Which combination of signs is most indicative of septic shock in a child?

• A. Normal mental status and warm extremities.
• B. Altered mental status and cool extremities.
• C. Severe dehydration with normal capillary refill.
• D. Hyperactive reflexes.

Answer: (B)

In septic shock for a child, the key issue is poor perfusion of the body's tissues. When perfusion drops, the brain can be deprived of blood flow, causing altered mental status, and the skin and extremities often become cool due to peripheral vasoconstriction. So, altered mental status together with cool extremities best signals septic shock in a pediatric patient because they reflect both brain and peripheral perfusion being compromised.

Normal mental status with warm extremities would suggest that perfusion is still adequate, not shock. Severe dehydration with normal capillary refill can occur but does not by itself indicate septic shock with poor perfusion. Hyperactive reflexes aren’t a typical sign of septic shock.