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Chapter 13. Hypovolemic Shock

Student Questions

What is the most common acid/base disorder seen in hypovolemic shock?

A. Metabolic alkalosis

B. Metabolic acidosis

C. Respiratory alkalosis

D. Respiratory acidosis

Answer: B

Option A: Incorrect. This is the opposite of metabolic alkalosis.

Option B: Correct. Hypovolemic shock occurs as a consequence of inadequate intravascular volume to meet the oxygen and metabolic needs of the body. Lactic acid is then produced as a by-product of anaerobic metabolism within tissues throughout the body resulting in the acid-base disturbance, metabolic acidosis.

Options C and D: Incorrect. Both respiratory alkalosis and respiratory acidosis relate to respiratory problems which are not routinely observed in patients with hypovolemic shock.

What should be the first pharmacologic intervention in an adult patient with hypovolemic shock (SBP < 90 mm Hg or MAP < 60 mm Hg)?

A. Administer 2 units of Type O PRBCs

B. Administer 1–2 L of isotonic crystalloid

C. Begin dopamine or norepinephrine infusion

D. Administer 5% albumin infusion

Answer: B

Option A: Incorrect. Red blood cell transfusions are administered only in cases of hemorrhagic shock and after administration of crystalloids.

Option B: Correct. Hypovolemic shock is a caused by a significant loss of intravascular volume. Therefore, restoration of effective circulating blood volume is the first goal for reversal of this condition. Isotonic crystalloids are readily available, inexpensive, and have equivalent outcome to colloids (eg, 5% albumin, Answer D).

Option C: Incorrect. Lastly, use of vasopressors such as dopamine and epinephrine (Answer C) are only given when crystalloids and/or red blood cell transfusions have been administered yet there is evidence of cerebral or myocardial ischemia.

Option D: Incorrect. Hypovolemic shock is a caused by a significant loss of intravascular volume. Therefore, restoration of effective circulating blood volume is the first goal for reversal of this condition. Isotonic crystalloids (Answer B) are readily available, inexpensive, and have equivalent outcome to colloids (eg, 5% albumin, Answer D).

Which of the following is the key goal of therapy in the first hour of hypovolemic shock?

A. MAP > 90 mm Hg

B. SBP > 90 mm Hg

C. SBP > 60 mm Hg

D. Normal urine output and serum lactate

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