Hypovolemic shock

  • Definition
    • Hypovolemic shock is an emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

  • Alternative Names
    • Shock - hypovolemic

  • Causes
    • Losing about a fifth or more of the normal amount of blood in your body causes hypovolemic shock.

      Blood loss can be due to:

      • Bleeding from cuts
      • Bleeding from other injuries
      • Internal bleeding, such as in the gastrointestinal tract

      The amount of circulating blood in your body may drop when you lose too many other body fluids. This can be due to:

      • Burns
      • Diarrhea
      • Excessive perspiration
      • Vomiting
  • Symptoms
  • Exams and Tests
    • A physical exam will show signs of shock, including:

      Tests that may be done include:

      • Blood chemistry, including kidney function tests and those tests looking for evidence of heart muscle damage
      • Complete blood count (CBC)
      • CT scan, ultrasound, or x-ray of suspected areas
      • Echocardiogram: sound wave test of heart structure and function
      • Endoscopy: tube placed in the mouth to the stomach (upper endoscopy) or colonoscopy (tube placed through the anus to the large bowel)
      • Right heart (Swan-Ganz) catheterization
      • Urinary catheterization (tube placed into the bladder to measure urine output)

      In some cases, other tests may be done as well.

  • Treatment
    • Get medical help right away. In the meantime, follow these steps:

      • Keep the person comfortable and warm (to avoid hypothermia).
      • Have the person lie flat with the feet lifted about 12 inches (30 centimeters) to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless they are in immediate danger.
      • Do not give fluids by mouth.
      • If person is having an allergic reaction, treat the allergic reaction, if you know how.
      • If the person must be carried, try to keep them flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury.

      The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood or blood products to be given.

      Medicines such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output).

  • Outlook (Prognosis)
    • Symptoms and outcomes can vary, depending on:

      • Amount of blood/fluid volume lost
      • Rate of blood /fluid loss
      • Illness or injury causing the loss
      • Underlying chronic medication conditions, such as diabetes and heart, lung, and kidney disease

      In general, people with milder degrees of shock tend to do better than those with more severe shock. Severe hypovolemic shock may lead to death, even with immediate medical attention. Older adults are more likely to have poor outcomes from shock.

  • Possible Complications
    • Complications may include:

      • Kidney damage
      • Brain damage
      • Gangrene of arms or legs, sometimes leading to amputation
      • Heart attack
      • Other organ damage
      • Death
  • When to Contact a Medical Professional
    • Hypovolemic shock is a medical emergency. Call the local emergency number (such as 911) or take the person to the emergency room.

  • Prevention
    • Preventing shock is easier than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock.

  • References
    • den Uil CA, Klijn E, Lagrand WK, et al. The microcirculation in health and critical disease. Prog Cardiovasc Dis. 2008;51:161-170. The microcirculation in health and critical disease. PMID: 18774014

      Groeneveld ABJ. Hypovolemic shock. In: Parrillo JE, Dellinger P, eds. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 26.

      Jones AE, Kline JA. Shock. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 6.

      Rivers E. Approach to the patient with shock. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 106.

      Tarrant AM, Ryan MF, Hamilton PA, Bejaminov O. A pictorial review of hypovolaemic shock in adults. Br J Radiol. 2008;81:252-257. PMID: 18180262