Hypovolemia – Causes, Symptoms, Treatment, Prevention

Hypovolemia – Causes, Symptoms, Treatment, Prevention.






Hypovolemia is a serious condition in which there is heavy reduction of blood volume in the body. If left untreated or not treated promptly, hypovolemia can cause death. Hence this condition needs emergency medical care and is a kind of hemorrhagic shock wherein loss of 1/5th of blood volume occurs. Hypovolemia shock is a life threatening disorder in which the person loses 20-25% of blood volume or body fluids. Under such condition, the heart would not be able to pump the required blood needed by the body. Sudden loss of blood can cause vital organ failure resulting in death.

Intense bleeding during accidents or internal bleeding can cause this condition. Severe Dehydration can result in loss of basic ions like sodium leading to reduction of intravascular water and hypovolemia. Complete depletion of sodium ions from the body can occur due to Diarrhea can lead to this condition.

Causes :

Severe loss of blood in volume is the major cause for hypovolemia. It can occur either through internal bleeding of organs or external bleeding due to accidents. Bleeding of organs in the digestive tract and severe loss of blood due to Vaginal Bleeding can cause this condition. Reduction in the levels of plasma due to discharge of bodily fluids by lesions or burns can cause hypovolemia. In rare cases rupture of Ectopic Pregnancy can cause heavy loss of blood.

Sudden depletion of sodium ions in the blood due to repeated vomiting or diarrhea can result in hypovolemia. Significant loss of body fluids can occur due to diarrhea can reduce the normal blood volume drastically. Loss of body fluids can occur due to prolonged diarrhea, severe burns and Stomach flu.

Symptoms Of Hypovolemia :

• Many symptoms can accompany loss of blood and bodily fluids.


• The skin becomes pale and bluish due to loss of blood.


• Heart rate increases due to reduced blood circulation increasing the risk of an attack.


• It can cause sudden increased Anxiety.


• Rate of respiration increases drastically and the person begins to breathe fast to make good the loss of fluids/blood.


• Blood Pressure falls suddenly due to reduction in the supply of blood to vital organs like kidney and brain.


• In the final stage, the person may have issues like confusion, altered mental state, disorientation and loss of consciousness. The pulse gets weaker and weaker.


• In case of internal bleeding, symptoms may not appear until the situation becomes worse and uncontrollable.

Tests :

If you are experiencing any of the above signs get yourself admitted to the nearest hospital immediately. Hypovolemia is an emergency medical condition requiring prompt treatment. You need to understand that some of the above symptoms would appear only if the blood volume has reduced by 20%.

Your doctor would complete physical examination and other emergency tests to ascertain if it is hypovolemia. Blood count (CBC) will be tested and imaging tests like X-ray or CT scan will be performed. Based on the physical status of the patient, echocardiogram would be done for assessing the working of the heart.

Hypovolemia Treatment :

Prompt treatment is required for patients with hypovolemia condition. If diagnosis is done at early stage wherein blood volume has reduced to 10% or less you have a fair chance of survival. Loss of blood volume at low level can be treated swiftly. The patient will be put on intravenous fluids to restore loss of body fluids and blood. It is very much essential to replace the lost electrolytes in the body.

Casualty treatment for hypovolemia includes blood plasma or platelet transfusion on emergency basis. Blood replacement would be initiated once the blood group result is obtained from the laboratory. The blood volume should be brought back to normalcy by injecting blood intravenously. Once the condition of the patient becomes stable, oral diet can be administered. Diet rich in protein is recommended.

For people with heavy loss of blood or body fluids treatment is difficult and complicated. Low levels of blood and fluids can lead to organ failure and such conditions are irreversible in many cases. Depending on the health condition of the patient, IV fluids is given. Medications like epinephrine or dopamine is given for improving the function of the heart.

The condition of the patient is monitored closely until things are improving and stabilized. For some people, Gangrene or tissue death may occur in particular part of the body due to poor circulation of the blood. In such cases, amputation of specific part is done surgically. In several cases of accidental trauma the patient loses heavy volumes of blood and dies due to hypovolemia and vital organ failure.

Prevention :

• Prompt medical attention is required for people with symptoms of hypovolemia. You can do nothing to prevent accidents but take steps to avoid such situation.


• Do not delay in checking with your doctor if you are experiencing low blood pressure, increased heartbeat, and other symptoms given above.


