Hypovolemic shock crystalloids

Compare and contrast the relative advantages and disadvantages of crystalloids, colloids, and blood products in the treatment of hypovolemic shock. 

In the absence of ongoing blood loss, administration of 2000 to 4000 mL of isotonic crystalloid will normally re-establish baseline vital signs in adult hypovolemic shock patients. 

Initial fluid resuscitation consists of isotonic crystalloid (0.9% sodium chloride or lariated Ringer s solution), colloid (5% Plasmanate or albumin, 6% hetastarch), or whole blood. Choice of solution is based on 02-carrying capacity (e.g., hemoglobin, hematocrit), cause of hypovolemic shock, accompanying disease states, degree of fluid loss, and required speed of fluid delivery. 

Colloids (especially albumin) are expensive solutions, and a large study involving almost 7,000 critically ill patients found no significant difference in 28-day mortality between patients resuscitated with either normal saline or 4% albumin. For these reasons, crystalloids should be considered first-line therapy in patients with hypovolemic shock. 

Hypovolemic shock due to acute blood loss during delivery is one of the major causes of maternal mortality. It has been suggested that albumin may increase the risk of death, and crystalloids have been suggested to be the volume expanders of choice (17). 

Some clinicians believe that colloid solutions have advantages beyond crystalloid solutions that justify their use for patients with hypovolemic shock. 

The primary therapy for hypovolemic shock is fluid replacement. The institutional cost of 1 L of most crystalloid solutions is less than 1. Assuming that such fluids are used, it is the associated costs of personnel and equipment that become the primary economic considerations in the resuscitation of patients with hypovolemic shock. However,... 

The "shock dose" concept is borrowed from small animal medicine. The shock dose for adult horses and neonatal foals is 50-80ml/kg crystalloid fluids. Depending on the perceived degree of hypovolemia, one-quarter to one-half of the shock dose is given as rapidly as possible (in less than 20 min) and the horse is reassessed. If the horse requires further fluid, another quarter of the shock dose is given and again the horse is reassessed. The final quarter of the shock dose is only given to severely hypovolemic horses. 

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