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Synonyms Oligemia, hypovolaemia, oligaemia
"Specialty "Emergency medicine
Symptoms headache, fatigue, nausea, profuse sweating, dizziness

Hypovolemia is a state of decreased "blood volume; more specifically, decrease in volume of "blood plasma.[1][2] It is thus the intravascular component of "volume contraction (or loss of blood volume due to things such as "bleeding or "dehydration), but, as it also is the most essential one, hypovolemia and volume contraction are sometimes used synonymously.

Hypovolemia is characterized by sodium depletion (salt depletion) and thus differs from "dehydration, which is defined as excessive loss of "body water.[3]



Common causes of hypovolemia are:[4]

Excessive sweating is not a cause of hypovolemia, because the body eliminates significantly more water than sodium.[8]


Clinical symptoms may not be present until 10–20% of total whole-blood volume is lost.

Hypovolemia can be recognized by "tachycardia, diminished blood pressure,[9] and the absence of "perfusion as assessed by skin signs (skin turning pale) and/or "capillary refill on "forehead, "lips and "nail beds. The patient may feel dizzy, faint, nauseated, or very thirsty. These signs are also characteristic of most types of "shock.

Note that in children compensation can result in an artificially high blood pressure despite hypovolemia. Children will typically compensate (maintain blood pressure despite loss of blood volume) for a longer period than adults, but will deteriorate rapidly and severely once they do begin to decompensate. This is another reason (aside from initial lower blood volume) that even the possibility of "internal bleeding in children should almost always be treated aggressively.

Obvious signs of external bleeding should be noted while remembering that people can bleed to death internally without any external blood loss. ("Blood on the floor, plus 4 more" = intrathoracic, intraperitoneal, retroperitoneal, pelvis/thigh)

There should be considered possible mechanisms of injury that may have caused internal bleeding, such as ruptured or bruised internal organs. If trained to do so and if the situation permits, there should be conducted a "secondary survey and checked the chest and abdomen for pain, deformity, guarding, discoloration or swelling. Bleeding into the abdominal cavity can cause the classical bruising patterns of "Grey Turner's sign or "Cullen's sign.

Stages of hypovolemic shock[edit]

Usually referred to as a "class" of shock. Most sources state that there are 4 stages of hypovolemic shock;[10] however, a number of other systems exist with as many as 6 stages.[11]

The 4 stages are sometimes known as the "Tennis" staging of hypovolemic shock, as the stages of blood loss (under 15% of volume, 15–30% of volume, 30–40% of volume and above 40% of volume) mimic the scores in a game of tennis: 15, 15–30, 30–40 and 40.[12] It is basically the same as used in classifying "bleeding by blood loss.

The signs and symptoms of the major stages of hypovolemic shock include:[13]

Stage 1 Stage 2 Stage 3 Stage 4
Blood loss Up to 15% (750 mL) 15–30% (750–1500 mL) 30–40% (1500–2000 mL) Over 40% (over 2000 mL)
Blood pressure Normal (Maintained
by "vasoconstriction)
Increased "diastolic BP "Systolic BP < 100 Systolic BP < 70
Heart rate Normal Slight "tachycardia (> 100 bpm) Tachycardia (> 120 bpm) Extreme tachycardia (> 140 bpm) with weak pulse
Respiratory rate Normal Increased (> 20) "Tachypneic (> 30) Extreme "tachypnea
Mental status Normal Slight anxiety, restless "Altered, confused Decreased "LOC, "lethargy, "coma
Skin "Pallor Pale, cool, clammy Increased "diaphoresis Extreme "diaphoresis; "mottling possible
"Capillary refill Normal Delayed Delayed Absent
Urine output Normal 20–30 mL/h 20 mL/h Negligible


Field care[edit]

The single most important step in the treatment of hypovolemic shock is to identify and control the source of bleeding.[14]

Emergency oxygen should be immediately employed to increase the efficiency of the patient's remaining blood supply. This intervention can be life-saving.[15]

The use of "intravenous fluids (IVs) may help compensate for lost fluid volume, but IV fluids cannot carry oxygen in the way that blood can; however, "blood substitutes are being developed which can. Infusion of "colloid or "crystalloid IV fluids will also dilute "clotting factors within the blood, increasing the risk of bleeding. It is current best practice to allow "permissive hypotension in patients suffering from hypovolemic shock,[16] both to ensure clotting factors are not overly diluted and also to stop blood pressure being artificially raised to a point where it "blows off" clots that have formed.

