Hypovolemic Shock

What Is Hypovolemic Shock?

Hypovolemic shock, also known as hemorrhagic shock, is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure. This condition requires immediate emergency medical attention.

What Causes Hypovolemic Shock?

Hypovolemic shock results from significant and sudden blood or fluid losses within your body. Blood loss of this magnitude can occur because of: 

  • bleeding from cuts or wounds
  • bleeding from blunt traumatic injuries due to accidents or seizure activity
  • internal bleeding from the digestive tract or due to a ruptured ectopic pregnancy 

In addition to actual blood loss, the loss of body fluids can cause a decrease in blood volume. This can occur in cases of:

  • excessive or prolonged diarrhea
  • severe burns
  • protracted and excessive vomiting
  • excessive sweating

When heavy bleeding occurs, there isn’t enough blood flow to the organs in your body. Blood carries oxygen and other essential substances to your organs and tissues. When your body loses these substances faster than it can replace them, organs in your body begin to shut down. As your heart shuts down and fails to circulate enough blood through your body, the symptoms of shock occur. Blood pressure plummets and there’s a severe drop in body temperature, which can be life-threatening.

What Are the Symptoms of Hypovolemic Shock?

The symptoms of hypovolemic shock vary with the severity of the fluid or blood loss. However, all symptoms of shock are life-threatening and need emergency medical treatment. Internal bleeding symptoms may be hard to recognize until the symptoms of shock appear, but external bleeding will be visible. Symptoms of hemorrhagic shock may not appear immediately. Older adults may not experience these symptoms until the shock progresses significantly.

Symptoms include:

  • anxiety
  • blue lips and fingernails
  • low or no urine output
  • profuse sweating
  • shallow breathing
  • dizziness
  • lightheadedness
  • confusion
  • chest pain
  • loss of consciousness
  • low blood pressure
  • rapid heart rate
  • weak pulse 

The sign of external hemorrhaging is bleeding profusely at the site of injury. 

Signs of internal hemorrhaging include:

  • abdominal pain
  • blood in the stool
  • black, tarry stool (melena)
  • blood in the urine
  • vaginal bleeding (heavy, usually outside of normal menstruation)
  • vomiting blood
  • chest pain
  • abdominal swelling

If you have any signs of hemorrhaging or of hemorrhagic shock, seek medical attention immediately. Have someone drive you to the hospital or call 911. Don’t drive to the hospital on your own if you’re bleeding profusely or if you have any symptoms of shock.

Emergency Care and First Aid

Untreated hypovolemic shock will lead to death. Hypovolemic shock is a medical emergency. Call 911 immediately if you observe a person experiencing shock symptoms. Until responders arrive:

  • Have the person lie flat with their feet elevated about 12 inches.
  • Refrain from moving the person if you suspect a head, neck, or back injury.
  • Keep the person warm.
  • Refrain from giving the person fluids by mouth because of the risk of choking.

Don’t elevate their head. Remove any visible dirt or debris from the injury site. Do not remove embedded glass, a knife, stick, arrow, or any other object stuck in the wound. If the area is clear of debris and no visible object protrudes from it, tie fabric, such as a shirt, towel, or blanket, around the site of injury to minimize blood loss. Apply pressure to the area. If you can, tie or tape the fabric to the injury.

What Complications Are Associated with Hypovolemic Shock?

A lack of blood and fluid in your body can lead to the following complications:

  • damage to organs such as your kidney or brain
  • gangrene of the arms or legs
  • heart attack

The effects of hypovolemic shock depend on the speed at which you’re losing blood or fluids and the amount of blood or fluids you are losing. The extent of your injuries can also determine your chances for survival. If you have chronic medical conditions such as diabetes or heart, lung, or kidney disease, these conditions can increase the likelihood you’ll experience more complications from hypovolemic shock.

How Is Hypovolemic Shock Diagnosed?

There are often no advance warnings of shock. Instead, symptoms tend to arise only when you’re already in the throes of the condition. A physical examination can reveal signs of shock, such as low blood pressure and rapid heartbeat. A person experiencing shock may also be less responsive when asked questions by the emergency room doctor.

Heavy bleeding is immediately recognizable, but internal bleeding sometimes isn’t found until you show signs of hemorrhagic shock. 

In addition to physical symptoms, your doctor may use a variety of testing methods to confirm you’re experiencing hypovolemic shock. These include:

  • blood testing to check for electrolyte imbalances and kidney function
  • computerized tomography (CT) scan or ultrasound to visualize body organs
  • echocardiogram to measure heart rhythm
  • endoscopy to examine the esophagus and other gastrointestinal organs
  • right heart catheterization to check how blood is circulating
  • urinary catheterization to measure the amount of urine in the bladder 

Your doctor may order other tests based on your symptoms.

How Is Hypovolemic Shock Treated?

Once at a hospital, a person suspected of having hypovolemic shock will receive fluids or blood products via an intravenous line. Doctors may also administer medications that increase the heart’s pumping strength. These include:

  • dopamine
  • dobutamine
  • epinephrine
  • norepinephrine 

Close cardiac monitoring, as well as monitoring your kidney function, will determine the effectiveness of the treatment you receive.

Long-Term Outlook

Common complications of hemorrhagic shock include: 

  • kidney damage
  • other organ damage
  • death

Some people may also develop gangrene due to decreased circulation to the limbs. This infection may lead to amputation of the affected limbs. 

Overall, your outlook will depend on the amount of blood you lost and the type of injury you sustained. The outlook is best in healthy patients who haven’t had severe blood loss. 

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