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a-z health information - Disease

 

Hypovolemic shock

Definition

Hypovolemic shock is an emergency condition in which severe blood and fluid loss make 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

The greater and more rapid the blood loss, the more severe the symptoms of shock.

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) and/or colonoscopy (tube place 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 immediate medical help. 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 to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless he or she is 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 him or her 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, patients 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. The elderly are more likely to have poor outcomes from shock.

Possible Complications

  • 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

Rivers E. Approach to the patient with shock. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 106.

Spaniol JR, Knight AR, Zebley JL, Anderson D, Pierce JD. Fluid resuscitation therapy for hemorrhagic shock. J Trauma Nurs. 2007;14:152-156.

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: Mosby Elsevier; 2013:chap 6.

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

den Uil CA, Klijn E, Lagrand WK, Brugts JJ, Ince C, Spronk PE, Simoons ML. The microcirculation in health and critical disease. Prog Cardiovasc Dis. 2008;51:161-170.


Review Date: 1/13/2014
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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