Toxic shock syndrome should be considered in distributive shock. Consequent exposure to the same antigen results in the IgE-mediated release of histamine from mast cells and basophils, leading to systemic vasodilation and capillary fluid leak. These IgE molecules then attach to the surface of mast cells in the tissues and basophils in blood. In anaphylaxis, the patient typically has a history of previous exposure to an antigen, although this is not required, with resulting IgE formation to that antigen. These inflammatory cytokines can also cause some cardiac dysfunction, called septic cardiomyopathy, which can contribute to the shock state. Drug overdose or toxicity should always be considered, particularly potent vasodilators such as calcium channel blockers and hydralazine.ĭistributive shock as a result of sepsis occurs due to a dysregulated immune response to infection that leads to systemic cytokine release and resultant vasodilation and fluid leak from capillaries. Other less common causes of distributive shock include adrenal insufficiency and capillary leak syndrome. In cases of trauma, neurogenic shock should also be on the differential. The most common causes of distributive shock in the emergency department are sepsis and anaphylaxis.
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