Pediatric Shock Part 3 Hypovolemic Shock

Hypovolemic Shock

It can result from a systemic drop in intravascular blood volume.   It also may be caused by significant hemorrhage from a traumatic injury (hemorrhagic shock) or by loss of other body fluids, such as from vomiting or diarrhea

Causes

·         Diarrhea

·         Hemorrhage

·         Vomiting

·         Inadequate fluid intake

·         Osmotic diuresis

·         Third space fluid loss

·         Burns

Hypovolemic Shock

·         Most common cause of shock in children

·         Results from diarrhea, vomiting, DKA, large burns, or trauma

·         Hypovolemia is complicated by poor oral intake

Hypovolemic Shock Symptoms

·         Tachypnea

·         Tachycardia

·         Hypotension or near normal BP

·         Weak peripheral pulses

·         Delayed capillary refill

·         Cool, clammy skin

·         Changes in mental status

·         Oliguria

Note:  Tachypnea represents a respiratory compensation to maintain acid-base balance that may result from lactic acidosis or ketoacidosis.

Management of Hypovolemic Shock

·         Identify type of fluid loss

·         Isotonic crystalloids 20ml/kg boluses, up to 60ml/kg

·         Correct metabolic abnormalities

·         Control external hemorrhage

·         Observe for ongoing, occult, fluid/blood loss

Stages and Signs and Symptoms of Dehydration

·         Mild

·         Moderate

·         Severe

Mild Dehydration

·         Child:  5% estimated weight loss or 50ml/kg fluid loss

·         Adolescent:  3% estimated weight loss or 30ml/kg fluid deficit

·         Symptoms:   Dry mucus membranes, oliguria

Moderate Dehydration

·         Child:  10% estimated weight loss or 100ml/kg fluid loss

·         Adolescent:  5-6% estimated weight loss or 50-50ml/kg fluid deficit

·         Symptoms:   Poor skin turgor, Sunken fontanels, Marked oliguria, Tachycardia, Quiet tachypnea

Severe Dehydration

·         Child:  15% estimated weight loss or 150ml/kg fluid loss

·         Adolescent:  7-9% estimated weight loss or 70-90ml/kg fluid deficit

·         Symptoms:   Marked tachycardia, Weak distal pulses, Narrow pulse pressure, Tachypnea, Hypotension, decreased level of consciousness

Source

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)