Mawater retention Peripheral vasoconsiriciion

Neural effects Cardiac stimulation Peripheral vasoconstriction

FIGURE 13-3. Expected neurohumoural response to hypovolemia. (ACTH, adrenocorticotropic hormone; ADH, antidiuretic hormone; Na, sodium.) (From Jimenez EJ. Shock. In: Civetta JM, Taylor RW, Kirby RR, eds. Critical Care. New York: Lippincott-Raven; 1997: 369, with permission.)

Table 13-2 Shock Manifestations on Major Organs

Heart

• Myocardial ischemia

• Dysrhythmias Brain

• Restlessness, confusion, obtundation

• Global cerebral ischemia Liver

• Release of liver enzymes

• Biliary stasis Lungs

• Pulmonary edema.

• Decreased glomerular filtration

• Acute kidney injury

• Stress-related mucosal disease

• Bacterial translocation

• Hematologic

• Thrombocytopenia

• Coagulopathies

ARDS, acute respiratory distress syndrome; Gl, gastrointestinal.

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