Septic shock and reaction to Rocephin/Ceftriaxone

[biscuitmama]

This morning we had a code blue on our nursing floor. A peds pt was just admitted from the ED with fever and emesis. MD ordered IV Rocephin/Ceftriaxone. Pt was alert, oriented, playing but as soon as the Cef was done infusing she dropped back in her bed, non responsive, pale pale pale, diaphoretic, fever 38.2, tachycardic, pulses thready, hypotensive, and unverifiable O2 sat bc the monitor couldn't pick anything up (occasionally, it would pick up and show >90%). Pt was ventilated with ambubag with good aeration in lungs. It didn't look like an anaphylactic reaction.

I overheard the MDs saying likely septic shock, and some interaction between the Cef and gram neg rods causing her reaction...? Pt was not given any abx down in the ED. Another nurse said they usu give them IV abx in ED and wait 45 mins to see if pts react to it, if they do then off to PICU, if not then to the nursing floor.

Does this sound familiar to anyone? Any idea what happened or can explain to me the pathophysiology?

Thanks!

[Guttercat, ASN, RN]

As someone mentioned, it's that outer membrane that causes trouble when the gm neg cell dies. Lipid A-- a component of the lipopolysaccharide (LPS) in the outer membrane-- is an endotoxin when released upon cell death.

As I understand it, these endotoxins are not in and of themselves "toxic," but rather they cause macrophages to release cytokines (interleukin-1, and Tumor Necrosis Factor). This is where the endotoxic shock comes in, as well as other complications, like DIC.

[intothecosmos]

I work in a pediatric hospital, and one of the most dangerous times for antibiotic therapy is anywhere up to an hour after the abx has been infused. When the bacteria dies, they release endotoxins into the blood stream which can cause a wide variety of symptoms that resemble septic shock. It can happen to anyone really, so you should always be careful and watch out for it if the person is receiving a loading dose of abx or has been really sick and now is getting IV abx.

[FranEMTnurse, CNA, LPN, EMT-I]

Great thread