is a pathological condition caused by a rapid decrease in the volume of circulating blood. Manifested by a decrease in blood pressure, tachycardia, thirst, nausea, dizziness, fainting, loss of consciousness and pallor of the skin. With the loss of a large volume of fluid, the disorders are aggravated, the result of hypovolemic shock is irreversible damage to internal organs and death. The diagnosis is made on the basis of clinical signs, test results and data from instrumental studies. Treatment - urgent correction of disorders (intravenous infusions, glucocorticoids) and elimination of the cause of hypovolemic shock.

ICD-10

R57.1

General information

Hypovolemic shock (from Latin hypo - lower, volume - volume) - a condition that occurs as a result of a rapid decrease in the volume of circulating blood. Accompanied by changes in the cardiovascular system and acute metabolic disorders: a decrease in stroke volume and filling of the ventricles of the heart, deterioration of tissue perfusion, tissue hypoxia and metabolic acidosis. It is a compensatory mechanism designed to ensure normal blood supply to internal organs in conditions of insufficient blood volume. With the loss of a large volume of blood, compensation is ineffective, hypovolemic shock begins to play a destructive role, pathological changes are aggravated and lead to the death of the patient.

Hypovolemic shock is treated by resuscitators. Treatment of the underlying pathology, which is the cause of the development of this pathological condition, can be carried out by orthopedic traumatologists, surgeons, gastroenterologists, infectious disease specialists and doctors of other specialties.

The reasons

There are four main reasons for the development of hypovolemic shock: irreversible blood loss during bleeding; irretrievable loss of plasma and plasma-like fluid in trauma and pathological conditions; deposition (accumulation) of a large amount of blood in the capillaries; loss of large amounts of isotonic fluid during vomiting and diarrhea. The cause of irretrievable blood loss can be external or internal bleeding as a result of trauma or surgery, gastrointestinal bleeding, as well as sequestration of blood in damaged soft tissues or in the fracture area.

The loss of a large amount of plasma is characteristic of extensive burns. The reason for the loss of plasma-like fluid is its accumulation in the lumen of the intestine and abdominal cavity with peritonitis, pancreatitis and intestinal obstruction. The deposition of a large amount of blood in the capillaries is observed in trauma (traumatic shock) and some infectious diseases. Massive loss of isotonic fluid as a result of vomiting and / or diarrhea occurs with acute intestinal infections: cholera, gastroenteritis of various etiologies, staphylococcal intoxication, gastrointestinal forms of salmonellosis, etc.

Pathogenesis

Blood in the human body is in two functional "states". The first is circulating blood (80-90% of the total volume), delivering oxygen and nutrients to the tissues. The second is a kind of reserve that is not involved in the general blood flow. This part of the blood is found in the bones, liver and spleen. Its function is to maintain the required volume of blood in extreme situations associated with a sudden loss of a significant part of the BCC. With a decrease in blood volume, baroreceptors are irritated, and the deposited blood is "ejected" into the general circulation. If this is not enough, a mechanism is activated to protect and preserve the brain, heart and lungs. Peripheral vessels (vessels that supply blood to the limbs and "less important" organs) narrow, and blood continues to actively circulate only in the vital organs.

If the lack of blood circulation cannot be compensated, centralization increases even more, spasm of peripheral vessels increases. Subsequently, due to the depletion of this mechanism, the spasm is replaced by paralysis of the vascular wall and a sharp dilation (expansion) of the vessels. As a result, a significant part of the circulating blood moves to the peripheral regions, which leads to an aggravation of insufficient blood supply to vital organs. These processes are accompanied by gross violations of all types of tissue metabolism.

There are three phases in the development of hypovolemic shock: deficiency of circulating blood volume, stimulation of the sympathoadrenal system, and shock itself.

