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Sepsis and septic shock in children
In a child, septic shock is recognised early by tachycardia, slow capillary refill and altered consciousness — not by blood pressure, which falls late; treatment is antibiotics within one hour, boluses of 10–20 mL/kg with reassessment, and adrenaline or noradrenaline when shock does not respond to fluids.
Why it matters in the exam
The question describes a child with fever, tachycardia, cold hands, capillary refill over 2 seconds and drowsiness, sometimes with a purpuric rash (meningococcus). The distractors offer waiting for results, unlimited fluids or dopamine. The correct answer: IV or IO access, cultures without delay, broad-spectrum antibiotics within one hour, and fluid in small boluses with reassessment after each.
The 2024 (Phoenix) definitions replaced SIRS: sepsis is infection with a Phoenix score of 2 or more (respiratory, cardiovascular, coagulation and neurological), and septic shock is sepsis with at least one cardiovascular point — severe hypotension for age, lactate above 5 mmol/L or need for a vasoactive drug. Per Surviving Sepsis 2020, give antibiotics within one hour in shock, and within 3 hours after assessment in sepsis without shock.
For fluids, where intensive care is available, up to 40–60 mL/kg can be given in the first hour in boluses of 10–20 mL/kg, stopping when there are signs of fluid overload (enlarging liver, crackles); balanced solutions are preferred. The first vasoactive drug is adrenaline or noradrenaline — not dopamine — and it can be started through a peripheral vein. In refractory shock consider hydrocortisone. When toxic shock syndrome is suspected add clindamycin.
Key points
- Early recognition by tachycardia, capillary refill and consciousness.
- Antibiotics within one hour in septic shock.
- Boluses of 10–20 mL/kg with reassessment.
- Adrenaline or noradrenaline as first-line vasoactive.
- Phoenix 2024: sepsis = infection with a score of 2 or more.
Summary table
| Topic | What to remember | Numbers | Trap |
|---|---|---|---|
| Recognition | Tachycardia, slow capillary refill, altered consciousness, cold or warm extremities | Capillary refill over 2 seconds | Normal blood pressure does not exclude shock |
| Definition (Phoenix 2024) | Sepsis = infection with a score of 2 or more; shock = sepsis with a cardiovascular point | Lactate above 5 mmol/L, severe hypotension, vasoactive drug | SIRS is no longer the definition |
| Antibiotics | Broad-spectrum by age and source | Within one hour in shock; within 3 hours in sepsis without shock | Do not delay for cultures or lumbar puncture |
| Fluids | Balanced solution or saline in boluses | 10–20 mL/kg per bolus, to a total of 40–60 mL/kg during hour one | Stop at signs of fluid overload |
| Vasoactive | Adrenaline or noradrenaline | Can be given peripherally | Not dopamine first-line |
| Refractory shock | Consider hydrocortisone; toxic shock syndrome | Clindamycin to reduce toxin | Look for a focus that needs drainage |
In the full version for subscribers
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Sources
- Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children, 2020 — Antimicrobials, fluids and vasoactive agents
- International Consensus Criteria for Pediatric Sepsis and Septic Shock (Phoenix criteria), 2024 — Phoenix Sepsis Score
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Septic Shock
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.