Key Concepts

© Hypovolemic shock occurs as a consequence of inadequate intravascular volume to meet the oxygen and metabolic needs of the body.

^^ Protracted tissue hypoxia sets in motion a downward spiral of events leading to organ dysfunction and eventual failure if untreated.

The overarching goals in treating hypovolemic shock are to restore effective circulating blood volume, as well as managing its underlying cause, thereby reversing organ dysfunction and returning to homeostasis.

O1 Three major therapeutic options are available to clinicians for restoring circulating blood volume: crystalloids (electrolyte-based solutions), colloids (large-molecular-weight solutions), and blood products.

© In the absence of ongoing blood loss, administration of 2,000 to 4,000 mL (about 4 to 8 pints) of isotonic crystalloid will normally re-establish baseline vital signs in adult hypovolemic shock patients.

® Colloid solutions administered are primarily confined to the intravascular space, in contrast to isotonic crystalloid solutions that distribute throughout the extracellular fluid space.

Blood products are indicated in adult hypovolemic shock patients who have sustained blood loss from hemorrhage exceeding 1,500 mL (about 3 pints).

Vasopressors may be warranted as a temporary measure in patients with profound hypotension or evidence of organ dysfunction in the early stages of shock.

O Major treatment goals in hypovolemic shock following fluid resuscitation are as follows: arterial systolic blood pressure (SBP) greater than 90 mm Hg within 1 hour, organ dysfunction reversal, and normalization of laboratory measurements as rapidly as possible (less than 24 hours).

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