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Homeostatic responses to loss of blood volume

This flowchart shows the action of decreased blood pressure and volume in the neural and endocrine mechanisms.

Circulatory shock

The loss of too much blood may lead to circulatory shock    , a life-threatening condition in which the circulatory system is unable to maintain blood flow to adequately supply sufficient oxygen and other nutrients to the tissues to maintain cellular metabolism. It should not be confused with emotional or psychological shock. Typically, the patient in circulatory shock will demonstrate an increased heart rate but decreased blood pressure, but there are cases in which blood pressure will remain normal. Urine output will fall dramatically, and the patient may appear confused or lose consciousness. Urine output less than 1 mL/kg body weight/hour is cause for concern. Unfortunately, shock is an example of a positive-feedback loop that, if uncorrected, may lead to the death of the patient.

There are several recognized forms of shock:

  • Hypovolemic shock in adults is typically caused by hemorrhage, although in children it may be caused by fluid losses related to severe vomiting or diarrhea. Other causes for hypovolemic shock include extensive burns, exposure to some toxins, and excessive urine loss related to diabetes insipidus or ketoacidosis. Typically, patients present with a rapid, almost tachycardic heart rate; a weak pulse often described as “thread;” cool, clammy skin, particularly in the extremities, due to restricted peripheral blood flow; rapid, shallow breathing; hypothermia; thirst; and dry mouth. Treatments generally involve providing intravenous fluids to restore the patient to normal function and various drugs such as dopamine, epinephrine, and norepinephrine to raise blood pressure.
  • Cardiogenic shock results from the inability of the heart to maintain cardiac output. Most often, it results from a myocardial infarction (heart attack), but it may also be caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply insufficient flow of blood through the cardiac vessels. Treatment involves repairing the damage to the heart or its vessels to resolve the underlying cause, rather than treating cardiogenic shock directly.
  • Vascular shock occurs when arterioles lose their normal muscular tone and dilate dramatically. It may arise from a variety of causes, and treatments almost always involve fluid replacement and medications, called inotropic or pressor agents, which restore tone to the muscles of the vessels. In addition, eliminating or at least alleviating the underlying cause of the condition is required. This might include antibiotics and antihistamines, or select steroids, which may aid in the repair of nerve damage. A common cause is sepsis    (or septicemia), also called “blood poisoning,” which is a widespread bacterial infection that results in an organismal-level inflammatory response known as septic shock    . Neurogenic shock is a form of vascular shock that occurs with cranial or spinal injuries that damage the cardiovascular centers in the medulla oblongata or the nervous fibers originating from this region. Anaphylactic shock is a severe allergic response that causes the widespread release of histamines, triggering vasodilation throughout the body.
  • Obstructive shock , as the name would suggest, occurs when a significant portion of the vascular system is blocked. It is not always recognized as a distinct condition and may be grouped with cardiogenic shock, including pulmonary embolism and cardiac tamponade. Treatments depend upon the underlying cause and, in addition to administering fluids intravenously, often include the administration of anticoagulants, removal of fluid from the pericardial cavity, or air from the thoracic cavity, and surgery as required. The most common cause is a pulmonary embolism, a clot that lodges in the pulmonary vessels and interrupts blood flow. Other causes include stenosis of the aortic valve; cardiac tamponade, in which excess fluid in the pericardial cavity interferes with the ability of the heart to fully relax and fill with blood (resulting in decreased preload); and a pneumothorax, in which an excessive amount of air is present in the thoracic cavity, outside of the lungs, which interferes with venous return, pulmonary function, and delivery of oxygen to the tissues.

Chapter review

Neural, endocrine, and autoregulatory mechanisms affect blood flow, blood pressure, and eventually perfusion of blood to body tissues. Neural mechanisms include the cardiovascular centers in the medulla oblongata, baroreceptors in the aorta and carotid arteries and right atrium, and associated chemoreceptors that monitor blood levels of oxygen, carbon dioxide, and hydrogen ions. Endocrine controls include epinephrine and norepinephrine, as well as ADH, the renin-angiotensin-aldosterone mechanism, ANH, and EPO. Autoregulation is the local control of vasodilation and constriction by chemical signals and the myogenic response. Exercise greatly improves cardiovascular function and reduces the risk of cardiovascular diseases, including hypertension, a leading cause of heart attacks and strokes. Significant hemorrhage can lead to a form of circulatory shock known as hypovolemic shock. Sepsis, obstruction, and widespread inflammation can also cause circulatory shock.

Listen to this CDC podcast to learn about hypertension, often described as a “silent killer.” What steps can you take to reduce your risk of a heart attack or stroke?