• 1 phase- BCC deficiency. Due to the lack of blood volume, venous flow to the heart decreases, central venous pressure and stroke volume of the heart decrease. The fluid that was previously in the tissues, compensatory moves into the capillaries.
• 2 phase- stimulation of the sympathoadrenal system. Irritation of baroreceptors stimulates a sharp increase in the secretion of catecholamines. The content of adrenaline in the blood increases hundreds of times, norepinephrine - dozens of times. Due to the stimulation of beta-adrenergic receptors, vascular tone, myocardial contractility and heart rate increase. The spleen, veins in skeletal muscle, skin and kidneys contract. Thus, the body manages to maintain arterial and central venous pressure, ensure blood circulation in the heart and brain due to the deterioration of blood supply to the skin, kidneys, muscular system and organs innervated by the vagus nerve (intestines, pancreas, liver). For a short period of time, this mechanism is effective, with a rapid recovery of the BCC, recovery follows. If the deficit of blood volume persists, in the future, the consequences of prolonged ischemia of organs and tissues come to the fore. Spasm of peripheral vessels gives way to paralysis, a large volume of fluid from the vessels passes into the tissues, which entails a sharp decrease in BCC in conditions of an initial deficit in the amount of blood.
• 3 phase– actually hypovolemic shock. BCC deficiency progresses, venous return and heart filling decrease, blood pressure decreases. All organs, including vital ones, do not receive the necessary amount of oxygen and nutrients, multiple organ failure occurs.

Ischemia of organs and tissues in hypovolemic shock develops in a certain sequence. First, the skin suffers, then the skeletal muscles and kidneys, then the abdominal organs, and finally the lungs, heart and brain.

Classification

To assess the patient's condition and determine the degree of hypovolemic shock in traumatology and orthopedics, the classification of the American College of Surgeons is widely used.

• Loss of no more than 15% of the BCC- if the patient is in a horizontal position, there are no symptoms of blood loss. The only sign of incipient hypovolemic shock may be an increase in heart rate by more than 20 per minute. when the patient moves to the upright position.
• Loss of 20-25% BCC- a slight decrease in blood pressure and increased heart rate. In this case, the systolic pressure is not lower than 100 mm Hg. Art., pulse no more than 100-110 beats / min. In the supine position, blood pressure may be normal.
• Loss of 30-40% BCC- decrease in blood pressure below 100 mm Hg. Art. in the supine position, pulse more than 100 beats / min, pallor and cooling of the skin, oliguria.
• Loss of more than 40% BCC- the skin is cold, pale, marbling of the skin is noted. Blood pressure is reduced, there is no pulse in the peripheral arteries. Consciousness is disturbed, coma is possible.

Symptoms of hypovolemic shock

The clinical picture of the state of shock depends on the volume and rate of blood loss and the compensatory capabilities of the body, which are determined by a number of factors, including the patient's age, his constitution, as well as the presence of severe somatic pathology, especially lung and heart diseases. The main signs of hypovolemic shock are a progressive increase in heart rate (

Treatment of hypovolemic shock

The main task at the initial stage of therapy is to ensure sufficient blood supply to vital organs, eliminate respiratory and circulatory hypoxia. Catheterization of the central vein is performed (with a significant decrease in BCC, catheterization of two or three veins is performed). A patient with hypovolemic shock is administered dextrose, crystalloid and polyionic solutions. The rate of administration should ensure the fastest possible stabilization of blood pressure and its maintenance at a level not lower than 70 mm Hg. Art. In the absence of the effect of the listed drugs, an infusion of dextran, gelatin, hydroxyethyl starch and other synthetic plasma substitutes is carried out.

If hemodynamic parameters do not stabilize, intravenous administration of sympathomimetics (norepinephrine, phenylephrine, dopamine) is performed. At the same time, inhalations with an air-oxygen mixture are performed. According to indications, IVL is performed. After determining the cause of the decrease in BCC, surgical hemostasis and other measures are performed to prevent a further decrease in blood volume. Hemic hypoxia is corrected by infusion of blood components and natural colloidal solutions (protein, albumin).

When the total amount of blood in a person decreases, he can feel it right away, since the condition of the body as a whole immediately worsens. This phenomenon is called hypovolemia.

What it is

The disease hypovolemia is characterized by the fact that the total amount of blood is significantly reduced. In a healthy person, the total blood volume is 75-58 ml/kg. This blood level in a person can be different for both men and women.

For men, the normal blood volume should be 75-66 ml/kg, while for women this figure goes a little lower than 58-65 ml/kg. It is also worth considering the total volume: for men, this figure is higher, 35-42 ml / kg, and for women, it is slightly underestimated 42-35 ml / kg.

Since with hypovolemia, the total volume of blood in the body drops significantly, various kinds of symptoms can occur, which will only adversely affect well-being and dehydration occurs.

The reasons

The causes of hypovolemia can be different: and violation of the integrity of the walls of veins and arteries.

At this point, the level of plasma in the blood drops significantly and the function of redistributing fluid in the tissues is also impaired.

With hypovolemia, lack of blood, diseases that are associated with the gastrointestinal tract are also characteristic, when the level of water, or rather the fluid in the body, also drops, which leads to dehydration.

