<P> Should the cause of the crisis not be successfully treated, the shock will proceed to the progressive stage and the compensatory mechanisms begin to fail . Due to the decreased perfusion of the cells, sodium ions build up within while potassium ions leak out . As anaerobic metabolism continues, increasing the body's metabolic acidosis, the arteriolar smooth muscle and precapillary sphincters relax such that blood remains in the capillaries . Due to this, the hydrostatic pressure will increase and, combined with histamine release, this will lead to leakage of fluid and protein into the surrounding tissues . As this fluid is lost, the blood concentration and viscosity increase, causing sludging of the micro-circulation . The prolonged vasoconstriction will also cause the vital organs to be compromised due to reduced perfusion . If the bowel becomes sufficiently ischemic, bacteria may enter the blood stream, resulting in the increased complication of endotoxic shock . </P> <P> At this stage, the vital organs have failed and the shock can no longer be reversed . Brain damage and cell death are occurring, and death will occur imminently . One of the primary reasons that shock is irreversible at this point is that much cellular ATP has been degraded into adenosine in the absence of oxygen as an electron receptor in the mitochondrial matrix . Adenosine easily perfuses out of cellular membranes into extracellular fluid, furthering capillary vasodilation, and then is transformed into uric acid . Because cells can only produce adenosine at a rate of about 2% of the cell's total need per hour, even restoring oxygen is futile at this point because there is no adenosine to phosphorylate into ATP . </P> <P> The first change seen in shock is an increased cardiac output followed by a decrease in mixed venous oxygen saturation (SmvO2) as measured in the pulmonary artery via a pulmonary artery catheter . Central venous oxygen saturation (ScvO2) as measured via a central line correlates well with SmvO2 and are easier to acquire . If shock progresses anaerobic metabolism will begin to occur with an increased blood lactic acid as the result . While many laboratory tests are typically performed there is no test that either makes or excludes the diagnosis . A chest X-ray or emergency department ultrasound may be useful to determine volume state . </P> <P> The best evidence exists for the treatment of septic shock in adults and as the pathophysiology appears similar in children and other types of shock treatment this has been extrapolated to these areas . Management may include securing the airway via intubation if necessary to decrease the work of breathing and for guarding against respiratory arrest . Oxygen supplementation, intravenous fluids, passive leg raising (not Trendelenburg position) should be started and blood transfusions added if blood loss is severe . It is important to keep the person warm as well as adequately manage pain and anxiety as these can increase oxygen consumption . </P>

What is the common end result in all shock states