Hypovolemic shock in children: Initial evaluation and management

INTRODUCTION

Hypovolemic shock is characterized by inadequate tissue perfusion from decreased intravascular volume as the result of fluid loss and/or inadequate fluid intake. The challenge for the clinician is to recognize children in hypovolemic shock early (before they develop hypotension), when they are more likely to respond favorably to treatment. Effective initial management of hypovolemic shock requires aggressive fluid resuscitation and control of ongoing losses (as with hemorrhage). Subsequent treatment includes repletion of deficits (based upon the type and amount of fluid that has been lost) and correction of metabolic abnormalities (such as hypoglycemia and electrolyte disturbances).

This topic will review the evaluation and treatment of hypovolemic shock in children. A general approach to the initial evaluation and management of shock in children, evaluation and treatment of hypovolemia in children, and the pathophysiology of shock are discussed separately. (See "Initial evaluation of shock in children" and "Initial management of shock in children" and "Clinical assessment and diagnosis of hypovolemia (dehydration) in children" and "Treatment of hypovolemia (dehydration) in children" and "Physiology and classification of shock in children".)

ETIOLOGY

Sources of volume loss that can lead to hypovolemic shock include the following:

• Vomiting and/or diarrhea
• Osmotic diuresis (as from hyperglycemia)
• Capillary leak (as occurs with sepsis and burn injury)
• Hemorrhage
• Inadequate fluid intake (particularly among infants and young children who cannot independently access fluids to replenish losses)

Worldwide, hypovolemic shock from diarrheal disease is a major cause of death among children [1]. The number of deaths from hypovolemic shock continues to decrease in the United States. The mortality rate in uncomplicated cases usually is less than 10 percent [2].