ipovolemico

Ipovolemico refers to a state in which the circulating blood volume is abnormally low. This reduction impairs venous return to the heart, decreases preload, and can compromise cardiac output and tissue perfusion. Hypovolemia may result from hemorrhagic loss (external or occult bleeding), nonhemorrhagic fluid losses such as vomiting, diarrhea, excessive sweating, or burns, and from fluid shifts into interstitial or third-space compartments.

Pathophysiology and clinical features

Volume depletion triggers compensatory mechanisms, including tachycardia, vasoconstriction, and activation of the renin–angiotensin–aldosterone system and antidiuretic hormone to conserve fluid. If losses exceed these compensatory responses, blood pressure falls and organ perfusion deteriorates. Clinically, early signs include fast heart rate and normal or narrowed pulse pressure; as it worsens, hypotension, rapid breathing, cold clammy skin, reduced urine output, and altered mental status may appear. In children, signs such as prolonged capillary refill time can be particularly informative.

Causes and diagnosis

Ipovolemico can arise from acute blood loss, dehydration from gastroenteritis or insufficient intake, burns with fluid loss, or shifts of fluid into interstitial spaces. Diagnosis is primarily clinical and is supported by laboratory and imaging data. Laboratory findings may show elevated lactate with signs of hypoperfusion; hematocrit can be normal or elevated in dehydration but may fall with ongoing hemorrhage. Urine output and bedside assessments of perfusion are important, and imaging may be used to identify causes such as active bleeding.

Management

Initial management focuses on securing the airway and breathing, establishing two or more large-bore IV lines, and administering isotonic crystalloids as a first-line resuscitation measure. In hemorrhagic or trauma-related cases, stop the source of loss and follow appropriate transfusion protocols, using balanced blood product strategies as indicated. Reassess frequently to guide further fluid therapy and consider vasopressors only after adequate volume resuscitation if needed. Treat the underlying cause and monitor organ perfusion and urine output.

Prognosis

Prognosis depends on the cause, the rapidity of recognition, and the effectiveness of resuscitation. Prompt identification and treatment improve outcomes and reduce the risk of progression to shock and organ dysfunction.