Management of Hypovolemic Shock in Older People

Introduction

Hypovolemic shock occurs when a sudden drop in the blood volume is caused due to excessive blood loss, usually caused by bleeding. This condition results in complications such as organ failure. This condition requires immediate treatment. The increased loss of fluid or blood reduces the amount of oxygen nutrients being supplied to the organs they need to function, resulting in organ failure and being fatal.

How Commonly Does This Hypovolemic Condition Occur?

Less than 1 out of 1,000 people get some form of shock. Hypovolemic shock is the second form of shock. Older adults are at greater risk of hypovolemic shock as they are more susceptible to dehydration, a common cause of hypovolemic shock.

What Are the Signs and Symptoms Associated With Hypovolemic Shock?

When more fluid or blood is lost, the signs and symptoms worsen. Some common symptoms are:

• Faster breathing than usual.

• Confusion or anxiety.

• Excessive sweating.

• Weakness.

• Passing out.

• Fast pulse.

• Reduced temperature.

• Low blood pressure.

• Skin feels cold.

What Are the Different Stages of Hypovolemic Shock?

Depending on the amount of blood loss, there are three stages of hypovolemic shock. These are:

• Mild: This is the initial stage of hypovolemic shock, where about 20 percent of the blood is lost. This stage is very difficult to diagnose as blood pressure and breathing tends to be expected. The only symptoms which are displayed at this stage are skin paleness and can experience anxiety.

• Moderate: Almost 20 to 40 percent of the blood is lost in the second stage. The individuals may experience raised heartbeat and breathing rates. Even in this stage, the blood pressure will be under the normal range. The diastolic pressure may be high. This stage displays symptoms such as sweating, anxiety, or restlessness.

• Severe: The affected person would have lost about 40 percent of blood in this stage. The systolic pressure will be 100 millimeters of mercury or lower in the third stage. This causes the heart rate to rise to 120 beats per minute, along with rapid breathing. The symptoms of this stage are

• Mental distress.

• Anxiety.

• Agitation.

• Excessive sweating.

• Skin appears pale and cold.

• Weak pulse with rapid heart rate.

• Drifting consciousness.

• Extremely pale.

• Cold to the touch.

What Are the Causes of Hypovolemic Shock?

The leading cause of hypovolemic shock is the loss of excessive blood, called hemorrhagic shock. This condition can be due to acute tissue injury, internal bleeding, or illness. This condition results from the loss of any body fluids, which can result in severe blood loss. Blood plasma is a part of blood that consists of red blood cells, white blood cells, and platelets. Plasma is composed of 92 percent of water. When a person loses more fluid, the plasma portion of the blood gets destroyed.

Many conditions do not cause acute blood loss, which can also reduce blood volume. Hypovolemic shock can also be caused due to

• Severe vomiting.

• Dehydration.

• Diarrhea.

• Excessive sweating.

Hypovolemic shock can be diagnosed easily when this condition is caused due to an external wound or injury. One of the important causes of hypovolemic shock is due to some underlying health condition. Internal bleeding, which results in hypovolemic shock, is challenging to diagnose and cannot be managed without surgery.

How Is Hypovolemic Shock Diagnosed?

This condition is diagnosed through every knee observation and examination. A physical examination will reveal whether the person reduced blood pressure, enhanced heartbeat, low body temperature, and increased heartbeat. The doctor recommends some tests, which are

• Blood test, which helps to diagnose the condition.

• EKG (electrocardiogram): This records the electrical signals from the heart and is used to diagnose various heart conditions.

• Echocardiogram: This utilizes sound waves to monitor blood movement through the heart and heart vessels.

• Right Heart Catheterization: A small, thin, hollow tube known as a catheter is used to view the heart.

• Computed tomography (CT).

• Endoscopy:

This procedure inserts a long, thin tube into the body to view the internal organs.

How Is Hypovolemic Shock Managed?

Hypovolemic shock can be managed only by managing the underlying cause. The doctors initially try to cease the fluid loss, stabilize the blood volume, and prevent any further complications. Usually, crystalloids are used as alternatives to replace the lost blood volume. This is administered intravenously, using thin fluids like saline solution. Sometimes, thicker solutions called colloids are also used.

In some severe cases, the remaining blood gets diluted, which can cause reduced levels of platelets and other blood components responsible for clot formation. The doctors usually replace these components if the person continues to bleed through red blood cell transfusion. The underlying condition can be treated once the shock is controlled and the blood volume stabilizes.

Older adults are at higher risk of being affected by hypovolemic shock as they are more susceptible to dehydration. This is an important trigger factor for hypovolemic shock. Older adults cannot handle reduced blood volume. The complications increase with age when other underlying conditions have resulted in organ damage like kidney failure or heart attack. Older adults must be treated immediately if they are affected by hypovolemic shock.

Some medications used to manage hypovolemic shock are

• Epinephrine.

• Dopamine.

• Norepinephrine.

• Dobutamine.

What Are the Complications Associated With Hypovolemic Shock?

• This condition enhances blood pressure and heart rate.

• Frequent headaches.

• Breathing difficulties.

• Irregular heartbeats.

What Is the Outlook of Hypovolemic Shock?

If hypovolemic shock is treated at an early stage, the effects caused by this condition can be reversed. If the person is affected by a mild form of hypovolemic shock and is young, the effects can be less, but there are also chances of heart attack and organ failure. Hypovolemic shock can be fatal if more than two organ damage occurs.

Conclusion

Hypovolemic shock is an emergency condition that needs to be treated immediately. In this condition, the blood volume reduces to a dangerous level. This condition has various stages. In the last stage, the patient's condition becomes critical, and treatment includes stabilizing blood volume and treating the underlying cause.