Hypovolemic shock

Hypovolemic shock
Updated: 02/05/2024
© Jun Wang, MD, PhD

General features
  • Associated with rapid fluid loss
  • Hemorrhagic or extracellular fluid loss
  • Most common type of shock in children, usually associated with diarrhea in developing countries
  • Markedly reduced circulating volume
  • Inadequate tissue perfusion
Etiology
  • Bleeding: solid organ injury, aortic aneurysm rupture, GI bleeding, bleeding due to ectopic pregnancy, surgery, etc
  • Extracellular fluid loss
    • GI: Retractable vomiting, diarrhea especially profuse diarrhea such as cholera, external drainage via stoma or fistulas
    • Urinary: diuretic therapy, osmotic diuresis, salt wasting nephropathy, etc
    • Skin: sweating in hot and dry climate, esp with interrupted skin barrier
    • Third space sequestration: intestinal obstruction, pancreatitis, crush injuries, peritonitis, major vein obstruction
Pathogenesis

Clinical presentations
  • History of blood and/or extracellular fluid loss
  • Symptoms
    • Symptoms associated with injury/bleeding
    • Symptoms of shock
  • Physical examination
    • Cold clammy and cyanotic
    • Dry mucosa
    • Decreased skin turgor
    • Low jugular venous pressure
    • Tachycardia and hypotension
Laboratory findings
  • Decreased urinary output
  • Impaired renal function: elevated BUN, creatinine and BUN/creatinine ratio
  • Low urine sodium concentration
  • Abnormal serum Na and K, depending on etiology
  • Metabolic acidosis or alkalosis
Diagnosis
  • Clinical presentation
  • Low urine sodium concentration
  • Reduced central venous pressure
Management
  • Treatment of underlying cause
  • Fluid resuscitation
    • Blood products
    • 0.9% saline
    • Buffered crystalloid
    • Albumin, colloid solutions, etc
  • Correct electrolyte and acid-base imbalance


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