THE SYNDROME of extreme hypotension, prostration with mental alertness, bluish pallor, and quiet death first was described as being associated with bacteremia due to gram-negative bacilli in 1951.1 The pathologic physiology of this syndrome remains unknown in spite of the many reports that have been published regarding it since 1951.2-5 In this study autopsies of patients who died with the classic clinical and laboratory findings of shock associated with bacteremia due to gram-negative bacteria were reviewed to determine if they would reveal any information that would help delineate pathogenesis.
In addition, the findings in these human autopsies were compared with those reported in dogs injected with a lethal dose of endotoxin to try to find evidence for the commonly made assumption that gram-negative shock in humans is similar to endotoxin shock in dogs.5-12
Materials and Methods
The hospital records of 230 patients with blood cultures positive for