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Clinical features and diagnosis Top
The signs and symptoms of shock may be accompanied or preceded by signs and symptoms of dehydration: dry mucous membranes, dry and hypoelastic skin, and increased thirst (except for elderly patients with hypodipsia). Altered mental status may develop before hypotension (particularly in the elderly). Tachycardia and orthostatic hypotension usually occur before the drop in blood pressure that may be observed in a patient when they are sitting or supine. History and results of physical examination indicative of the cause of shock are helpful in establishing the diagnosis. Also see Dehydration. Acid-base (eg, contraction alkalosis or metabolic acidosis) or electrolyte disturbances (eg, hyponatremia or hypernatremia, hypokalemia or hyperkalemia) can be also considered as warnings of hypovolemic conditions.
1. IV infusion of crystalloid, colloid, or blood product solutions (see Shock). In patients with persistent hypotension and hypoperfusion despite a rapid administration of ~1500 to 2000 mL of a crystalloid (or ~1000 mL of a colloid), administer norepinephrine in a continuous IV infusion (see Shock) while continuing fluid resuscitation. The basis of treatment of hypovolemic shock is volume resuscitation, not catecholamines; nevertheless, catecholamines may be helpful in maintaining vital organ perfusion. Subsequent to the initial volume resuscitation, smaller boluses of fluids in the form of fluid challenge can be used to titrate the overall fluid loading with a careful view to avoiding overresuscitation or administration of fluid when it does not lead to any appreciable benefit in clinical status. When applicable, dynamic indices of preload (see Shock) can be useful for predicting the response to fluids.
2. Simultaneously treat the underlying causes of shock, for instance, treat the disease that causes vomiting, diarrhea, intestinal obstruction, polyuria, or fluid loss via the skin.
3. Other management procedures: see Shock.