Hypovolemic Shock in Children

Introduction

Shock is defined as the body's inability to deliver proper amounts of oxygen to meet the metabolic demands of the tissues. As a result, it results in generalized cellular hypoxia in the body. Hypovolemic shock is one of the most common forms of shock in children. There is a state of acute energy failure in the body due to dysregulation of glucose substrate and oxygen delivery. Blood volume refers to the total amount of blood present in the body. If the child suffers from hypovolemic shock, the blood volume drops significantly. Hypovolemic shock is a medical emergency as, in severe cases, it can result in organ failure. Therefore, diagnosing and treating it as early as possible is essential.

What Are the Causes of Hypovolemic Shock?

Hypovolemic shock is caused by sudden blood or fluid loss from the body. The loss of body fluids or actual blood loss results in a decrease in blood volume. As a result, there is a reduction in intravascular fluid volume and decreased stroke volume.

Following are the various causes of hypovolemic shock.

• Dehydration is caused by vomiting and diarrhea.

• Hemorrhage.

• Pathologic urinary losses.

• Prolonged Diarrhea.

• Translocation of fluids due to a severe burn.

• Excessive sweating.

• Protracted vomiting.

• Blood loss due to deep cuts or wounds.

• Bleeding from the digestive tract.

• Internal bleeding.

• Blood in the urine.

• Peritonitis.

• Bowel obstruction.

• Traumatic injury.

• Pancreatitis.

• Nephrotic syndrome.

• Diabetes Insipidus.

What Are the Stages of Hypovolemic Shock?

Hypovolemic shock occurs in various stages. As it progresses, the symptoms are seen in children.

Following are the multiple stages of hypovolemic shock.

• Stage One - In this stage, less than 15 percent of fluid is lost in the body. However, breathing and blood pressure appears normal at this stage. However, the child feels anxious, and their skin seems pale.

• Stage Two - In this stage, 15 to 30 percent fluid loss is present. There is an increase in heart rate and breathing. Initially, blood pressure appears to be expected, but diastolic blood pressure increases as the disease progresses.

• Stage Three - In this stage, 30 to 40 percent fluid loss is present. A significant drop in blood pressure and heart rate is increased to more than 120beats per minute. The breathing rate is increased, and the frequency of urination is decreased.

• Stage Four - In this stage, there is more than 40 percent of bodily fluid loss. The condition of the child becomes critical. A child's pulse rate is decreased, and the heart rate is increased. The child almost stops urinating, and there is the presence of internal bleeding from the organ.

• Hemorrhagic Shock occurs due to excessive blood loss from a child's body due to trauma or an accident. The child needs immediate medical attention because it can turn into a fatal situation. In addition, it can cause severe damage to tissue and organs in the body.

What Are the Symptoms of Hypovolemic Shock?

The symptoms of Hypovolemic shock change with the progression of stages.

Following are the various symptoms seen in children according to the settings.

• Stage One

  • It is the earliest stage; therefore, the symptoms are mild.

  • There is no change in blood pressure and breathing.

  • The child feels anxious.

  • Pale skin.

• Stage Two

  • Increased heart rate

  • High blood pressure.

  • Sweating.

  • Anxiety.

  • Restlessness.

• Stage Three

  • Increased heart rate.

  • Rapid breathing rate.

  • Mental distress, including anxiety and agitation.

  • Skin becomes pale and cold.

  • Weak pulse rate.

  • Sweating.

• Stage Four

  • Rapid increase in heart rate.

  • Excessive rapid breathing.

  • Urine output is decreased.

  • Confusion.

  • Weakness.

  • Decreased pulse rate.

  • Lips and fingernails become blue.

  • Loss of consciousness.

  • Mental status becomes abnormal.

• Hemorrhagic Shock

  • Severe abdominal pain.

  • Blood is present in urine and stool.

  • Melena.

  • Presence of blood in vomit.

  • Severe pain in my chest.

  • The abdomen is swollen.

What Are the Complications of Hypovolemic Shock?

Following are the various complications of Hypovolemic shock:

• Lack of body fluid can lead to severe dehydration.

• Damage to various organs such as the kidney and brain.

• Severe hypoxia.

• Metabolic acidosis.

• Heart attack.

• Severe tachycardia

• Gastrointestinal diseases.

What Are the Risk Factors of Hypovolemic Shock?

Hypovolemic shock can occur due to various causes, such as illness, medical condition, or injury. The risk factors can be external and internal.

• External Risk Factors - Children suffering from diabetes insipidus, diuresis, and diarrhea risk hypovolemic shock. Trauma and surgery also increase the risk.

• Internal Risk Factors - These factors cause fluid shifts such as bleeding, burns, ascites, peritonitis, and dehydration.

How Is Hypovolemic Shock Diagnosed in Children?

The symptoms tend to arise as there is a progression of the stages. However, physical signs such as rapid heartbeat, rapid breathing, low pulse rate, pale skin color, and cold extremities are evident. Following are the few diagnostic tests a pediatrician suggests if the child is suspected of hypovolemic shock.

• Blood investigations.

• Focused assessment with sonography for trauma.

• Computed tomography scan.

• Echocardiogram.

What Is the Treatment Plan for Hypovolemic Shock?

If the child suffers from hypovolemic shock, an intravenous fluid transfusion is done to recover the fluid loss. The primary goal of treatment is to control fluid loss and improve circulation. In addition, treating the primary cause, such as illness or injury, is essential to stabilize the damage caused by hypovolemic shock.

Following are the various treatment plans followed.

• Medications to improve circulation such as dopamine, dobutamine, and epinephrine.

• Antibiotic therapy to prevent bacterial infections and septic shock.

• Blood plasma transfusion.

• Platelet transfusion.

• Administration of intravenous crystalloids.

Conclusion

Hypovolemic shock in pediatric patients can be challenging to diagnose for both parents and pediatricians. However, if mild symptoms such as a change in behavior, fussiness, or change in appetite are seen, parents should consider a healthcare visit. Detailed history and proper examination should be made to diagnose and sound management. A systematic approach should be made to treatment to ensure better care. Hypovolemic shock can turn into a life-threatening emergency if not treated at the proper time. It is essential to stabilize the condition of a child if the symptoms are severe.