• If you are above 60 years, get yourself examined with your doctor at regular intervals.


• Internal bleeding is more dangerous than accidental bleeding and in many cases it can be fatal.


• Hypovolemia is a life threatening condition and call 911 promptly if you or your loved ones are experiencing any of the above signs and symptoms.

Complications :

• Hypovolemia shock can cause several complications due to sudden loss of blood volume.


• It can result in organ damage and paralyzed function of vital organs like heart or kidney.


• Gangrene or tissue death is yet another complication of hypovolemia affecting legs or arms.

Who Are At Risk?

Anyone can get hypovolemia shock irrespective of age and sex.

However it is common in older adults and people with chronic medical conditions like Diabetes, heart problems, and kidney disease and lung issues.

Those who are taking blood thinners for long term without consulting doctor are at increased risk of hypovolemic shock.

Elderly people are more vulnerable to this kind of shock due to internal bleeding and mortality rates are high since no symptoms are observed until the advance stage.

Outlook :

Prognosis for hypovolemia shock depends on the rate of blood loss or fluid loss from the body. Age and health condition of the patient and intensity of injury and intensity or organ damage also determines the rate of survival. People with severe blood loss have few chances of survival.

Hypovolemia

Hypovolemia






Hypovolemia is the condition caused by loss of blood resulting in reduction in total volume of blood/fluids in the body. It can happen due to accident or any medical condition like internal bleeding. Even Diarrhea can dehydrate the body causing intense loss of fluids. Taking diuretic drugs, excess of sweat and lack of adequate fluid in the body can also cause hypovolemia.

Due to loss of fluids/blood, the soft mucous membranes of the body will dry out and subsequently the skin will lose its elasticity becoming hard. The immune system of the body will act immediately for compensating the loss of fluids by increasing the heartbeat, and constricting blood vessels thus sustaining the regular blood flow to vital organs. Eventually Blood Pressure decreases suddenly causing collapse of heart and tissue damage. The condition of hypovolemia occurs when the body loses adequate blood (1/5) of the total volume. This condition is a medical emergency and has to be treated immediately.

Symptoms :

To begin with the mucous membranes will become dry and the urine output will reduce. The skin becomes rough and loses elasticity. The soft skin layer of the mouth and nose becomes hard and dry. If left untreated and there is continuous loss of fluids it can cause serious symptoms gradually.

Some of the serious Symptoms of hypovolemia are given below:-

Reduction in concentration and concentration level, change in color of the lips and fingernails (becoming pale blue), sharp pain in the chest, rapid heartbeat, palpitations, uncontrolled vomiting (which contributes for further loss of fluids) and internal bleeding are some of the serious symptoms of this disorder.

For severe cases, bloody discharge happens through rectum and for pregnant women there will be Vaginal Bleeding. Depending on the severity of the symptoms the person has to be hospitalized urgently.

Causes :

Loss of body fluids and blood can happen due to many factors. Persistent diarrhea, less intake of water/fluids, sudden sweating, and large burns caused by trauma can cause hypovolemia. Intake of diuretic medications (given for controlling blood pressure) can considerably reduce the urine output.

Accidents or any type of external injury can cause bleeding thus causing heavy loss of blood. Some of the rare conditions that cause this disorder are severe blood clotting, excess of sweating, kidney disorders, and repeated or uncontrolled vomiting and diarrhea. Pregnant women can lose heavy fluids when the placenta gets detached early. Hypovolemia is caused by certain life threatening factors like Ectopic Pregnancy (when the fetus develops outside the uterus), large burns, internal bleeding and serious injury.

Complications :

Hypovolemia if left untreated can cause serious consequences and may even be mortal. However not all the people having loss of fluids will have such conditions and only infants and elderly people are placed in high risk.

Tests :

The doctor will look for the above symptoms and tests are usually done in the intensive care unit along with treatment, for severe cases. For people with moderate loss of fluids/blood your doctor will look for the above symptoms after collecting the medical history.

Treatment :

Since hypovolemia causes fluid imbalance treatment will be oriented towards replacing body fluids or controlling loss of fluids. Depending on the cause the treatment is initiated. In case of injury or trauma, your doctor will take steps for preventing further loss of body fluids. If necessary he will provide artificial ventilation for the patient with symptoms of rapid breathing. Emergency treatment is to be given for heavy loss of blood or fluids caused by accidental injury. The patient will be put on intravenous fluids in the hospital. The doctor will keep his airway clear so that he can breathe comfortably. Blood transfusion will be done if the condition is unstable due to volumes of blood loss.

