Hypovolemic Shock

What is hypovolemic shock?

Hypovolemic shock is a dangerous condition in which your heart can’t get your body the blood (and oxygen) it needs to function. This happens because you’ve lost a large amount ― more than 20% ― of your blood volume. You can also get hypovolemic shock from losing a large amount of fluids after a lot of diarrhea, throwing up or sweating.

Because hypovolemic shock keeps your organs from getting enough blood or oxygen, you need to get treatment right away. Call 911 for this medical emergency.

What happens to blood pressure during hypovolemic shock?

At first, your diastolic (bottom or second number) blood pressure increases. As you keep losing blood or fluids, your systolic (top or first number) blood pressure comes down.

Who does hypovolemic shock affect?

Hypovolemic shock can affect anyone who’s had a traumatic accident that causes a lot of bleeding. A loss of fluids from throwing up, sweating or having diarrhea can also affect anyone, and any of these can lead to hypovolemic shock.

How common is hypovolemic shock?

Fewer than 1 out of every 1,000 people gets some type of shock. Hypovolemic shock is the second most common type of shock and the most common type children get (from diarrhea in undeveloped nations).

How does hypovolemic shock affect my body?

Hypovolemic shock severely limits your body’s ability to get blood to all of your organs. This can lead to organ failure, which can be deadly. While your body fights to meet its demand for oxygen, it makes your brain and heart the top priority for receiving oxygen. This is why your arms and legs can get cold. Some of the blood they would normally get is sent to the organs that keep you alive.

The blood in your body takes up about 7% of your body weight, which is about 5 liters or 1.3 gallons in someone who weighs 70 kg or 154 pounds. With hypovolemic shock, there’s a large loss of blood or fluids. The four stages of hypovolemic shock are:

• Stage 1: You’ve lost 15% of your body’s blood (750 mL or about 25 ounces). Blood pressure and heart rate may still be normal at this point.
• Stage 2: You’ve lost 15% to 30% of your body’s blood (750 mL to 1,500 mL or up to almost 51 ounces). Your heart rate starts to go up and you start to breathe faster.
• Stage 3: You’ve lost 30% to 40% of your blood (1,500 to 2,000 mL or up to 68 ounces). Your blood pressure drops very low and your heart rate and breathing get faster. You can’t produce much pee.
• Stage 4: You’ve lost more than 40% of your body’s blood (more than 2,000 mL or 68 ounces). Your blood pressure is low and your heart rate is high. You’re producing very little or no pee.

What are the symptoms?

As you lose more blood or fluids, your symptoms get worse. Hypovolemic shock symptoms include:

• Breathing faster than normal.
• Feeling confused or anxious.
• Sweating a lot.
• Passing out.
• Having skin that feels cool.
• Feeling weak.
• Having a low temperature and low blood pressure.
• Having a fast pulse.

What causes hypovolemic shock?

Major blood or fluid loss causes hypovolemic shock. You may be bleeding a lot inside your body, where you can’t see it, or outside your body, where you can see an obvious injury. You can also get hypovolemic shock from burns, pancreatitis, or from too much sweating, throwing up or diarrhea.

Types of bleeding that lead to hypovolemic shock include bleeding from:

• A traumatic injury.
• Surgery.
• Ectopic pregnancy.
• An aneurysm that has burst.
• Gastrointestinal problems, such as an ulcer.

How is hypovolemic shock diagnosed?

Your healthcare provider will do a physical exam and order tests.

Tests for hypovolemic shock include:

• Blood tests.
• Electrocardiogram (EKG).
• Echocardiogram.
• Right heart (Swan-Ganz) catheterization.
• Computed tomography (CT) or other imaging.
• Endoscopy.

How is hypovolemic shock treated?

Once you’re in an ambulance or at the hospital, your provider will give you fluids (like saline) first and then blood through an IV. They will also give you medicines to help bring your blood pressure back up to normal. It’s important that they also treat the problem that caused your hypovolemic shock, such as stopping the bleeding. If an accident caused your bleeding, you may need surgery to repair your injury.

Your provider will continue to monitor you in the Intensive Care Unit.

What medications are used for hypovolemic shock?

You may receive these medicines for hypovolemic shock:

• Epinephrine (Adrenalin®).
• Norepinephrine (Levophed®).
• Dopamine.
• Dobutamine (Inotrex®).

Complications/side effects of the treatment

Side effects of hypovolemic shock medicines include:

• Increase in blood pressure and heart rate.
• Difficulty breathing.
• Headache.
• Irregular heartbeat.

How can I reduce my risk?

Since traumatic injury is a major cause of hypovolemic shock, you can’t predict or prevent when it could happen to you. However, there are things you can do to reduce your risk of hypovolemic shock from other causes:

• If you’re taking diuretics, be sure to take the correct dose and to keep drinking fluids so you don’t get dehydrated.
• If you have diarrhea or are throwing up, be sure to keep drinking water or an electrolyte solution to replace the fluids you’re losing.
• If you’re sweating a lot, drink plenty of water to replace the fluids lost through sweat.

If you’re bleeding badly, get to an emergency room or call 911. Getting help quickly can help you avoid losing too much blood and getting hypovolemic shock.

What can I expect if I have hypovolemic shock?

Your ability to survive and recover from hypovolemic shock depends on how much blood or fluid you’ve lost and how quickly it happened. Other medical problems, including the one that caused your hypovolemic shock, will also affect how well you do.

Outlook for hypovolemic shock

If your provider treats shock early, they can reverse its effects. The odds are in your favor if you have mild hypovolemic shock and are younger. However, you could have organ damage or a heart attack. If two or more organs stop working, that increases the possibility that shock will be fatal. Even if you get treatment, hypovolemic shock can be fatal.

How do I take care of myself?

When you get home from the hospital, follow your healthcare provider’s instructions for continuing your recovery. Since your body has been through a lot, you’ll need to rest at home and heal before you return to work. Keep taking the medicines your provider ordered for you and be careful with any healing wounds.

When should I see my healthcare provider?

Your provider will want to have follow-up appointments with you to make sure you’re healing well. Be sure not to miss any appointments because your provider can catch problems that may be developing.

When should I go to the ER?

Call 911 when you see someone having hypovolemic shock symptoms. The sooner you get help for the person, the better. While waiting for help, make sure the person is lying down with their feet up about a foot higher than the rest of their body. Other than raising their feet, don’t move their body. Try to stop the person’s bleeding and keep them warm.

If you’ve been through hypovolemic shock yourself, you may need to go back to the ER if your wounds start bleeding again or get infected.

What questions should I ask my doctor?

• Will hypovolemic shock have long-lasting effects?
• When will I heal completely?
• How long will I need to keep taking the medicines you prescribed?

A note from Cleveland Clinic

Hypovolemic shock is a medical emergency, but getting care quickly gives you the best chance of survival. Your provider may be able to reverse the condition, but you’ll need time to recover and heal. This is especially true if a traumatic injury caused your shock. Be sure to follow your provider’s instructions for taking care of yourself and your wounds.