adj.

血液量減少の、血液量不足の

関: hypovolaemia、hypovolemia

WordNet

of or relating to a decrease in the volume of circulating blood (同)hypovolaemic
a blood disorder consisting of a decrease in the volume of circulating blood (同)hypovolaemia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/14 10:54:13」(JST)

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In physiology and medicine, hypovolemia (also hypovolaemia, oligemia or shock) is a state of decreased blood volume; more specifically, decrease in volume of blood plasma.^[1]^[2] It is thus the intravascular component of volume contraction (or loss of blood volume due to things such as hemorrhaging or dehydration), but, as it also is the most essential one, hypovolemia and volume contraction are sometimes used synonymously.

Hypovolemia is characterized by salt (sodium) depletion and thus differs from dehydration, which is defined as excessive loss of body water.^[3]

Causes

Common causes of hypovolemia are^[4]

Loss of blood (external or internal bleeding or blood donation^[5])
Loss of plasma (severe burns^[6]^[7] and lesions discharging fluid)
Loss of body sodium and consequent intravascular water; e.g. diarrhea or vomiting
Vasodilation (involving widening of blood vessels) such as trauma leading to dysfunction of nerve activity on blood vessels and inhibition of the vasomotor center in the brain or drugs such as vasodilators typically used to treat hypertensive individuals.

Excessive sweating is not a cause of hypovolemia, because the body eliminates significantly more water than sodium.^[8]

Diagnosis

Clinical symptoms may not be present until 10–20% of total whole-blood volume is lost.

Hypovolemia can be recognized by tachycardia, diminished blood pressure,^[9] and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill on forehead, lips and nail beds. The patient may feel dizzy, faint, nauseated, or very thirsty. These signs are also characteristic of most types of shock.

Note that in children, compensation can result in an artificially high blood pressure despite hypovolemia. Children will typically compensate (maintain blood pressure despite loss of blood volume) for a longer period than adults, but will deteriorate rapidly and severely once they do begin to decompensate. This is another reason (aside from initial lower blood volume) that even the possibility of internal bleeding in children should almost always be treated aggressively.

Also look for obvious signs of external bleeding while remembering that people can bleed to death internally without any external blood loss. ("Blood on the floor, plus 4 more" = intrathoracic, intraperitoneal, retroperitoneal, pelvis/thigh)

Also consider possible mechanisms of injury that may have caused internal bleeding such as ruptured or bruised internal organs. If trained to do so and the situation permits, conduct a secondary survey and check the chest and abdomen for pain, deformity, guarding, discoloration or swelling. Bleeding into the abdominal cavity can cause the classical bruising patterns of Grey Turner's sign or Cullen's sign.

Stages of hypovolemic shock

Usually referred to as "Class" of shock. Most sources state that there are 4 stages of hypovolemic shock,^[10] however a number of other systems exist with as many as 6 stages.^[11]

The 4 stages are sometimes known as the "Tennis" staging of hypovolemic shock, as the 4 stages of % volume of blood loss mimic the scores in a game of tennis: 15, 15-30, 30-40, 40.^[12] It is basically the same as used in classifying bleeding by blood loss.

Stage 1

Up to 15% blood volume loss (750 mL)
Compensated by constriction of vascular bed
Blood pressure maintained
Normal respiratory rate (12-20 breaths per minute)
Pallor of the skin (paleness)
Normal mental status^[13] to slight anxiety
Normal capillary refill^[13] (less than 3 seconds)
Normal urine output^[13]

Stage 2

15–30% blood volume loss (750–1500 mL)
Cardiac output cannot be maintained by arterial constriction
Tachycardia >100bpm
Increased respiratory rate (more than 20 respirations per minute)
Systolic blood pressure maintained
Increased diastolic blood pressure
Narrow pulse pressure (gap between the systolic and diastolic pressure)
Pale, cold, and clammy skin as blood flow is directed away to major organs such as the heart, lungs, and brain
Mildly anxious/Restless
Delayed capillary refill^[13]
Urine output of 20-30 milliliters/hour^[13]