Medications are given by shots for managing blood pressure and for regularizing heartbeat and to strengthen heart contractions. The treatment can be given only after knowing the underlying medical issues that has caused loss of fluids. For patients with uncontrolled vomiting or diarrhea intravenous fluids are given for compensating fluid loss and for arresting vomiting or diarrhea. He would be given electrolyte solution for balancing loss of fluids.

Blood plasma transfusion, platelet transfusion and intravenous colloids that contain complex sugars are different methods of treatment for restoring blood volume. Depending on the severity of the case, red blood cell transfusion is done for some people. Medications like epinephrine, dopamine and vasopressors are given for maintaining blood pressure. In rare cases, hypovolemia can cause kidney/heart failure and brain damage due to sudden blood loss or fluid loss.

Hypovolemia

Hypovolemia

What is Hypovolemia?

Hypovolemia is a modification that occurs inside the human body, characterized by a reduction of the blood volume (more specifically, blood plasma). This change is also known as oligemia or hypovolemic shock, being encountered in a wide range of medical emergencies. Hypovolemia should not be confused with a person becoming dehydrated – in the first case, sodium is reduced, while in dehydration one loses water excessively. In the medical field, the hypovolemic shock is considered a medical emergency – the decrease in the blood volume affects the heart, the overall circulation and it can lead to multiple organ failure.

Signs and Symptoms

Doctors and other specialists have come up with a classification of hypovolemia and, as you will see, depending on the amount of blood plasma lost, the signs and symptoms will differ.

In the first stage of hypovolemia, the patient loses up to 15% of the overall blood volume, which means approximately 750 ml. At this point, the loss of blood plasma is still compensated by the body, which means that the Blood Pressure remains stable. The patients present a respiratory rate within normal limits (12-20 breaths/minute). However, one can notice that the skin has become pale and there are some patients who might exhibit anxiety-like status. In the majority of patients, the mental status remains unaffected at this point. Both the capillary refill and the urine output are within normal levels.

The second stage of hypovolemia is characterized by the loss of 15-30% of the total blood volume, which means between 750 and 1500 ml. The heart muscle is affected by the reduced amount of blood plasma, resulting in tachycardia (>100bpm) and increased respiratory rate (over 20 breaths/minute). While the systolic BP remains stable, one can notice an increase in diastolic blood pressure. The pulse becomes narrow and skin becomes excessively pale – as the blood is redirected towards major organs (heart, lungs, brain), the skin will also turn clammy and cold. The patient can present symptoms of anxiety, feeling restless. The capillary refill is delayed and the urine output is reduced to 20-30 ml/h.

In the third stage of hypovolemia, the blood loss is more considerate, reaching a percentage of 30-40 (as quantity – 1500-2000 ml). In patients who are in the third stage, the systolic BP is very low – it can even go under 100 mm Hg. By now, the patient exhibits increased heart rhythm (tachycardia – >120bpm) and a higher respiratory rate (>30 breaths/minute). The mental status is no longer intact, the patient presents marked confusion, feeling anxious and agitated. The skin is cold and pale, with profuse sweating. The capillary refill is delayed and the urine output is reduced to 20 ml/h.

Within the fourth stage of hypovolemia, the blood volume loss is over 40%, which means a decrease over 2000 ml. The pulse is barely felt and the patient exhibits market tachycardia (>140bpm). The respiratory rate is increased as well, while the systolic pressure is as reduced as 70 mmHg or even less. The mental status is severely affected, the patient can lose consciousness, entering into a state of severe lethargy or coma. An intense paleness characterizes the skin, which is extremely sweaty and cold. The capillary refill is no longer possible, the urine output is barely noticeable and the condition is life-threatening.

