From the Guidelines
Treatment for Hypovolemia
The primary goal in treating hypovolemia is to restore circulating blood volume and ensure adequate perfusion of vital organs. Crystalloids are the first-line choice for fluid resuscitation 1.
Initial Fluid Resuscitation
For mild to moderate cases of hypovolemia, isotonic crystalloids such as 0.9% sodium chloride (normal saline) or lactated Ringer's solution are recommended, with an initial dose of 20-30 mL/kg of body weight, administered over 30 minutes to 1 hour 1.
Severe Hypovolemia or Shock
In cases of severe hypovolemia or shock, more aggressive fluid resuscitation may be necessary, with doses up to 40-50 mL/kg of body weight. Colloids such as albumin may be considered in specific situations, but their use is generally reserved for cases where crystalloids are not effective 1.
Monitoring and Adjustments
In addition to fluid resuscitation, monitoring of vital signs, urine output, and laboratory parameters such as hemoglobin, hematocrit, and electrolytes is crucial to guide further treatment. Blood transfusions may be necessary if hypovolemia is due to significant blood loss.
Vasopressor Use
Medications such as vasopressors (e.g., norepinephrine) may be required in cases of refractory shock, but their use should be carefully titrated and monitored due to potential side effects 1.
Individualized Treatment
The treatment should be tailored to the individual patient's needs, with ongoing assessment and adjustment of the treatment plan as necessary to ensure optimal outcomes.
From the FDA Drug Label
Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement Whole blood or plasma, if indicated to increase blood volume, should be administered separately
The treatment for hypovolemia (decreased blood volume) is blood volume replacement with fluids such as:
- Whole blood
- Plasma
- Dextrose containing solutions This should be done before administering any vasopressor, or concurrently in emergency situations to maintain blood pressure and prevent organ ischemia 2.
From the Research
Treatment for Hypovolemia
The treatment for hypovolemia (decreased blood volume) typically involves the administration of fluids to restore adequate blood volume and ensure sufficient oxygen delivery to tissues. The following are some key points regarding the treatment of hypovolemia:
- Hypertonic saline solution or hypertonic saline plus dextran 70 can be effective in restoring adequate hemodynamic conditions after hypovolemic shock 3.
- Closed-loop algorithms and resuscitation systems are being developed to control IV infusion rate during early resuscitation of hypovolemia, with blood pressure being the most used variable for the initial assessment of hemorrhagic shock and the treatment response to volume loading 4.
- The decisive approach in the therapy of hypovolemic shock is to initially attain normovolemia by rapid administration of volume replacement agents in the sense of controlled hemodilution 5.
- The chief goal of fluid management should be to ensure adequate oxygen delivery by optimizing blood oxygenation, perfusion pressure, and circulating volume 6.
- The choice of resuscitation fluid may be important, with some evidence suggesting that certain colloids might be helpful in diminishing post-ischemic microvascular leukocyte adherence 6.
Fluid Administration
The administration of fluids is a critical component of the treatment of hypovolemia. The following are some key points regarding fluid administration:
- The infusion of small volumes of hypertonic saline solution or hypertonic saline plus dextran 70 can be effective in restoring adequate hemodynamic conditions after hypovolemic shock 3.
- The calculated plasma volume expansion, immediately after the bolus infusion, was significantly higher in the hypertonic groups, compared with isotonic groups 3.
- Significantly greater volumes of fluids were required to restore systolic pressure in the patients receiving isotonic saline solution than in the groups receiving hypertonic solution 3.
- Excessive volume administration may lead to fluid overload and associated impairment of pulmonary function 6.
Monitoring and Diagnosis
The monitoring and diagnosis of hypovolemia are critical components of its treatment. The following are some key points regarding monitoring and diagnosis:
- Patient monitoring in the intensive care unit typically relies upon central venous pressure devices, whereas the primary focus in the operating theater is blood volume deficit estimated from suction devices 6.
- Estimates of intraoperative blood loss can be inaccurate, potentially leading to inappropriate fluid management 6.
- Currently, several possibilities are available to diagnose hypovolemia or hypervolemia, including standard clinical assessment, novel approaches as dedicated laboratory markers or sonography, and tests of fluid responsiveness 7.