Various laboratory values can be abnormal in hypovolemic shock.

Patients can have

increased BUN and serum creatinine as a result of prerenal kidney failure. Hypernatremia or
hyponatremia can result, as can hyperkalemia or hypokalemia. Lactic acidosis can result from
increased anaerobic metabolism. However, the effect of acid-base balance can be variable as
patients with large GI losses can become alkalotic. In cases of hemorrhagic shock, hematocrit
and hemoglobin can be severely decreased. However, with a reduction in plasma volume,
hematocrit and hemoglobin can be increased due to hemoconcentration.
Low urinary sodium is commonly found in hypovolemic patients as the kidneys attempt to
conserve sodium and water to expand the extracellular volume. However, sodium urine can
be low in a euvolemic patient with heart failure, cirrhosis, or nephrotic syndrome. A
fractional excretion of sodium under 1% is also suggestive of volume depletion. Elevated
urine osmolality can also suggest hypovolemia. However, this number also can be elevated in
the setting of impaired concentrating ability by the kidneys.
Central venous pressure (CVP) is often used to assess volume status. However, its usefulness
in determining volume responsiveness has recently come into question. Ventilator settings,
chest wall compliance, and right-sided heart failure can compromise CVPs accuracy as a
measure of volume status. Measurements of pulse pressure variation via various commercial
devices has also been postulated as a measure of volume responsiveness. However, pulse
pressure variation as a measure of fluid responsiveness is only valid in patients without
spontaneous breaths or arrhythmias. The accuracy of pulse pressure variation also can be
compromised in right heart failure, decreased lung or chest wall compliance, and high
respiratory rates.
Similar to examining pulse pressure variation, measuring respiratory variation in inferior
vena cava diameter as a measure of volume responsiveness has only been validated in
patients without spontaneous breaths or arrhythmias. Measuring the effect of passive leg
raises on cardiac contractility by echo appears to be the most accurate measurement of
volume responsiveness, although it is also subject to limitations. [3][[4]