What Is Hypovolemic Shock?

Highlights
1. Hypovolemic shock requires immediate emergency medical attention.
2. This condition is also known as hemorrhagic shock.
3. It is a condition that occurs when you lose more than one-fifth of your bodys blood.
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 bodys 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.
Hypovolemic shock is the most common type of shock, with very young children and older
adults being the most susceptible.

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 serious cuts or wounds

bleeding from blunt traumatic injuries due to accidents

internal bleeding from abdominal organs or ruptured ectopic pregnancy

bleeding from the digestive tract

significant vaginal bleeding

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

Blood carries oxygen and other essential substances to your organs and tissues. When heavy
bleeding occurs, there is not enough blood in circulation for the heart to be an effective pump.
Once your body loses these substances faster than it can replace them, organs in your body begin
to shut down and the symptoms of shock occur. Blood pressure plummets, which can be lifethreatening.

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.
Some symptoms are more urgent than others.

Mild symptoms
Mild symptoms can include:

headache

fatigue

nausea

profuse sweating

dizziness

Severe symptoms
Severe symptoms, which must be taken seriously and warrant emergency medical attention,
include:

cold or clammy skin

pale skin

rapid, shallow breathing

rapid heart rate

little or no urine output

confusion

weakness

weak pulse

blue lips and fingernails

lightheadedness

loss of consciousness

The sign of external hemorrhaging is visible, profuse bleeding from a body site or area of injury.
Signs and symptoms of internal hemorrhaging include:

abdominal pain

blood in the stool

black, tarry stool (melena)

blood in the urine

vomiting blood

chest pain

abdominal swelling

While some symptoms like abdominal pain and sweating can point to something less urgent like
a stomach virus, you should seek immediate medical attention when seeing groupings of these
symptoms together. This is especially true for the more serious symptoms. The longer you wait,
the more damage can be done to your tissues and organs.

Hypovolemia Risk Factors

The risk factors of this disease include many conditions in which an individual is likely to lose
significant amounts of body fluids. These include:

Excessive bleeding

Sweating

Vomiting

Diarrhea

Donating blood

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 youre 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. Chronic medical conditions such as diabetes, previous stroke, heart,
lung, or kidney disease, or taking blood thinners like Coumadin or aspirin can increase the
likelihood that youll experience more complications from hypovolemic shock.
Part 6 of 9:

How is hypovolemic shock diagnosed?

There are often no advance warnings of shock. Instead, symptoms tend to arise only when youre
already experiencing 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 isnt found until
you show signs of hemorrhagic shock.
In addition to physical symptoms, your doctor may use a variety of testing methods to confirm
that youre experiencing hypovolemic shock. These include:

blood testing to check for electrolyte imbalances, kidney, and liver function

CT scan or ultrasound to visualize body organs

echocardiogram, an ultrasound of the heart

electrocardiogram to assess heart rhythm

endoscopy to examine the esophagus and other gastrointestinal organs

right heart catheterization to check how effectively the heart is pumping

urinary catheter 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, to replenish the blood lost and improve circulation. Treatment
revolves around controlling loss of fluid and blood, replacing whats been lost, and stabilizing
damage that both caused and resulted from the hypovolemic shock. This will also include
treating the injury or illness that caused the shock, if possible.
These include:

blood plasma transfusion

platelet transfusion

red blood cell transfusion

intravenous crystalloids

Doctors may also administer medications that increase the hearts pumping strength to improve
circulation and get blood where its needed. These include:

dopamine

dobutamine

epinephrine

norepinephrine

Antibiotics may be administered to prevent septic shock and bacterial infections.

Close cardiac monitoring will determine the effectiveness of the treatment you receive.

Hypovolemic shock in older adults

Hypovolemic shock is dangerous for everyone, but it can be particularly dangerous in older
adults. Older adults who experience hypovolemic shock have higher mortality rates than their
younger counterparts. They have less tolerance for the shock, and earlier treatment to prevent
other complications is vital. This can be made more complicated, as older adults may not show
symptoms of shock until later than younger populations.
Part 9 of 9:

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.
Recovery from hypovolemic shock depends on factors like the patients prior medical condition
and the degree of the shock itself.
Those with milder degrees of shock will have an easier time recovering. If severe organ damage
results from the shock, it can take much longer to recover, with continued medical interventions
needed. In severe cases, organ damage may be irreversible.
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 havent had severe blood loss.

Hypovolemic shock refers to a medical or surgical condition in which rapid fluid loss
results in multiple organ failure due to inadequate circulating volume and subsequent inadequate
perfusion. Most often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock).
Acute external blood loss secondary to penetrating trauma and severe GI bleeding disorders are 2
common causes of hemorrhagic shock. Hemorrhagic shock can also result from significant acute
internal blood loss into the thoracic and abdominal cavities.
Two common causes of rapid internal blood loss are solid organ injury and rupture of an
abdominal aortic aneurysm. Hypovolemic shock can result from significant fluid (other than
blood) loss. Two examples of hypovolemic shock secondary to fluid loss include refractory
gastroenteritis and extensive burns. The remainder of this article concentrates mainly on
hypovolemic shock secondary to blood loss and the controversies surrounding the treatment of
this condition. The reader is referred to other articles for discussions of the pathophysiology and
treatment for hypovolemic shock resulting from losses of fluid other than blood.
The many life-threatening injuries experienced during the wars of the 1900s have significantly
affected the development of the principles of hemorrhagic shock resuscitation. During World
War I, W.B. Cannon recommended delaying fluid resuscitation until the cause of the
hemorrhagic shock was repaired surgically. Crystalloids and blood were used extensively during
World War II for the treatment of patients in unstable conditions. Experience from the Korean
and Vietnam wars revealed that volume resuscitation and early surgical intervention were
paramount for surviving traumatic injuries resulting in hemorrhagic shock. These and other
principles helped in the development of present guidelines for the treatment of traumatic
hemorrhagic shock. However, recent investigators have questioned these guidelines, and today,
controversies exist concerning the optimal treatment of hemorrhagic shock.
The prognosis is dependent on the degree of volume loss.