pediatric patients with septic shock

All patients admitted at Paediatric Intensive care unit (PICU) during the period of the study and met the inclusion criteria.~* Sex: Both males and females.~* Age: 1 month to 16 years.~* Sample size: 50 patients with septic shock admitted at PICU. All patients included in the study will be evaluated clinically and radiologically at fluid resuscitative phase of septic shock after fluid resuscitation.~This evaluation will include:~• Clinical examination:~Clinical evaluation will be done initially and after fluid resuscitation:~* Vital data (systolic, diastolic, and mean blood pressure, heart rate, Temperature).~* Urine output, capillary perfusion time, Central venous pressure (CVP).~* Detailed physical examination • Investigations:~A) Laboratory:~* Complete blood count.~* Venous blood gases.~* C-reactive protein.~* Kidney function tests.~* Albumin.~* Serum lactate. -Echocardiography (measurement of stroke volume, stroke volume index,cardiac index) \_carotid doppler ultrasonography