Hypovolemia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Synonyms and keywords: hypovolaemia; hypovolemic.
Overview
Hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma.
Causes
Common Causes
- Bleeding
- Sepsis
- Severe burns
- Dehydration
- Drugs such as diuretics or vasodilators typically used to treat hypertensive individuals
Causes by Organ System
| Cardiovascular | Obstruction of a major venous system, Dissecting aortic aneurysm, Abdominal aortic aneurysm rupture, Iliac artery aneurysm dissection, Blood vessel trauma |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | ACE inhibitors, Diuretics, Ixabepilone, Vasodilators |
| Ear Nose Throat | No underlying causes |
| Endocrine | Hypoaldosteronism, Diabetes insipidus |
| Environmental | Heat stroke, Excessive Sweating |
| Gastroenterologic | Gastric volvulus, Gastric ulcer, Acute pancreatitis, Cirrhosis, Splenic rupture, Small bowel obstruction, Paralytic Ileus, Nausea and vomiting, Gastric volvulus, Duodenal ulcer, Diarrhoea, Bleeding Oesophageal varices |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | External drainage |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | Fracture of bone |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | Protein energy malnutrition, Marasmus |
| Obstetric/Gynecologic | Uterine rupture, Phlegmasia alba dolens, Ovarian hyperstimulation syndrome, Ectopic pregnancy rupture |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | Alcohol consumption |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | Salt-wasting nephropathies |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Crush injury, Blood vessel trauma |
| Urologic | No underlying causes |
| Miscellaneous | Osmotic diuresis, Extreme weight loss, Bleeding, Severe burns, Retroperitoneal haemorrhage, Postpartum haemorrhage, |
Causes in Alphabetical Order
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Natural History, Complications and Prognosis
Severe hypovolemia may lead to hypovolemic shock which in turn can be associated with multiple organ failure, renal failure, brain damage, coma and death (desanguination).Note that in children, compensation can result in an artificially high blood pressure despite hypovolemia.This is another reason (aside from initial lower blood volume) that even the possibility of internal bleeding in children should always be treated aggressively.People can bleed to death internally without any external blood loss.
Diagnosis
Clinical symptoms may not present until 10-20% of total whole-blood volume is lost. Also consider possible mechanisms of injury (especially the steering wheel and/or use/non-use of seat belt in motor vehicle accidents) that may have caused internal bleeding such as ruptured or bruised internal organs.If trained to do so and the situation permits, conduct a secondary survey and check the chest and abdominal cavities for pain, deformity, guarding or swelling.(Injuries to the pelvis and bleeding into the thigh from the femoral artery can also be life-threatening.)
Symptoms
The patient may feel :
- Very thirsty
Physical Examination
- Low blood pressure and the absence of perfusion
- Pale skin
- Reduced capillary refill assessed on forehead, lips and nail beds
Treatment
Minor hypovolemia from a known cause that has been completely controlled (such as a blood transfusion from a healthy patient who is not anemic) may be countered with initial rest for up to half an hour, oral fluids including moderate sugars (apple juice is good) and the advice to the donor to eat good solid meals with proteins for the next few days.Typically, this would involve a fluid volume of less than one liter (1000 ml), although this is highly dependent on body weight.Larger people can tolerate slightly more blood loss than smaller people.More serious hypovolemia should be assessed by a nurse or doctor.When in doubt, treat hypovolemia aggressively.Note that in children, compensation can result in an artificially high blood pressure despite hypovolemia.
First Aid
External bleeding should be controlled by direct pressure. If direct pressure fails, other techniques such as elevation and pressure points should be considered. The tourniquet should be used in the case of massive hemorrhage i.e. arterial bleeds, such as the femoral artery. If a first-aider recognizes internal bleeding, the life-saving measure to take is to immediately call for emergency assistance.
Field Care
Emergency oxygen should be immediately employed to increase the efficiency of the patient's remaining blood supply.This intervention can be life-saving.
The use of intravenous fluids(IVs) may help compensate for lost fluid volume, but IV fluids cannot carry oxygen in the way that blood can.See also emergency medical services for a discussion of techniques used in IV fluid management of hypovolemia.
Hospital Treatment
If the hypovolemia was caused by medication, the administration of antidotes may be appropriate but should be carefully monitored to avoid shock or the emergence of other pre-existing conditions.
Blood transfusions coupled with surgical repair are the definitive treatment for hypovolemia caused by trauma.See also the discussion of shock and the importance of treating reversible shock while it can still be countered.
References
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