Treatment of severe hypovolemia or hypovolemic shock in adults
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
- Section Editors
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
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 . Vasopressors (eg, norepinephrine) generally should not be administered, since they do not correct the primary problem and tend to further reduce tissue perfusion . (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".)
RATE OF FLUID REPLETION
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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