What Is Hypovolemic Shock?
Hypovolemic shock, also known as hemorrhagic shock, is a
life-threatening condition that results when you lose more than 20 percent
(one-fifth) of your body’s blood or fluid supply. This severe fluid loss makes
it impossible for the heart to pump a sufficient amount of blood to your body.
Hypovolemic shock can lead to organ failure. This condition requires immediate
emergency medical attention.
Hypovolemic shock is the most common type of shock, with very
young children and older adults being the most susceptible.
What causes hypovolemic shock?
Hypovolemic shock results from significant and sudden blood or
fluid losses within your body. Blood loss of this magnitude can occur because
- bleeding from serious cuts or wounds
- bleeding from
blunt traumatic injuries due to accidents
- internal bleeding
from abdominal organs or ruptured ectopic pregnancy
- bleeding from the
In addition to actual blood loss, the loss of body fluids can
cause a decrease in blood volume. This can occur in cases of:
- excessive or
- severe burns
- protracted and
Blood carries oxygen and other essential substances to your organs
and tissues. When heavy bleeding occurs, there is not enough blood in
circulation for the heart to be an effective pump. Once your body loses these
substances faster than it can replace them, organs in your body begin to shut
down and the symptoms of shock occur. Blood pressure plummets, which can be
What are the symptoms of hypovolemic shock?
The symptoms of hypovolemic shock vary with the severity of the
fluid or blood loss. However, all symptoms of shock are life-threatening and
need emergency medical treatment. Internal bleeding symptoms may be hard to
recognize until the symptoms of shock appear, but external bleeding will
be visible. Symptoms of hemorrhagic shock may not appear immediately. Older
adults may not experience these symptoms until the shock progresses
Some symptoms are more urgent than others.
Mild symptoms can include:
- profuse sweating
symptoms, which must be taken seriously and warrant emergency medical
- cold or clammy skin
- pale skin
- rapid, shallow breathing
- rapid heart rate
- little or no urine output
- weak pulse
- blue lips and fingernails
- loss of consciousness
The sign of external hemorrhaging is visible, profuse bleeding from
a body site or area of injury.
Signs and symptoms of internal hemorrhaging include:
- abdominal pain
- blood in the stool
- black, tarry stool (melena)
- blood in the urine
- vomiting blood
- chest pain
- abdominal swelling
While some symptoms like abdominal pain and sweating can point
to something less urgent like a stomach virus, you should seek immediate
medical attention when seeing groupings of these symptoms together. This is
especially true for the more serious symptoms. The longer you wait, the more
damage can be done to your tissues and organs.
If you have any signs of hemorrhaging or of hemorrhagic shock,
seek medical attention immediately.
Emergency care and first aid
Untreated hypovolemic shock will lead to death. Hypovolemic
shock is a medical emergency. Call 911 immediately if you observe a person
experiencing shock symptoms. Until responders arrive:
- Have the person lie flat with
their feet elevated about 12 inches.
- Refrain from moving the person
if you suspect a head, neck, or back injury.
- Keep the person warm to avoid
- Don’t give the person fluids by
Don’t elevate their head. Remove any visible dirt or debris from
the injury site. Do not remove embedded glass, a knife, stick, arrow, or
any other object stuck in the wound. If the area is clear of debris and no
visible object protrudes from it, tie fabric, such as a shirt, towel, or
blanket, around the site of injury to minimize blood loss. Apply pressure to
the area. If you can, tie or tape the fabric to the injury.
What complications are associated with hypovolemic shock?
A lack of blood and fluid in your body can lead to the following
- damage to organs such as your
kidney or brain
- gangrene of the arms or legs
- heart attack
The effects of hypovolemic shock depend on the speed at which
you’re losing blood or fluids and the amount of blood or fluids you are losing.
The extent of your injuries can also determine your chances for survival. Chronic
medical conditions such as diabetes, previous stroke, heart, lung, or kidney
disease, or taking blood thinners like Coumadin or aspirin can increase the
likelihood that you’ll experience more complications from hypovolemic shock.
How is hypovolemic shock diagnosed?
There are often no advance warnings of shock. Instead, symptoms
tend to arise only when you’re already experiencing the condition. A physical
examination can reveal signs of shock, such as low blood pressure and rapid
heartbeat. A person experiencing shock may also be less responsive when asked
questions by the emergency room doctor.
Heavy bleeding is immediately recognizable, but internal
bleeding sometimes isn’t found until you show signs of hemorrhagic shock.
In addition to physical symptoms, your doctor may use a variety
of testing methods to confirm that you’re experiencing hypovolemic shock. These
- blood testing to check for
electrolyte imbalances, kidney, and liver function
- CT scan or ultrasound to
visualize body organs
- echocardiogram, an ultrasound
of the heart
- electrocardiogram to assess
- endoscopy to examine the
esophagus and other gastrointestinal organs
- right heart catheterization to
check how effectively the heart is pumping
- urinary catheter to measure the
amount of urine in the bladder
Your doctor may order other tests based on your symptoms.
How is hypovolemic shock treated?
Once at a hospital, a person suspected of having hypovolemic
shock will receive fluids or blood products via an intravenous line, to
replenish the blood lost and improve circulation. Treatment revolves around
controlling loss of fluid and blood, replacing what’s been lost, and
stabilizing damage that both caused and resulted from the hypovolemic shock.
This will also include treating the injury or illness that caused the shock, if
- blood plasma transfusion
- platelet transfusion
- red blood cell transfusion
- intravenous crystalloids
Doctors may also administer medications that increase the
heart’s pumping strength to improve circulation and get blood where it’s needed.
Antibiotics may be administered to prevent septic shock and
Close cardiac monitoring will determine the effectiveness of the
treatment you receive.
Hypovolemic shock in older adults
Hypovolemic shock is dangerous for everyone, but it can be
particularly dangerous in older adults. Older adults who experience hypovolemic
shock have higher mortality rates than their younger
counterparts. They have less tolerance for the shock, and earlier treatment to
prevent other complications is vital. This can be made more complicated, as
older adults may not show symptoms of shock until later than younger
Common complications of hemorrhagic shock include:
- kidney damage
- other organ damage
Some people may also develop gangrene due to decreased
circulation to the limbs. This infection may lead to amputation of the affected
Recovery from hypovolemic shock depends on factors like the
patient’s prior medical condition and the degree of the shock itself.
Those with milder degrees of shock will have an easier time
recovering. If severe organ damage results from the shock, it can take much
longer to recover, with continued medical interventions needed. In severe
cases, organ damage may be irreversible.
Overall, your outlook will depend on the amount of blood you
lost and the type of injury you sustained. The outlook is best in healthy
patients who haven’t had severe blood loss.