|
| Mismatch between intravascular volume and blood pressure |
| States in which blood pressure is not primarily determined by intravascular volume |
|
Intravascular volume low
Blood pressure high | Vasoconstriction |
| (i) Stimulants (cocaine, amphetamines), catecholamines (pheochromocytoma, severe stress, delirium tremens) |
| (ii) Severe hypothyroidism |
|
Intravascular volume high
Blood pressure low | Cardiac dysfunction |
| (i) Cardiogenic shock |
| (ii) Severe cardiomyopathy, heart failure, valvular heart disease |
| Vasodilation |
| (i) Distributive shock + excess volume resuscitation |
| (ii) Autonomic neuropathy |
|
| Mismatch between intravascular and extravascular volume |
|
Intravascular volume low
Extravascular volume high | Vasodilation and/or “third spacing” |
| (i) Distributive shock (sepsis, anaphylaxis) |
| (ii) Hemorrhagic pancreatitis |
| (iii) Crush injury |
| Delayed reequilibration |
| (i) Severe renal failure + diuresis or ultrafiltration |
| (ii) Nephrotic syndrome + diuresis |
| (iii) End-stage liver disease + diuresis or large volume paracentesis or ultrafiltration |
| (iv) Heart failure + diuresis or ultrafiltration |
|
| Intravascular volume high, Extravascular volume not high | Delayed reequilibration |
| (i) Rapid blood transfusion + anuria or severe renal failure |
| (ii) Rapid hypertonic sodium bicarbonate or saline infusion |
|
