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


Back to shock
Back to contents

Comments

Post a Comment

Popular posts from this blog

Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas...
Read more

Anemia

Anemia Updated: 07/13/2024 © Jun Wang, MD, PhD   General features Decrease in red cell mass Hemoglobin: Levels of hemoglobin in a specific volume of whole blood Hematocrit: Fraction of whole blood composed of red blood cells Red cell count: Quantity of red cell in a specific volume of whole blood Three major groups based on RBC sizes Microcytic Normocytic Macrocytic Three major causes Blood loss: acute or chronic Increased red cell destruction: hemolysis Reduced production: marrow failure due to genetic abnormality or nutritional deficiency Etiology Genetic abnormality Hemoglobinopathies RBC cytoskeletal abomorlities Enzyme abnormalities Fanconi anemia Nutritional deficiencies: iron, VB12, folate, general malnutrition Physical etiologies: trauma, burns, frostbite, prosthetic valves, etc Chronic diseases: chronic infections, neoplasia, autoimmune disorders, kidney or liver diseases, etc Infectious diseases: hepatitis, sepsis , malaria, e...
Read more

Lymphoid neoplasms

Lymphocytic neoplasms Updated: 05/17/2020 © Jun Wang, MD, PhD Terminology Lymphoma : Proliferations forming discrete tissue masses Leukemia : Widespread involvement of the bone marrow and usually the peripheral blood Any "lymphoma" can present with or evolve to a leukemic picture, and any "leukemia" can occasionally present with a mass lesion Other hematology terms Important risk factors Immunodeficiency (primary or secondary) Autoimmune disorders Viruses (HIV, KSHV/HHV8, HTLV-1) H. pylori infection Radiation Chemotherapy Diagnostic approaches Complete history, especially those with possible epidemic characters, such as Burkitt lymphoma CBC, Bone marrow Morphology/immunohistochemistry Immunofluorescence flow cytometry Cytogenetic studies Molecular studies Commonly used markers All lymphomas: CD45 B-cell neoplasms: CD5, CD10, CD19, CD20, CD79a, CD23, bcl2, bcl6, cyclin D1, light chai...
Read more