Paediatrics: Hypovolaemic shock

Hypovolaemic shock

Shock is characterized by inadequate systemic perfusion. The most common type, hypovolaemic shock, is related to abnormally low circulating blood volume.

Causes

The causes of hypovolaemia are:

• Trauma.
• GI bleeding.
• Burns.
• Peritonitis.
• Diarrhoea.
• Diabetic ketoacidosis.

Diagnosis

Perform a rapid clinical examination and direct your initial treatment towards the patient’s vital signs.

Initial treatment

Follow a standard protocol

• Airway, Breathing, Circulation, Disability (ABCD).
• Blood: in patients with significant blood loss, transfusion will be required (about 2mL/kg to increase haemoglobin concentration by 1g/dL). (Patient may need O –ve unmatched blood in an emergency). Monitor the response with laboratory testing.
• Fluid: acutely, blood pressure and perfusion need to be restored with the crystalloid infusion. IV bolus of normal saline, 20mL/kg, can be given over 15min and repeated if necessary. If more than 60mL/kg is required consider endotracheal intubation and ventilatory support. In the patient who is dehydrated, the water and electrolyte deficit needs to be replaced.
• Refractory hypotension: intubation and intensive care monitoring and therapy are required.