CRA79 MANAGEMENT OF SEPTIC SHOCK IN PNEUMONIA ASPIRATION OF STROKE PATIENT: A CASE REPORT

Herry Saputra Yunior¹, Irvan Medison¹, Dewi Wahyu Fitrina², Dessy Mizarti²

¹Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine,Andalas University, Padang West Sumatra, Indonesia
²Departement of Pulmonology and Respiratory Medicine, Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia

Introduction
Pneumonia aspiration is a common comorbid in stroke patients. Stroke raises pneumonia risk with risk factors including advanced age, male gender, impaired consciousness, dysphagia, and stroke severity.

Case Report
A 79-year-old male, former smoker, was referred with stroke and symptoms of shortness of breath, thick white sputum for 3 days, and fever for 1 week. He had dysarthria and dysphagia for 4 days. Lung examination revealed crackles, and chest X-ray showed bilateral infiltrates. Pneumonia treatment began with Ampicillin-Sulbactam and Levofloxacin. The patient's condition worsened with decreased consciousness, hypotension, and persistent fever. Blood gas analysis showed metabolic acidosis and elevated lactate. Lab tests revealed increased urea and creatinine, indicating kidney involvement. He was diagnosed with septic shock and managed with fluid resuscitation, antibiotics escalation, IV vasopressors, and hydrocortisone. He was recovered after 14 days of treatment.

Discussion
Pneumonia aspiration related to stroke develop into septic shock. It affects 5–26% of stroke cases, usually within the first 48 hours, and can increase mortality risk up to 49%. Stroke can trigger overactivation of the sympathetic nervous system, damaging alveolar membranes and leading to fluid buildup in the lungs. This creates a favorable environment for bacterial growth. The management based on surviving sepsis campaign that recommends fluid resuscitation, antibiotics, IV vasopressors, and steroid for managing septic shock.

Conclusion: Stroke significantly raises pneumonia risk, which can escalate into septic shock. Early diagnosis and aggressive treatment are essential to reduce mortality in such cases.

Keyword: Pneumonia, Stroke, Septic Shock