225. The Sorcerer's Apprentice, part 1

Laney's first pregnancy was uncomplicated. At 26 and healthy her delivery should have been uncomplicated, and it was. Well, a little more than average bleeding, but no need for a transfusion.  For several days she didn't feel well ("must be the low blood count"), but on the fifth day postpartum, she came in to urgent care , having not been able to empty her bladder for several hours.  The bladder is stretched and pushed during labor, so not uncommon to experience urinary retention. A catheter was placed, more than a quart of urine drained, and she was told to return in three days for its removal--three days being enough to swelling and inflammation to subside and normal bladder function return.

On that day her mother called saying Laney was "hot" so she was told to go to urgent care. There her blood pressure was low, labs abnormal; sent to the ER thinking she was in septic shock.  At the ER, her blood pressure continued to drop, and blood oxygen levels were dangerously low. She was immediately intubated and given oxygen and "vasopressors"--medicines that keep the blood pressure up by causing blood vessels to constrict, thus promoting blood flow and oxygen to her brain and other vital organs.  

But what caused the blood vessels to dilate in the first place? Probably cytokines--small proteins released by bacteria or the overwhelmed immune system.

Consider the sorcerer's apprentice, who tasked with cleaning the dungeon, animated some brooms, mops and buckets to do his work. While he slept, the animated objects reproduced themselves and soon there was a stick army and a flood.

In septic shock, cytokines act as the apprentice's spell, causing blood vessels to dilate, which lowers the blood pressure, depriving vital organs of oxygen.