Stage 3

30–40% blood volume loss (1500–2000 mL)
Systolic BP falls to 100mmHg or less
Classic signs of hypovolemic shock
Marked tachycardia (increased heart rate) >120 bpm
Marked tachypnea (increased rate of respiration) >30 respirations per minute
Alteration in mental status (confusion,^[13] anxiety, agitation)
Sweating with cool, pale skin
Delayed capillary refill^[13]
Urine output of approximately 20 milliliters/hour^[13]

Stage 4

Loss greater than 40% (>2000 mL)
Extreme tachycardia (>140^[13]) with weak pulse
Pronounced tachypnea
Significantly decreased systolic blood pressure of 70 mmHg or less
Decreased level of consciousness, lethargy,^[13] coma^[13]
Skin is sweaty, cool, and extremely pale (moribund)
Absent capillary refill^[13]
Negligible urine output^[13]

Treatment

Minor hypovolemia from a known cause that has been completely controlled (such as a blood donation from a healthy patient who is not anemic) may be countered with initial rest for up to half an hour. Oral fluids that include moderate sugars and electrolytes are needed to replenish depleted sodium ions. Furthermore the advice for the donor is to eat good solid meals with proteins for the next few days. Typically, this would involve a fluid volume of less than one liter, although this is highly dependent on body weight. Larger people can tolerate slightly more blood loss than smaller people.

More serious hypovolemia should be assessed by a physician.

First aid

External bleeding should be controlled by direct pressure. If direct pressure fails, a tourniquet should be used in the case of severe hemorrhage that cannot be controlled by direct pressure. Tourniquet use in civilian first-aid, is now advocated as part of the C-ABC approach. Other techniques such as elevation and pressure points are not always effective but should still be attempted. As a rule of thumb, anywhere you can feel a pulse can be used as a pressure point to stop bleeding (with the obvious exception of the carotid pulses!). If a first-aid provider recognizes internal bleeding the life-saving measure to take is to immediately call for emergency assistance.

Field care

Emergency oxygen should be immediately employed to increase the efficiency of the patient's remaining blood supply. This intervention can be life-saving. ^[14]

The use of intravenous fluids (IVs) may help compensate for lost fluid volume, but IV fluids cannot carry oxygen in the way that blood can, however blood substitutes are being developed which can. Infusion of colloid or crystalloid IV fluids will also dilute clotting factors within the blood, increasing the risk of bleeding. It is current best practice to allow permissive hypotension in patients suffering from hypovolemic shock^[15] both to ensure clotting factors are not overly diluted but also to stop blood pressure being artificially raised to a point where it "blows off" clots that have formed.

Hospital treatment

If the hypovolemia was caused by medication, the administration of antidotes may be appropriate but should be carefully monitored to avoid shock or the emergence of other pre-existing conditions^{[citation needed]}.

Fluid replacement is beneficial in hypovolemia of stage 2, and is necessary in stage 3 and 4.^[13] Blood transfusions coupled with surgical repair are the definitive treatment for hypovolemia caused by trauma^{[citation needed]}. See also the discussion of shock and the importance of treating reversible shock while it can still be countered.

For a patient presenting with hypovolemic shock in hospital the following investigations would be carried out:

Blood tests: U+Es/Chem7, FBC, Glucose, Cross-match
Central Venous Line/Blood Pressure
Arterial line/Arterial Blood Gases
Urine output measurements (via urinary catheter)
Blood pressure
SpO2 Oxygen saturations

The following interventions would be carried out:

IV access
Oxygen as required
Surgical repair at sites of hemorrhage
Inotrope therapy (Dopamine, Noradrenaline) which increase the contractility of the heart muscle
Fresh frozen plasma/whole blood

History

Historically a term desanguination (from Latin sanguis, blood) was in use, meaning a massive loss of blood. The term was widely used by the Hippocrates in traditional medicine practiced in the Greco-Roman civilization and in Europe during the Middle Ages. The word was possibly used to describe the lack of personality (by death or by weakness) that often occurred once a person suffered hemorrhage or massive blood loss.

