Pathogenesis:

• These toxins are normally present in intestines and intestinal mucosa provides efficient barriers and prevents toxin gets absorbed in circulation.
• Small quantities are absorbed into blood which are removed by liver.
• Endotoxemia results when liver starts failing and when mucosal barrier of intestine gets disrupted due to ischemia, necrosis, trauma, ionizing radiation, bacterial overgrowth or inflammatory disease.
• Toxins escaped from intestine gets access to peritoneum and gets access to blood stream and toxins appears in peripheral blood.

Endotoxemia also occurs when gram-ve bacteria containing LPS gains access into tissue /blood. Most of these organism liberate endotoxin during their proliferation and gains access to blood from primary foci of systemic or superficial tissue infections.