Shock is a biological response associated with hypotension and signs of altered tissue perfusion. Shock can be induced by many different mechanisms. Shock itself induces cytokine production as a result of disturbed microcirculation or ischemia-reperfusion injury. Alternatively, severe inflammatory conditions, such as sepsis and severe acute pancreatitis, are usually associated with prominent mediator production, which often leads to shock. TNF-alpha and IL-1 beta increase the vascular permeability, and nitric oxide reduces systemic vascular resistance. In the management of patients who have experienced clinical insult, we must consider the symptoms of systemic inflammatory response syndrome provoked by inflammatory mediators as a warning sign of the development of shock and organ dysfunction. Early withdrawal from SIRS and avoidance of infectious complications (second attack) should be attempted.