Take medications as prescribed, eat a healthy diet, exercise, and don’t smoke.

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References

Centers for Disease Control and Prevention (US). Getting blood pressure under control: high blood pressure is out of control for too many Americans [Internet]. Atlanta (GA); [cited 2013 Apr 26]. Available from: (External Link)

Questions & Answers

ഫസ്റ്റ് ചാപ്റ്റർ ഇംപോർട്ടൻസ് പോസ്റ്റ്
Reshma Reply
Yes....
Loving
nhi samjh aya
Anshika
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Loving
I don't know
Anshika
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Loving
what is mean of? reshma
Asad
D bone in d ankle joint re what ?
Ifunanya Reply
can one define a cell as a basic unit of a living organism
Michael Reply
Which of the following hormones are responsible for the adolescent growth spurt? estrogen and testosterone, even in women?
Kepa Reply
estrogen
Farhana
Estrogen!
Jazil
estrogen hormone
Michael
yes estrogen hormone
Anshika
yes
Sale
What is sling give d characteristics of sling uses of sling
adamu Reply
a sling a rope used in hunting ie throwing of rocks
Michael
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Arman Reply
me 2
adamu
joint have 3 cartilaginous joint fibrous joint synovial joint U can reserch in Google can explain U well
sopheaktra
define sling
adamu
To throw with a circular or arcing motion
real
what is respiration
Osele Reply
what is respiration
Paul
Respiration is the process by which oxygen is taken in and carbon dioxide is given out.
Md
Respiration is the combination of inhalation and exhalation.
Khim
inhalation is the taking in air from environment to lung and exhalation is taking out sir from the lung to environment ..
Khim
is the process by wich gases(oxygen and carbon(IV)oxide go through the nose, trachea and the lungs to the blood stream
Michael
what is holistic
Kibrom Reply
Holistic means encompassing the whole of a thing, and not just the part. Holistic medicine looks at the whole person for answers, not just at physical symptoms. You might have heard of holistic medicine, which tries to treat someone as mind and body, instead of treating only the part of the patient
I want to learn one by one system like skeleton system... muscular system
Mary Reply
i want to learn this
Kibrom
what is the difference between regional anatomy and system anatomy
David
system anatomy is when we study the system like digestive, circulatory, reproductive, but regional anatomy is studying the anatomy by regions of body like anatomy of neck, thorax, head etc. Regional anatomy may include system anatomy...
Biplav
yes
Anshika
explain in details factors that affects bone development
Precious Reply
describe the process of bone healing
Precious
out line factors that delays bone healing
Precious
actually,for the bone formation they must be sufficient level of calcium,phosphorus and vitamin D in the body for it to happen smoothly.
lucky
the above mentioned substances are the ones able for the formation and repairing of bones.
lucky
explain in details factors that affects bone development
Precious
what are tissue
muki Reply
a lots of cells make tissue and a cell body is tissue
Rabab
cells come together to form a tissue and tissues come together to form an organ
Adoma
what is appendicular skeleton
OSE Reply
appendicular skeleton is upper limbs and lower limbs
sopheaktra
what is decompression sickness?
Japhar Reply
It occurs in Scuba divers when they rise too quicky to the sea surface , their oxygen tanks have oxygen mixed with N2 gas which has a high solubility at sea level , when the diver rises the N2 gas bubbles out of plasma and this causes Air Ebolism
Siphiwesihle
if a single part if Nervous system doesn't function like synapse? what will occur
Lilian Reply
no transmission of impulses no respond cause mechanical damage
Komolika
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Jachike
a MORAH /MORAH
Kechi
meaning?
Jachike
transmission of impure
sopheaktra
when calcium ion channels block . lightheadedness Low blood pressure. Slower heart rate. Drowsiness. Constipation. Swelling of feet ankles and legs. Increased appetite. Gastroesophageal reflux disease (GERD
sopheaktra
I'm not sure about it
sopheaktra
low blood pressure
Anshika
what is this substance
Peng Reply
In the human body, there are no atoms as separate entities. Instead, they constantly interact with other atoms to form and break down more complex materials. To fully understand anatomy and physiology, you must understand how atoms are involved in such interactions. The key is to understand the beha
Warid
what are functions of muscle cell
Veronicah
please can someone help with ten functions of the following hormones 1.Gastrin 2. Adrenal sex hormone 3. Secretin 4. Follicle Stimulating Hormone 5. Glucagon 6. Progesterone
Har
4.produces the oetrogen and bursts open to release egg cells.
Komolika
5.regulates the level of glucose in the blood and it is secreted when glucose low in the blood.
Komolika

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