General symptoms for hypovolemia include:

• Anxiety


• Confusion


• Agitation


• The lips and nails become blue due to the blood being re-directed to major organs


• The urine output is reduced or barely noticeable


• The skin is cold, clammy and the patient sweats profusely


• The respiratory rate is increased


• The patient might experience vertigo or pain in the chest (possible sign of Heart Attack)


• Loss of consciousness – coma


• Reduced blood pressure


• Increased heart rate – tachycardia


• Barely noticeable pulse

Hypovolemia can also be caused by internal bleeding and one must learn how to recognize the signs of such problems. These are:

• Severe pain in the abdomen


• Blood in the stool or in the urine


• Severe bleeding from the vagina (not caused by the menstrual cycle)


• Coughing or vomiting blood


• Pain in the chest (possible heart attack)


• Swelling in different parts of the body

Types of Hypovolemia

There are two main types of hypovolemia, meaning relative and absolute. It is said that the hypovolemia is relative when the vascular tree increases in size, while the blood volume is not sufficient to handle the new changes. On the other hand, absolute hypovolemia can be encountered in several situations. For example, absolute hypovolemia often appears after severe dehydration but also in those who have suffered from hemorrhages, severe Diarrhea or excessive loss of liquids (through urine or sweat).

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Pathophysiology

The human body is designed to perfection, with complex mechanisms for compensation in case of damage. In the situation that a person suffers from hypovolemia, there will be an individual response from each of the following systems: neuroendocrine, hematologic, cardiovascular and renal.

The hematologic system responds to the acute loss of blood volume by activating the coagulation process, causing the blood vessels to constrict. The cardiovascular system will try to compensate by making the heart pump more rapidly and constricting the blood vessels that are located in the periphery. As a secondary mechanism of compensation, it will distribute the blood to the major organs (brain, lungs, heart), taking it away from the skin, gastrointestinal tract and muscles (hence the pale skin).

The renal system has a complex response to the hypovolemia – it starts by increasing the secretion of serotonin. This allows for angiotensinogen to be transformed into angiotensinogen 1 – this will then be transformed in the lungs and the liver in angiotensinogen 2. The purpose of all these responses is to counteract the effects of the hypovolemic shock. Angiotensinogen 2 acts by constricting the smooth muscles and also by stimulating the secretion of aldosterone. This has the purpose of reabsorbing sodium and water, thus maintaining the homeostasis of the body. Last, but not least, the neuroendocrine system responds to the hypovolemic shock by increasing the production of ADH (antidiuretic hormone), with the purpose of reabsorbing sodium and water.

Hypovolemia Treatment

These are the most common methods of treatment recommended for hypovolemia:

• Blood donation – it is important that the donor is healthy and that he/she does not suffer from anemia


• The patient is advised to lie down and rest until the homeostasis is restored


• The loss of blood plasma can be compensated by the administration of oral fluids – these have to include electrolytes and sugar, replenishing the body with what it has lost


• If the hypovolemia is caused by an external wound with hemorrhage, it is important to apply pressure to the wound – this is a medical emergency and the patient should be taken to the hospital before it is too late


• Emergency oxygen is applied as a first aid measure, helping the remaining blood volume to maintain the homeostasis of the body


• Intravenous fluids represent a temporary solution for hypovolemia but it is important to understand that these cannot carry oxygen in the same way that blood does


• Antidotes are administered in patients who suffer from hypovolemia induced by medication


• If the hypovolemia is caused by trauma, surgical intervention will be necessary, at the same time with a blood transfusion.

Hypovolemia vs Dehydration

As it was mentioned at the start of the article, it is very important not to confuse hypovolemia with dehydration. Often times, we hear even medical professionals who are using these terms loosely, as they consider them to be synonyms. When one says dehydration, it means that a person practically loses water and nothing else. The state of dehydration can be confirmed by performing blood tests – these will reveal a normal level of sodium. Hypovolemia, on the other hand, refers to the blood volume being decreased – this means that, besides water, the patient also loses sodium and other electrolytes that are vital for life. While the state of dehydration can be compensated by the administration of water, the treatment of hypovolemia is more complex, as you have seen above.

Hypovolemia lab values

These are the changes you will encounter in the lab tests for hypovolemia:

• Sodium excretion increased


• Specific gravity increased


• BUN (blood urea nitrogen) increased – demonstrates kidney function


• Hct (hematocrit) increased


• Osmolality
  
  
  
  • ICF volume increased
  
  
  • ECF volume decreased
  
  
  
  


• Potassium decreased.

Complications

First and foremost, you should know that, untreated, this condition is life-threatening. The higher the blood volume loss, the higher the risk of damage to major organs or complete failure – most often affected: kidneys, heart or brain. The loss of blood volume can also lead to major circulatory problems, with gangrene affecting the limbs. As the heart pumps more and more, trying to compensate for the blood loss, there is an increased risk of heart attack.