In cases in which loss of blood volume is clearly attributable to bleeding (as opposed to, e.g., dehydration), most medical practitioners of today prefer the term exsanguination for its greater specificity and descriptiveness, with the effect that the latter term is now more common in the relevant context.^[16]

References

^ MedicineNet > Definition of Hypovolemia Retrieved on July 2, 2009
^ TheFreeDictionary.com --> hypovolemia Citing Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009
^ MedicineNet > Definition of Dehydration Retrieved on July 2, 2009
^ Sircar, S. Principles of Medical Physiology. Thieme Medical Pub. ISBN 9781588905727
^ Danic B, Gouézec H, Bigant E, Thomas T (June 2005). "[Incidents of blood donation]". Transfus Clin Biol (in French) 12 (2): 153–9. doi:10.1016/j.tracli.2005.04.003. PMID 15894504.
^ http://www.totalburncare.com/orientation_burn_shock.htm
^ http://www.patient.co.uk/doctor/Resuscitation-in-Hypovolaemic-Shock.htm
^ http://highered.mcgraw-hill.com/sites/dl/free/0077262514/621682/Saladin_24_Ext_Outline.doc
^ http://www.stagesofshock.com/stage3/index.html
^ http://dynamicnursingeducation.com/class.php?class_id=47&pid=18
^ http://www.stagesofshock.com/stage1/index.html
^ Cite error: The named reference Dr._Michael_V._Switzerland was invoked but never defined (see the help page).
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
^ Takasu A, Prueckner S, Tisherman SA, Stezoski SW, Stezoski J, Safar P. (2000), Effects of increased oxygen breathing in a volume controlled hemorrhagic shock outcome model in rats., PMID 10959021
^ http://www.trauma.org/archive/resus/permissivehypotension.html Permissive Hypotension
^ L. Geeraedts Jr., H. Kaasjager, A. van Vugt, and J. Frölke,. "Exsanguination in trauma: A review of diagnostics and treatment options". Injury 40 (1): 11–20. doi:10.1016/j.injury.2008.10.007.

External links

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UpToDate Contents

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1. 成人における重症循環血液量減少または循環血液量減少性ショックの治療 treatment of severe hypovolemia or hypovolemic shock in adults
2. 成人における体液量減少の病因、臨床症状、および診断 etiology clinical manifestations and diagnosis of volume depletion in adults
3. 小児における循環血液量減少症（脱水）の治療 treatment of hypovolemia dehydration in children
4. 小児における血液量減少性ショック：初期評価およびマネージメント hypovolemic shock in children initial evaluation and management
5. 成人におけるショック：種類、症状、および診断的アプローチ shock in adults types presentation and diagnostic approach

English Journal

Spontaneous CSF Leaks: Low CSF Volume Syndromes.

Mokri B.Author information Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: bmokri@mayo.edu.AbstractPractically all cases of spontaneous intracranial hypotension results from spontaneous cerebral spinal fluid (CSF) leaks, often at the level of the spine and only rarely from the skull base. The triad of orthostatic headaches, diffuse pachymeningeal enhancement on head imaging and low CSF opening pressure is considered the hallmark of these leaks but substantial variability is noted in most aspects of this disorder including in features of the headaches, imaging and CSF findings, response to treatment and outcome.
Neurologic clinics.Neurol Clin.2014 May;32(2):397-422. doi: 10.1016/j.ncl.2013.11.002. Epub 2014 Feb 28.
Practically all cases of spontaneous intracranial hypotension results from spontaneous cerebral spinal fluid (CSF) leaks, often at the level of the spine and only rarely from the skull base. The triad of orthostatic headaches, diffuse pachymeningeal enhancement on head imaging and low CSF opening pr
PMID 24703536

Draining the edema: a new role for aquaretics?