The fact is that the human stomach needs liquid every day, especially since this organ is capable of producing up to 7-8 liters of liquid mass, taking into account that another 2-3 liters get with food. With the full and well-coordinated work of the gastrointestinal tract, only 9-10% of all fluid that enters the human body is excreted along with sweat and defecation, and the rest is utilized.

When the gastrointestinal tract is not coordinated, most of the water is excreted from the body, which can lead to dehydration - hypovolemia.

If a person has diseases that are directly related to the kidneys, then in this way the fluid from the body will be excreted faster, more often and more.

In general, the kidneys are a paired organ that removes fluid and harmful components from the body. During normal operation, the removal of fluid from the body is carried out several times a day, and thus this process is normal and harmonious.

Also, due to the fact that the body is dehydrated, a person can lose weight, and sharp symptoms can begin.

All of these symptoms of hypovolemia are only initial indications that a person may develop hypovolemia. If timely action is not taken, the disease will progress.

A sick person may change skin color. It becomes dimmer, elasticity changes, such a characteristic feature is immediately noticeable.

Under those circumstances, when the stage of hypovolemia is sufficiently advanced, there will be: a significant decrease in body temperature, weak, poor outflow of urine.

With hypovolemia, they can suddenly open, which will be quite difficult to stop, which can lead to the fact that the patient's blood pressure may drop.

Classification

The classification of hypovolemia can be divided into three types:

• The first type of hypovolemia implies a simple form. Under such circumstances, in a sick person, the total blood volume, the level of plasma in the blood decreases, and other indicators may decrease.
• In the second type of hypovolemia, most often there is a sharp decrease in fluid, the level of erythrocytes drops sharply.

Such a phenomenon can lead to a sharp deterioration in well-being, a person may lose consciousness. If, nevertheless, this situation happened, immediate hospitalization is needed for the administration of drugs or additional blood.

• In the third type of hypovolemia, the plasma level drops significantly. There are risks of blood clotting.

Secondary signs can manifest themselves in vomiting, loose stools and various pathologies on the part of the body.

It is important to understand that hypovolemia is a rather complex disease. The very phenomenon that a person begins to dehydrate the body should alert and become a reason to consult a doctor.

• What is hypovolemia
• What causes hypovolemia
• Symptoms of hypovolemia
• Treatment of hypovolemia

What is hypovolemia

Hypovolemia- conditions characterized by a decrease in the total volume of blood and, as a rule, a violation of the ratio of its formed elements and plasma. There are normocythemic, oligocythemic and polycythemic hypovolemia.

What causes hypovolemia

Normocythemic hypovolemia- a condition manifested by a decrease in the total blood volume while maintaining Ht within the normal range.

• The most common causes of normocythemic hypovolemia: acute blood loss, shock conditions, vasodilatation collapse. In the last two cases, normocythemic hypovolemia develops as a result of the deposition of a large volume of blood in the venous (capacitive) vessels and a significant decrease in the BCC in connection with this.
• Manifestations of normocythemic hypovolemia are determined by the nature of the cause that caused it (blood loss, shock, collapse), as well as the inclusion of compensation mechanisms aimed at eliminating acute hypoxia.

Oligocythemic hypovolemia

Oligocythemic hypovolemia- a condition characterized by a decrease in the total volume of blood with a predominant decrease in the number of its formed elements. Ht is below normal.

The most common causes of oligocythemic hypovolemia.

• Conditions after acute blood loss (at the stage when the transport of fluid from the tissues and the release of deposited blood into the vascular bed still do not eliminate hypovolemia, and the flow of blood cells from the organs of hematopoiesis does not eliminate the deficiency of red blood cells).
• Erythropenia as a result of massive hemolysis of erythrocytes (for example, with burns of a large surface of the body, when hemolysis is combined with the loss of the body's liquid part of the blood due to plasmorrhagia) and suppression of erythropoiesis (for example, with aplastic or regenerative conditions).

Polycythemic hypovolemia

Polycythemic hypovolemia- a condition in which a decrease in the total volume of blood in the body is mainly due to a decrease in plasma volume. The Ht index in this condition is above the normal range.

The most common causes of polycythemic hypovolemia.

