Diseases and Disorders

Hypovolemic/Hemorrhagic Shock

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INTRODUCTION

DRG Category: 640

Mean LOS: 5.1 days

Description MEDICAL: Nutritional and Miscellaneous Metabolic Disorders with Major CC

classification section:

Hypovolemic shock results from a decreased effective circulating volume of water, plasma, or whole blood and is the most common type of shock in adults and children. External, sudden blood loss resulting from penetrating trauma and severe gastrointestinal bleeding are common causes of hemorrhagic shock. A significant loss of greater than 30% of circulating volume results in a decrease in venous return, which in turn diminishes cardiac output and decreases perfusion to vital organs and causes the symptoms associated with shock. When there is insufficient oxygen available to the cells, metabolism shifts from aerobic to anaerobic pathways. In this process, lactic acid accumulates in the tissues, and the patient develops metabolic acidosis. In addition, the tissues do not receive adequate glucose, and they cannot accomplish the removal of carbon dioxide. This disruption in normal tissue metabolism results initially in cellular destruction and, if left uncorrected, death. Significant hypovolemic shock (< 40% loss of circulating volume) lasting several hours or more is associated with a fatal outcome.

The American College of Surgeons separates hypovolemic/hemorrhagic shock into four classifications: Stage I occurs when up to 15% of the circulating volume, or approximately 750 mL of blood, is lost. These patients often exhibit few symptoms because compensatory mechanisms support bodily functions. Stage II occurs when 15% to 30%, or up to 1,500 mL of blood, of the circulating volume is lost. These patients have subtle signs of shock, but vital signs usually remain normal. Stage III occurs when 30% to 40% of the circulating volume, or from 1,500 to 2,000 mL of blood, is lost. This patient looks acutely ill. The most severe form of hypovolemic/hemorrhagic shock is stage IV. This patient has lost more than 40% of circulating volume, or least 2,000 mL of blood, and is at risk for exsanguination. Complications of hypovolemic shock include adult respiratory distress syndrome, sepsis, acute renal failure, disseminated intravascular coagulation, cerebrovascular accident, and multiple organ dysfunction syndrome.

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