Sepsis remains a critical challenge in healthcare due to its high mortality rate and complex pathophysiology. Despite advancements in clinical care, early and accurate diagnosis and risk stratification remain difficult. Traditional biomarkers like CRP, PCT, and cytokines are insufficient for reliable diagnosis and prognosis. Metabolomics, which analyzes small molecules involved in cellular metabolism, offers a promising approach to identify molecular pathways affected by sepsis and septic shock. This review discusses the pathophysiology of sepsis, its clinical challenges, and the role of metabolomics in improving diagnosis, prognosis, and treatment. Sepsis is a systemic inflammatory response to infection, leading to organ dysfunction and shock. Early recognition and treatment are crucial, as delays in appropriate antimicrobial therapy increase mortality. Current treatments focus on maintaining homeostasis and preventing multi-organ failure. However, the lack of predictive parameters limits effective management. Metabolomics provides insights into metabolic changes associated with sepsis, such as altered glucose, fatty acid, and amino acid metabolism. Studies have identified potential biomarkers, including acetylcarnitine, 3-hydroxybutyrate, and various metabolites, which could aid in early diagnosis and prognosis. Metabolomics also helps in understanding treatment response and personalized medicine. Despite progress, challenges remain in standardizing biomarker definitions and improving clinical application. The integration of metabolomics with clinical data holds promise for better management of sepsis and septic shock.Sepsis remains a critical challenge in healthcare due to its high mortality rate and complex pathophysiology. Despite advancements in clinical care, early and accurate diagnosis and risk stratification remain difficult. Traditional biomarkers like CRP, PCT, and cytokines are insufficient for reliable diagnosis and prognosis. Metabolomics, which analyzes small molecules involved in cellular metabolism, offers a promising approach to identify molecular pathways affected by sepsis and septic shock. This review discusses the pathophysiology of sepsis, its clinical challenges, and the role of metabolomics in improving diagnosis, prognosis, and treatment. Sepsis is a systemic inflammatory response to infection, leading to organ dysfunction and shock. Early recognition and treatment are crucial, as delays in appropriate antimicrobial therapy increase mortality. Current treatments focus on maintaining homeostasis and preventing multi-organ failure. However, the lack of predictive parameters limits effective management. Metabolomics provides insights into metabolic changes associated with sepsis, such as altered glucose, fatty acid, and amino acid metabolism. Studies have identified potential biomarkers, including acetylcarnitine, 3-hydroxybutyrate, and various metabolites, which could aid in early diagnosis and prognosis. Metabolomics also helps in understanding treatment response and personalized medicine. Despite progress, challenges remain in standardizing biomarker definitions and improving clinical application. The integration of metabolomics with clinical data holds promise for better management of sepsis and septic shock.