Bockenhauer D.Author information Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK, d.bockenhauer@ucl.ac.uk.AbstractInvestigations into edema formation in nephrotic syndrome have mostly focused on the primary role of sodium. While there is controversy about whether sodium retention is an inherent aspect of nephrotic syndrome (overfill hypothesis) or a secondary consequence (underfill hypothesis), the critical role of sodium in driving fluid retention is generally accepted. Consequently, treatment of edema is based on enhancing renal sodium excretion, using saluretics to block tubular reabsorption of sodium. However, there is also evidence of renal water retention: urine in nephrotic patients is typically highly concentrated (unless urinary concentrating ability is impaired by loop diuretics), and vasopressin levels are commonly elevated. Consequently, aquaretics, i.e., drugs that inhibit renal water reabsorption, may constitute effective treatments for nephrotic edema. In fact, these drugs are already approved for the treatment of non-nephrotic edematous states, such as those encountered in congestive heart or liver failure. In this edition of Pediatric Nephrology, two case reports raise the possibility that aquaretics may also be helpful in the treatment of nephrotic edema. These case reports provide no solid evidence for such treatment, and there clearly are serious concerns about inducing critical hypovolemia with potentially catastrophically consequences, such as thrombosis and shock. Yet these concerns similarly apply to saluretics, which clinicians routinely use in the treatment of edema. In addition, the described powerful effect of aquaretics with respect to the resolution of edema, as well as our understanding of the underlying physiology, argue for a more systematic, yet careful assessment of these drugs in the treatment of nephrotic syndrome.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2014 May;29(5):767-9. doi: 10.1007/s00467-014-2763-1. Epub 2014 Jan 31.
Investigations into edema formation in nephrotic syndrome have mostly focused on the primary role of sodium. While there is controversy about whether sodium retention is an inherent aspect of nephrotic syndrome (overfill hypothesis) or a secondary consequence (underfill hypothesis), the critical rol
PMID 24482024

Cardiovascular manifestations of the emerging dengue pandemic.

Yacoub S1, Wertheim H1, Simmons CP2, Screaton G3, Wills B2.Author information 1Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, National Hospital for Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam.2Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hospital for Tropical Diseases, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.3Department of Medicine, Imperial College, Du Cane Road, London W12 0NN, UK.AbstractDengue is one of the most important emerging viral diseases globally. The majority of symptomatic infections result in a relatively benign disease course. However, a small proportion of patients develop severe clinical manifestations, including bleeding, organ impairment, and endothelial dysfunction with increased capillary permeability causing hypovolaemic shock that can lead to cardiovascular collapse. Evidence is increasing that dengue can also cause myocardial impairment, arrhythmias and, occasionally, fulminant myocarditis. No antiviral agents or vaccines are licensed for dengue, and treatment remains supportive with judicious fluid replacement for patients with severe disease. Defining the role of cardiac dysfunction in the haemodynamic compromise of severe dengue has potentially important management implications. In this Review, we will outline the current understanding of the cardiovascular manifestations of dengue, including myocardial and vascular involvement, and conclude with a discussion of the available therapeutic options and potential future research directions.
Nature reviews. Cardiology.Nat Rev Cardiol.2014 Apr 8. doi: 10.1038/nrcardio.2014.40. [Epub ahead of print]
Dengue is one of the most important emerging viral diseases globally. The majority of symptomatic infections result in a relatively benign disease course. However, a small proportion of patients develop severe clinical manifestations, including bleeding, organ impairment, and endothelial dysfunction
PMID 24710495

Japanese Journal

新生児用呼吸補助システムにおける血管吸引防止装置の開発

長谷川優太,宮城成宏,野口展士,中川聡,幡多徳彦,荒船龍彦,野中一洋,本間章彦,福井康裕,舟久保昭夫
生体医工学 52(Supplement), O-541-O-541, 2014
… However, we confirmed that hypovolemic is caused by suction of vessel. …
NAID 130004695898

Successful Endovascular Treatment of Traumatic Thoracic Aortic Injury Complicated by Severe Pelvic Hemorrhage

