">Adson's sign</a></li>

<li><i><a href="Arteriovenous_fistula" title="Arteriovenous fistula">arteriovenous fistula</a></i>

<ul><li><a href="Nicoladoni%E2%80%93Branham_sign" title="Nicoladoni–Branham sign">Nicoladoni–Branham sign</a></li></ul></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Vein" title="Vein">Venous</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Friedreich's_sign" title="Friedreich's sign">Friedreich's sign</a></li>

<li><a href="Caput_medusae" title="Caput medusae">Caput medusae</a></li>

<li><a href="Kussmaul's_sign" title="Kussmaul's sign">Kussmaul's sign</a></li>

<li><a href="Trendelenburg_test" title="Trendelenburg test">Trendelenburg test</a></li>

<li><i><a href="Superior_vena_cava_syndrome" title="Superior vena cava syndrome">superior vena cava syndrome</a></i>

<ul><li><a href="Pemberton's_sign" title="Pemberton's sign">Pemberton's sign</a></li></ul></li></ul>

</div></td></tr></tbody></table><div></div></td></tr></tbody></table></div></div><div><div class="zim-footer">

This article is issued from <a class="external text" title="Last edited on 2024-08-13" href="https://en.wikipedia.org/wiki/?title=Distributive_shock&oldid=1240035319">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

</div>

</div></div>

</div>

</main>

</div>

</body></html>