• Conditions that cause increased body fluid loss: repeated vomiting (eg, in pregnant women or as a result of exogenous intoxication), prolonged diarrhea (eg, in violation of membrane digestion, intestinal toxic infections), polyuria (eg, in renal failure), increased and prolonged sweating ( for example, in hot climates or in hot workshops in production) and extensive skin burns (accompanied by plasmorrhagia).
• Conditions that prevent sufficient fluid intake in the body (water "starvation"): lack of drinking water and the inability to drink water (for example, as a result of muscle spasm in tetanus or rabies).

Symptoms of hypovolemia

Manifestations of oligocythemic hypovolemia.

• A decrease in the oxygen capacity of the blood (as a result of erythropenia).
• Signs of hypoxia (for example, a decrease in the oxygen content in the blood, acidosis, a decrease in p0 2 of venous blood, etc.).
• Disorders of organ tissue circulation and microcirculation of varying degrees, due, among other factors, to a decrease in BCC.

Manifestations of polycythemic hypovolemia.

• Violations of organ tissue microcirculation due to hypovolemia and polycythemia.
• Increased blood viscosity, aggregation of blood cells in microvessels of organs and tissues, and disseminated microthrombosis.
• Signs of an underlying pathology causing polycythemic hypovolemia (for example, shock, diabetes insipidus, renal failure, burn disease, etc.).

Treatment of hypovolemia

Treatment symptomatic

Which Doctors Should You See If You Have Hypovolemia?

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Hypovolemia is one of the dangerous diseases of the hematopoietic system, which can lead to death of a person. What is Hypovolemia Syndrome? What is the disease and what are its varieties? Consider the causes, symptoms, types of hypovolemia, methods of treatment.

The decrease in the volume of blood circulation in hematology is called hypovolemia. With the development of this disease, there is a violation of the formed elements in the blood plasma. Normally, the volume of circulating plasma (VCV) in the human body fluctuates around 69 ml/kg in men and 65 ml/kg in women. Hypovolemia refers to serious conditions that, if medical care is not provided in a timely manner, can lead to the death of a person. This disease is not independent, but develops as a complication against the background of internal diseases. That is why after a person has symptoms of hypovolemia, it is important to establish the etiological factor and only then take treatment measures. With hypovolemia, an incorrect distribution of intracellular fluid occurs, which leads to a decrease in blood circulation.

Hypovolaemia - decreased blood volume

Important: Hypovolemia syndrome can develop both in severe pathologies of internal organs and in less dangerous conditions, so it is important to establish the causes of hypovolemia and only then treat.

The reasons

A decrease in circulating blood volume can occur for multiple reasons, but basically this condition manifests itself in the following diseases:

1. Dehydration of the body.
2. Metabolic disorders: diabetes mellitus.
3. Kidney disease: glomerulonephritis, renal failure.
4. Trauma to internal organs.
5. Complication after surgery.
6. Peritonitis.
7. Internal bleeding.
8. Diseases of the gastrointestinal tract.
9. endocrine disorders.
10. Pathologies of the cardiovascular system.

Predisposing factors for the development of hypovolemia are:

1. Insufficient water intake.
2. Regular stress, depression.
3. Burns.
4. Blood transfusion.
5. Repeated and profuse vomiting.
6. Diarrhea.

Dehydration is one of the causes of hypovolemia

These are not all the reasons that can provoke the development of hypovolemia. In rare cases, patients are diagnosed with hypovolemia of the thyroid gland, in which there is not only a decrease in fluid, but also a decrease in hormone production. Basically, this condition is diagnosed extremely rarely and only after prolonged blood loss.

Kinds

In hematology, there are three main types of hypovolemia, each of which has its own characteristics:

1. Normocytemic - characterized by a decrease in circulating blood with persistent hematocrit. The main cause of this condition is considered to be acute blood loss, collapse and other serious conditions leading to a decrease in current in the veins and large arteries.
2. Oligocythemic hypovolemia - a decrease in the amount of blood and formed elements with a decrease in hematocrit. The main reason for the development of this condition is considered to be, which develops as a result of a deficiency of red blood cells or extensive hemolysis of red blood cells. This condition is typical for 1st or 2nd degree burns.
3. Polycythemic hypovolemia - is caused by a decrease in blood volume against the background of a decrease in the amount of plasma.

Stages of the disease

The course of hypovolemia directly depends on the amount of blood loss, as well as the symptoms with which the patient turned to the doctors.

