Endotoxin Shock

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Abstract
Endotoxin shock is a state of peripheral vascular collapse caused by a lipo-carbohydrate-protein complex found in gram-negative bacteria, especially in the coliform group. Infections caused by Escherichia coli, Aerobacter aerogenes and Proteus organisms are the most common cause. The most serious complication is renal failure, and the mortality rate is over 70%. Experimental studies in dogs and monkeys have been directed along two main lines. First, in what way does endotoxin initiate shock? Second, how can endotoxin be reversed? Endotoxin is mediated through a heat-labile factor in blood, possibly complement, with the liberation of vasoactive substances, especially histamine, and also epinephrine, norepinephrine and serotonin. Vasoconstriction and vasodilation result with the pooling and stagnation of blood, and a reduced cardiac output. The primary difficulty is the deficient perfusion of tissues and organs with oxygenated blood. Experimental endotoxin shock can be reversed with a combination of adrenocortical steroids and pressor drugs. Aldos-terone and angiotensin II were particularly effective in the dog and in the monkey, and on this basis a trial in man is warranted.