Shock in children results from varied causes, hypovolemic and septic shock being the most common causes. Pediatric septic shock results due to inflammatory response to a focus of infection. In sepsis, there is release of various cytokines which results in increased capillary permeability and myocardial dysfunction. The early manifestations of shock in children include tachycardia, cold peripheries, prolonged CFT, narrow pulse pressure and late signs include altered mental status and hypotension. Early recognition of shock and early interventions are associated with favourable outcomes.

Metabolic supplementation refers to a therapeutic strategy aimed at correcting the underlying metabolic derangements that occur during critical illness, particularly in conditions such as sepsis, septic shock, multi-organ dysfunction, and acute kidney injury (AKI). During severe illness, multiple metabolic pathways become dysregulated, including impaired cellular energy production, mitochondrial dysfunction, oxidative stress, hormonal disturbances, and dysregulated immune responses. These disturbances can further perpetuate organ dysfunction, making targeted metabolic support an important adjunct to conventional resuscitation strategies. The cornerstone of metabolic resuscitation involves the administration of key micronutrients and metabolic cofactors that support mitochondrial function, reduce oxidative stress, and modulate inflammation. One of the most studied regimens is the combination of intravenous Vitamin C, hydrocortisone, and thiamine. Vitamin C acts as a potent antioxidant and cofactor for catecholamine synthesis; thiamine supports mitochondrial oxidative metabolism and prevents lactic acidosis; while hydrocortisone helps restore vascular responsiveness and modulate the exaggerated inflammatory response.