There are three main degrees of hypovolemia, each of which has characteristic features:

1. Easy degree. Blood loss averages no more than 15% of the total blood circulation. Patients have a decrease in blood pressure, tachycardia, rapid pulse and breathing. The skin is pale, the upper and lower extremities are cold, there is also increased dryness in the mouth, general weakness.
2. Average degree. Blood loss is up to 40%. The patient's condition is rather severe, blood pressure is below 90 mm Hg, rapid pulse, heavy irregular breathing, excessive sweating, cyanosis of the lips, pallor, increased drowsiness, feeling of lack of air. In some cases, vomiting, fainting, and a decrease in the amount of urine may be present.
3. Severe degree. The patient loses up to 70% of the total blood volume, pressure is below 60 mmHg, the pulse is barely audible, severe tachycardia, confusion, convulsions are possible, breathing is hard. This condition is extremely dangerous for human life, as it can lead to death.

How does hypovolemia manifest itself?

Clinical signs of hypovolemia are quite pronounced and are accompanied by the following symptoms:

1. Decreased diuresis.
2. Increased thirst.
3. Paleness of the skin.
4. Decrease in body temperature.
5. Increase in heart rate.
6. Weight loss.
7. Dryness and peeling of the skin.
8. Swelling of the legs.
9. Increased fatigue.
10. Decreased blood pressure.
11. Frequent headaches.
12. "Flies" before the eyes.

Diagnosis and treatment

If hypovolemia is suspected, the doctor prescribes a series of laboratory tests that allow you to determine the number of red blood cells and blood plasma, and a urine test is also prescribed. With a decrease in extracellular fluid, a blood test is performed along with protein solutions, glucose, and electrolyte solutions. The results of the research allow you to create a complete picture of the disease, determine the stage, type, prescribe the appropriate treatment.

Hypovolemia is a condition characterized by a decrease in blood volume in the human body. Hypovolemia can develop against the background of various disorders and health problems, but all of them are accompanied by loss of fluid, or its release from the bloodstream into the surrounding tissues.

Normally, a healthy man in the body should circulate 70 ml of blood for every kilogram of weight. For women, this figure is 66 ml. Only when the vessels are filled with blood as expected, the normal level of blood pressure is maintained in the body. If the volumes of this life-supporting fluid decrease, then the pressure begins to fall, a person develops, tissues suffer from oxygen starvation, and the work of all internal organs is disrupted.

In the human body, water is present almost everywhere, and not only in the vascular bed. It is called extracellular fluid. It is necessary to provide nutrition to tissues and to normalize metabolic processes in it. Blood and extracellular fluid are interconnected, so the loss of water by the body will necessarily affect the volume and concentration of blood.

The liquid part of the blood is called plasma, the rest of its volume is represented by platelets, erythrocytes and leukocytes. Depending on the type of hypovolemia, the ratio of the cellular and plasma components of the blood will differ. As a result, the total volume of circulating blood in the body decreases, and the proportions between its main constituent elements (plasma and blood cells) can also be disturbed.

Of course, all doctors are familiar with such a concept as hypovolemia. However, to date, there is no clear scheme for identifying this disorder, which significantly complicates the diagnostic process. The same feature applies to the treatment of hypovolemia. Therefore, often the patient is prescribed an unreasonable blood transfusion, which can harm human health. The doctor, before prescribing treatment, must identify the cause that led to hypovolemia and clearly distinguish this concept from dehydration.

It should be borne in mind that severe hypovolemia can lead to the development of shock conditions that threaten human life. Therefore, sometimes the decision on the method of providing first aid to the patient must be made very quickly. Otherwise, it will not be possible to save his life.

What can happen in the body with hypovolemia:

The level of proteins and electrolytes in the liquid component of the blood and in the extracellular space changes.

Peripheral vessels dilate, thereby increasing the capacity of the vascular bed as a whole.

Hypovolemia can develop due to direct excretion of blood cells and plasma from the body.

The causes of hypovolemia can be the following:

Bleeding accompanied by blood loss.

The development of burn disease.

The development of dehydration against the background of damage to the body by an intestinal infection.

Pathological or physiological hemolysis.

Copious excretion of urine at.

• Although a person does not notice this, he loses fluid during breathing, and also when he sweats. When an individual is healthy, then the body completely keeps these processes under its control. The volume of water that a person drinks throughout the day is enough for him to make up for these losses (if he drinks in accordance with his age norm). When you are in the heat, with febrile conditions, with excessive physical exertion, the balance of water in the body may change.

  Blood loss is the most common cause of hypovolemia. Bleeding can be external and internal. First of all, blood loss affects the functioning of the heart.

  This affects the body in the following way: