Management of

hypovolemic shock due

to fluid loss
GARIKIPATI KRISHNA VENU
ROLL NO.36
 Body fluids

 Fluid distribution
 Intracellular space=2/3rd of body weight
 Extra cellular space=1/3rd of body weight
 Interstitial space 80%
 Vascular space 20%
Clinical manifestations:

 Anxiety
 Tachycardia
 Hypotension
 Delayed capillary refill
 Thirst
Management

 Fluid therapy
 Plasma expanders
Fluid therapy(Re expansion of
intravascular volume)
 Fluid therapy
 Crystalloid

1. 0.9% saline
2. Ringer lactate
Colloid

1. 5% albumin
2. Gelatin , Hetastarch
 20 ml/kg in 5-15 minutes
 Repeat upto 60ml/kg
Fluid therapy
 Normal saline
 It is 0.9% Nacl .In shock it has to administered 60-90ml/kg
 It has same concentration of that of solutes of blood.
 Advantages:

1. Fluid is evenly distributed throughout the body .

2. Long storage life
3. Easily available
 Disadvantages:

1. Larger volumes needed,longer time needed

2. Risk of intestinal edema
3. Small volume effect I.e only 250-300 ml is intravascular remaining
fluid is distributed to interstitial space
Ringer lactate solution
 1000ml of ringer lactate will expandintravascularvolume by
200-250ml within 1hr
 Advantages:1.Used in dehydration effectively
2.Easily available
3.It maintains more stable blood Ph when compared to normal saline
4.Long storage life
 Disadvantages:1.Chest pain,coughing, itching, difficulty in
breathing
2.Venous thrombosis,edema formation
Plasma expanders
 Dextran: obtained from sugar beet(Dose-20ml/kg)
 It is available in two forms-dextran 70 , dextran 40
 Advantages:
1. Long acting(24 hrs ),slowly excreted by glomerular
filtration
2. Cheap and stored for long time(10 years)
 Disadvantages:
1. Interfere with coagulation and platelet aggregation
2. Fall in Bp and itching
 Drugs:Dextran70(6% solution in dextrose)
Lomodex(10% solution in dextrose)
 Human Albumin:(20% Human albumin in 100ml)
 It holds and draws additional fluid from tissue
 Advantages:1.Does not interfere with coagulation
2.No risk of transmitting serum hepatitis as it's heat treated
3.No risk of sensitization
 Disadvantages:1.It is expensive
2.Febrile reaction to human albumin
Drugs :Albupan50,100ml inj.;Albumed5%,20% infusion(100ml)
 Polygeline(degraded gelatin polymer)(MW.30,000)
 Advantages:1.Hypersensitivity reactions are rare
2.No interference with blood grouping
3.Expansion lasts for 12 hrs
 Disadvantages:Short acting,Expensive,Causes hypotension
Drugs:Haemaccel,Seraccel 500ml vac
 Hetastarch :Complex mixture of ethoxylated amylopectin
 Average mol.wt 4.5 lac(range 10,000 to 1 million)
 Advantages:1.long elimination life (17 days)
2.Improve harvesting of granulocytes bcz.it accelerates
erythrocyte sedimentation
 Disadvantages :1.Not compatible with many drugs and no
injectable drugs should be added with using
2.Hyperamylaesemia
3.Plasma vol. expands slightly in excess of volume infused
4.vomiting,fever,itching,chills.
Drugs:Expan6% inj.(100,500 ml vac)
Improved perfusion:
 Warmth
 Strong pulses
 Better capillary refill
 Improved mental status
 Lowered heart rate
 B.P ideal
 High urine output
THANK YOU!!!