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Hypovolemic Shock – Symptoms, Causes, Treatment

What Is Hypovolemic Shock?

One of the leading causes of death is due to hypovolemic shock. From the name itself, you can already tell that this has something to with blood and fluid volume. Hypovolemic shock is actually a result of blood and fluid loss brought about by several circumstances such as massive bleeding during surgery. One may be diagnosed to have suffered from a hypovolemic shock when the total blood loss is about 10 percent or more of the total blood volume. The severe blood loss would cause the major organs of the body to just shutdown and eventually leading to death. Just like the other types of shock, hypovolemic shock is always considered to be an emergency condition because this may signify an impending death. Prompt intensive medical attention is always necessary when dealing with hypovolemic shock because failure to do so would result to a cascade of lethal events. Among all the organs, it is the heart that is initially affected with hypovolemic shock. You’ll further understand this condition as you read the remaining of this article.


Hypovolemic shock can actually be classified into four stages. The staging process is otherwise known as tennis because just like in a tennis match, the scores may be equivalent to the percentage of blood volume loss in each stage: 15, 15-30, 30-40, 40, respectively.

  • Stage I– The amount of blood loss is less than 15% (750ml).
  • Stage II– The amount of blood loss is around 15-30% (750-1500ml).
  • Stage I– The amount of blood loss is around 30-40% (1500-2000ml).
  • Stage I– The amount of blood loss is greater than 40% (2000ml or greater).

Each stage may be characterized by the progression of the common symptoms which may accompany hypovolemic shock.

Hypovolemic Shock Symptoms

It is very crucial that you acquaint yourself with the common signs and symptoms of an impending hypovolemic shock. The manifestations of hypovolemis shock are hugely different between children and adults. Hypotension or low blood pressure would automatically manifest in older adults soon as there is active blood loss. The manifestations of hypovolemia in children are somewhat different because despite the blood loss, their blood pressure reading would still be normal as a form of compensation. However, when children begin to decompensate from hypovolemic shock, their blood pressure would drop down almost immediately. This is something to be really alert about. Signs of active bleeding should also be immediately detected so as to prevent further blood loss. Due to decreased circulating blood in the body, the following symptoms are to be expected:

  • Changes in sensorium- This may include anxiety, confusion, disorientation and in severe cases, coma may result)
  • Hyperventilation and difficulty breathing
  • Cold, clammy skin
  • Scanty or no urine output at all- This is primarily due to poor blood perfusion to the different organs especially towards the kidneys.
  • Pallor (Pale skin)
  • Palpitations
  • Profuse sweating

Hypovolemic Shock Causes

There can be several possible causes for the development of hypovolemic shock. This may not only pertain to blood loss but the loss of other body fluids as well. Among the common causes of hypovolemic shock are the following:

  • Dehydration (especially when one suffers from diarrhea)
  • Burns
  • Bleeding (especially during surgery or when there’s a rupture of an ovarian cyst in Polycystic Ovarian Syndrome or PCOS)
  • Medications- There are drugs that would lead to hypovolemic shock especially when they are not appropriately used. Among the medications which may cause hypovolemic shock are vasodilators. Hypertensive individuals who take vasodilators are at risk for developing hypovolemic shock.

There’s no strong evidence that profuse sweating and excessive alcohol intake would both lead to hypovolemic shock. Donating blood cannot also be pointed out as another reason for hypovolemic shock though this may be a contributing factor.

Diagnosis

Hypovolemic shock can be diagnosed by basing on its symptoms alone. However, there are also other tests that would help confirm hypovolemic shock, including:

  • ABG – The arterial blood gas (ABG) result of an individual who has hypovolemic shock would reveal both respiratory and metabolic acidosis.
  • X-ray – Imaging studies like x-ray would be suggestive of lung collapse (atelectasis). Lesions may also be detected on the lungs.
  • CBC – The hematocrit levels are likely to increase due to decreased blood volume.

Hypovolemic Shock Treatment

Various treatment modalities are involved in managing patients with hypovolemic shock. The treatment would usually vary from one individual to another. Some of the factors that must be considered in treating hypovolemic shock are the age of the patient, weight and as well as the severity of blood and fluid loss. Minor forms of fluid loss such as those which are caused by blood donation may only require complete rest and including protein-rich foods in their diet.

Oxygen administration

Soon as the patient arrives at the emergency department, oxygen must be administered immediately so as to establish a patent airway and help deliver oxygen to the different parts of the body.

Fluid replacement

This therapy is essential in the management of hypovolemic shock. Blood and fluid transfusion may be needed for stage 2 hypovolemic shock and are critical for stages 3 and 4.

Medications

Certain medications like dobutamine, dopamine and epinephrine are also needed in helping improve the blood pressure of the patient. Antisecretory agents such as somatostatin and octreotide which both have a constrictive property may also help reverse the effect of hypovolemic shock by constrict the blood vessels.

Most of all, it is very critical to treat the underlying cause of the hypovolemic shock. The presence of bleeding, especially an active one, should be effectively controlled.

Prognosis

Most hypovolemic shock cases are considered to be a serious one. However, the rate of recovery would also very due to several factors which include the amount of blood loss and the presence of an underlying condition that would hamper the body’s capacity to compensate blood loss.

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