decompensation

Decompensation is the deterioration of a disease state that was previously compensated, resulting from failure of the body's reserve to maintain stable function. It occurs when a chronic condition is overwhelmed by a stressor such as infection, bleeding, dehydration, electrolyte disturbance, or nonadherence to therapy.

In heart failure, acute decompensation presents with worsening dyspnea, edema, fatigue, and signs of congestive failure; hemodynamics show reduced cardiac output and elevated filling pressures. Pathophysiology includes neurohormonal activation and fluid retention that overwhelm compensatory mechanisms. Management focuses on identifying and treating triggers, using diuretics and vasodilators to reduce congestion, considering inotropes for low output, and providing oxygen or noninvasive ventilation as needed.

In decompensated cirrhosis, there is new or worsening ascites, jaundice, hepatic encephalopathy, or variceal bleeding. Triggers include infection, GI hemorrhage, dehydration, and nephrotoxic drugs. Management aims to address the precipitating factor, control portal hypertension, and support organ function; ascites may require diuretics or paracentesis, encephalopathy lactulose and antibiotics if infection is present, and careful fluid and electrolyte management.

Other contexts include psychiatric decompensation, where a previously stable condition worsens due to stressors or nonadherence, increasing risk of harm. Management involves crisis assessment, adjustment of medications, psychotherapy, and social supports.

Diagnosis relies on clinical evaluation, supplemented by laboratory tests and imaging as indicated. Decompensation signals disease progression and is associated with higher morbidity and mortality; timely recognition and treatment can improve outcomes.