Hospital treatment[edit]

"Fluid replacement is beneficial in hypovolemia of stage 2, and is necessary in stage 3 and 4.[13] See also the discussion of "shock and the importance of treating reversible shock while it can still be countered.

For a patient presenting with hypovolemic shock in hospital the following investigations would be carried out:

The following interventions would be carried out:

Vasopressors (like Norepinephrine, Dobutamine) should generally be avoided, as they may result in further tissue ischemia and don't correct the primary problem. Fluids are the preferred choice of therapy.[17]


In cases in which loss of blood volume is clearly attributable to bleeding (as opposed to, e.g., dehydration), most medical practitioners of today prefer the term "exsanguination for its greater specificity and descriptiveness, with the effect that the latter term is now more common in the relevant context.[18]

See also[edit]


  1. ^ "Hypovolemia definition - MedicineNet - Health and Medical Information Produced by Doctors". Medterms.com. 2012-03-19. Retrieved 2015-11-01. 
  2. ^ "Hypovolemia | definition of hypovolemia by Medical dictionary". Medical-dictionary.thefreedictionary.com. Retrieved 2015-11-01. 
  3. ^ "Dehydration definition - MedicineNet - Health and Medical Information Produced by Doctors". Medterms.com. 2013-10-30. Retrieved 2015-11-01. 
  4. ^ Sircar, S. Principles of Medical Physiology. Thieme Medical Pub. "ISBN "9781588905727
  5. ^ Danic B, Gouézec H, Bigant E, Thomas T (June 2005). "[Incidents of blood donation]". Transfus Clin Biol (in French). 12 (2): 153–9. "doi:10.1016/j.tracli.2005.04.003. "PMID 15894504. 
  6. ^ "Burn Shock / House Staff Manual". Total Burn Care. Retrieved 2015-11-01. 
  7. ^ "Resuscitation in Hypovolaemic Shock. Information page | Patient". Patient.info. Retrieved 2015-11-01. 
  8. ^ "Saladin 5e Extended Outline : Chapter 24 : Water, Electrolyte, and Acid–Base Balance". Highered.mcgraw-hill.com. Retrieved 2015-11-01. 
  9. ^ "Stage 3: Compensated Shock". Archived from the original on 2010-06-11. 
  10. ^ Hudson, Kristi. "Hypovolemic Shock - 1 Nursing CE". Archived from the original on 2009-06-06. 
  11. ^ "Stage 1: Anticipation stage (a new paradigm)". Archived from the original on 2010-01-16. 
  12. ^ Greaves, Ian; Porter, Keith; Hodgetts, Timothy; et al., eds. (2006). Emergency Care: A Textbook for Paramedics. Elsevier Health Sciences. p. 229. "ISBN "9780702025860. 
  13. ^ a b Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. "ISBN "0-7817-7153-6. 
  14. ^ Bulger, E. M., Snyder, D., Schoelles, K., Gotschall, C., Dawson, D., Lang, E., ... & White, L. (2014). An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care, 18(2), 163-173.
  15. ^ Takasu A, Prueckner S, Tisherman SA, Stezoski SW, Stezoski J, Safar P. (2000), Effects of increased oxygen breathing in a volume controlled hemorrhagic shock outcome model in rats., "PMID 10959021
  16. ^ "Permissive Hypotension". Trauma.Org. 1997-08-31. Retrieved 2015-11-01. 
  17. ^ "Failure of dobutamine to improve liver oxygenation during resuscitation with a crystalloid solution after experimental haemorrhagic shock". Pubmed-NCBI. 1996-08-31. Retrieved 2017-11-21. 
  18. ^ L. Geeraedts Jr.; H. Kaasjager; A. van Vugt; J. Frölke. "Exsanguination in trauma: A review of diagnostics and treatment options". Injury. 40 (1): 11–20. "doi:10.1016/j.injury.2008.10.007. 

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