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Treatment of severe hypovolemia or hypovolemic shock in adults

Jess Mandel, MD
Paul M Palevsky, MD
Section Editors
Richard H Sterns, MD
Scott Manaker, MD, PhD
Deputy Editor
Geraldine Finlay, MD


Rapid volume repletion is indicated in patients with severe hypovolemia (ie, decreased peripheral perfusion, as indicated by delayed capillary refill and cool mottled extremities) or hypovolemic shock (ie, severe hypovolemia plus hypotension). Delayed therapy can lead to ischemic injury and possibly to irreversible shock and multiorgan system failure. Three issues generally need to be considered in this setting: the rate of fluid replacement; the type of fluid infused; and the role for buffer therapy in patients with concurrent lactic acidosis [1]. Vasopressors (eg, norepinephrine) generally should not be administered, since they do not correct the primary problem and tend to further reduce tissue perfusion [2]. (See "Use of vasopressors and inotropes".)

Treatment of hypovolemia is discussed here. Manifestations and diagnose of volume depletion are discussed separately. (See "Etiology, clinical manifestations, and diagnosis of volume depletion in adults".)


It is not possible to precisely predict the total fluid deficit in a given patient with hypovolemic shock, particularly if fluid loss continues (eg, persistent bleeding or third space sequestration). In general:

Initial – At least one to two liters of isotonic crystalloid are initially given as rapidly as possible in an attempt to restore tissue perfusion.

Early correction of the volume deficit is essential in hypovolemic shock to prevent the decline in tissue perfusion from becoming irreversible. Irreversible shock is associated with loss of vascular tone, a drop in systemic vascular resistance, pooling of blood in the capillaries and tissues, and an impaired response to vasoactive medications. (See "Definition, classification, etiology, and pathophysiology of shock in adults".)

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Literature review current through: Oct 2017. | This topic last updated: Jun 26, 2017.
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