Ueki Chikara,Shintani Tsunehiro,Akimoto Takehide,Sakaguchi Genichi
Annals of Vascular Diseases, 2014
… A 25-year-old woman committed suicide with a high-rise fall and presented hypovolemic shock caused by blunt thoracic, abdominal injury. …
NAID 130004687774

Hypovolemic shockを伴う再膨張性肺水腫を発症した気胸の1例

深田真宏,丸山修一郎,奥本龍夫,藤井徹也,金谷欣明,横山伸二
日本臨床外科学会雑誌 75(1), 68-72, 2014
… 自然気胸に対しドレナージを施行後，hypovolemic shockを伴う再膨張性肺水腫（re-expansion pulmonary edema:RPE）を発症した1例を報告する．症例は43歳，男性．右自然気胸に対し発症10日目に胸腔ドレナージ施行．その後大量の泡沫状喀痰を排出し，呼吸循環動態が不安定となった．RPEと診断し，PEEPを付加した人工呼吸器管理を開始した．収縮期血圧60mmHg，心拍数120回/分とショック状態となり，輸液負荷と昇圧剤にて循環管理を行 …
NAID 130004679162

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リンク元	「血液量減少」「血液量不足」「hypovolaemia」
拡張検索	「hypovolemic shock」

「血液量減少」

Hypovolemia
	Classification and external resources
ICD-10	E86, R57.1, T81.1
ICD-9	276.52
MedlinePlus	000167
MeSH	D020896

　　[★]

英: hypovolemia、hypovolaemia、hypovolemic
関: 血液量不足、血液量減少症

[show details]

血液量減少 : 約 130,000 件
循環血液量減少 : 約 88,300 件
血液量不足 : 約 16,000 件
血液量減少症 : 約 80 件
循環血液量減少症 : 約 27 件

「血液量不足」

　　[★]

英: hypovolemia、hypovolaemia、hypovolemic
関: 血液量減少、血液量減少症

「hypovolaemia」

　　[★] 血液量減少、血液量不足

関: hypovolemia、hypovolemic

「hypovolemic shock」

　　[★] 血液量減少性ショック、循環血液量減少性ショック、乏血性ショック

[1] MedicineNet > Definition of Hypovolemia Retrieved on July 2, 2009

[2] TheFreeDictionary.com --> hypovolemia Citing Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009

[3] MedicineNet > Definition of Dehydration Retrieved on July 2, 2009

[4] Sircar, S. Principles of Medical Physiology. Thieme Medical Pub. ISBN 9781588905727

[5] Danic B, Gouézec H, Bigant E, Thomas T (June 2005). "[Incidents of blood donation]". Transfus Clin Biol (in French) 12 (2): 153–9. doi:10.1016/j.tracli.2005.04.003. PMID 15894504.

[6] ttp://www.totalburncare.com/orientation_burn_shock.htm

[7] ttp://www.patient.co.uk/doctor/Resuscitation-in-Hypovolaemic-Shock.htm

[8] ttp://highered.mcgraw-hill.com/sites/dl/free/0077262514/621682/Saladin_24_Ext_Outline.doc

[9] ttp://www.stagesofshock.com/stage3/index.html

[dynamicnursingeducation.com-10] ttp://dynamicnursingeducation.com/class.php?class_id=47&pid=18

[11] ttp://www.stagesofshock.com/stage1/index.html

[Dr._Michael_V._Switzerland] Cite error: The named reference Dr._Michael_V._Switzerland was invoked but never defined (see the help page).

[agabegi2nd-13] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.

[14] Takasu A, Prueckner S, Tisherman SA, Stezoski SW, Stezoski J, Safar P. (2000), Effects of increased oxygen breathing in a volume controlled hemorrhagic shock outcome model in rats., PMID 10959021

[15] ttp://www.trauma.org/archive/resus/permissivehypotension.html Permissive Hypotension

[16] L. Geeraedts Jr., H. Kaasjager, A. van Vugt, and J. Frölke,. "Exsanguination in trauma: A review of diagnostics and treatment options". Injury 40 (1): 11–20. doi:10.1016/j.injury.2008.10.007.

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