Hypovolemia

What is hypovolemia?

Hypovolemia occurs when you don’t have enough fluid (blood) volume circulating in your body. A low volume of fluid could include water, blood (plasma) in your circulatory system and/or lymphatic fluid. Lymphatic fluid is a liquid substance full of white blood cells that helps remove toxins and waste from your body.

About 50% to 60% of your body consists of fluid. If you have hypovolemia, you lose more than 15% of the total volume of fluid within your circulatory system.

Immediate treatment for hypovolemia is necessary to prevent life-threatening complications like organ damage, shock or death.

What is hypovolemic shock?

Hypovolemic shock is the most severe form of hypovolemia that needs emergency treatment. This condition occurs when you lose a significant amount of fluid or blood, which prevents your heart from pumping blood throughout your body. Hypovolemic shock can cause your organs to stop functioning.

People who experience hypovolemic shock lose more than 20% of the amount of fluid in their body, which could be from a severe injury (cuts or burns), internal bleeding, vomiting or diarrhea.

How common is hypovolemia and who does it affect?

Hypovolemia can affect anyone. The exact rate of occurrence is unknown but hypovolemia is common among people who have illnesses with a sudden onset, a severe injury or among people who are critically ill.

How does hypovolemia affect my body?

Your body needs a certain amount of fluid (blood) to keep your organs functioning. Like the plants in your garden, your body needs fluids to stay alive. If there is a drought and your garden doesn’t get enough water from rain, your plants will wilt. Your body needs fluids to keep you from wilting too. When you’re diagnosed with hypovolemia, your healthcare provider will give you supplemental fluids to replace the fluid you lost in the same way that you use a watering can to water the plants in your garden when it doesn’t rain.

What are the symptoms of hypovolemia?

Symptoms of hypovolemia range in severity for each person. Signs of hypovolemia include:

• Dizziness when standing.
• Dry skin and dry mouth.
• Feeling tired (fatigue) or weak.
• Muscle cramps.
• Unable to pee (urinate) or the color of your urine is darker than normal.

Severe symptoms of hypovolemia that could indicate life-threatening hypovolemic shock include:

• Confusion.
• Difficulty breathing or fast breathing.
• Excessive sweating.
• Losing consciousness.
• Low blood pressure.
• Low body temperature.
• Pale skin tone or a blue tone to the skin and lips (cyanosis).

If you experience any of these symptoms, especially after an injury, visit the emergency room immediately.

What causes hypovolemia?

Loss of bodily fluid or blood causes hypovolemia. There are several ways that your body can lose blood or fluid including:

• Injury: An external cut, burn or wound.
• Illness: A condition with symptoms of persistent vomiting and diarrhea.
• Internal bleeding: An underlying condition that causes blood loss within your body.
• Dehydration or malnutrition: A lack of water and salt (electrolyte) intake decreases blood volume.
• Excessive sweating: Participating in strenuous activities where you sweat for a long time or a condition that causes you to sweat more than normal (hyperhidrosis).

How is hypovolemia diagnosed?

After taking your medical history, your healthcare provider will give a physical exam and offer diagnostic laboratory tests to check your fluid and sodium levels. Low sodium in your body can be a sign of hypovolemia. After tests and a hypovolemia diagnosis, your provider will pinpoint the source of your loss of fluid, which will lead to immediate treatment.

What tests diagnose hypovolemia?

Your provider may offer several tests to confirm a diagnosis including:

• Skin and mucous membranes: During a physical exam, your provider will examine your skin and the mucous membranes in your mouth, tongue and nose for dryness, which is a sign of the condition.
• Pulse, body temperature and blood pressure: Your provider will test your vitals while you’re sitting and while you’re standing to monitor changes. During this process when you change your posture, your provider will examine your symptoms, especially if you get dizzy when you’re upright, which is a sign of hypovolemia.
• Blood or urine tests to measure kidney function.
• Imaging tests like an ultrasound or echocardiogram.

How is hypovolemia treated?

Immediate treatment leads to the best outcome for people diagnosed with hypovolemia. The goal of treatment for hypovolemia is to increase the amount of fluid volume in your body via fluid replacement (fluid resuscitation). During this procedure, an IV (intravenous) tube injects fluids into your vein. Depending on what type of fluid your body needs, your fluid replacement could include:

• Blood transfusion: Blood from a donor replaces lost blood in your body.
• Crystalloid solution: Tiny molecules of dissolved saline (salt in water), sugar in water (dextrose) or a combination of sodium, chloride, potassium, calcium and lactate (lactated Ringer’s solution).
• Colloids: Large molecules that stay in your blood vessels (albumin, hetastarch).

In addition to fluid replacement, your provider will treat the cause of your hypovolemia, which could include:

• Treating an infection or illness.
• Healing a wound.
• Providing missing nutrients (like sodium or electrolytes).

How soon after treatment will I feel better?

Hypovolemia lasts until your body can replenish the amount of fluid lost. This could take a couple of days to a few weeks. Once treatment begins, it will progress in steps to make sure your body receives enough fluid to maintain blood flow and prevent life-threatening symptoms. At first, you might receive a larger amount of IV fluid, and once your fluid volume gets closer to 100%, the amount of fluid you receive will decrease until your fluid volume stabilizes and your symptoms go away.

How can I reduce my risk of hypovolemia?

While you can’t always prevent external factors that cause hypovolemia, you can take steps to reduce your risk by:

• Treat your infections, injuries or illnesses immediately.
• Avoid activities that cause excessive sweating.
• Drink water and stay hydrated.
• Prevent cuts and burns by wearing personal protective equipment (PPE).

What can I expect if I have hypovolemia?

The prognosis varies for people diagnosed with hypovolemia. Each case is dependent on treating and stopping the cause of blood or fluid loss. If hypovolemia receives an early diagnosis and treatment, the prognosis is usually good. Untreated cases or delayed treatment can have a life-threatening outcome that can cause permanent organ damage or death.

Once treatment begins to replenish the fluid lost in your body, symptoms will decrease and go away when your fluids reach their normal capacity.

How do I take care of myself?

After a hypovolemia diagnosis, you can take care of yourself by:

• Resting.
• Avoiding strenuous activity.
• Staying hydrated.
• Eating a well-balanced and nutritious diet.

When should I go to the ER?

Visit the emergency room immediately if you have symptoms of hypovolemia, especially if your symptoms occur after:

• An injury like a burn, cut or wound.
• An illness like the stomach flu where you have persistent vomiting or diarrhea.
• An episode where you can’t eat or drink.

An activity or event that caused you to sweat more than normal.

What questions should I ask my doctor?

• How long will I need IV fluids?
• What caused my body to lose blood?
• When can I return to my normal activities after treatment?
• How do I keep my body hydrated after treatment?

What is the difference between hypovolemia and hypervolemia?

Hypovolemia and hypervolemia are both conditions that identify how much fluid or blood is in your body. The root “hypo” in hypovolemia means “under” and “hyper” means “over.” If you have hypovolemia, you don’t have enough fluid in your body. If you have hypervolemia, you have too much fluid in your body.

A note from Cleveland Clinic

Blood or fluid loss is a serious condition that needs immediate treatment. If you recently had an injury or illness and you experience symptoms of hypovolemia, visit the emergency room immediately. If you have very mild symptoms, contact your provider to discuss ways you can replenish the amount of fluid your body lost, like staying hydrated and resting. While your diagnosis might be a temporary delay to your normal activities, treatment for hypovolemia can get you back on your feet and feeling better as soon as your body’s fluids reach their normal capacity.