[Pathophysiology of hemodynamic and metabolic disturbances following circulatory shock (author's transl)]

Circulatory shock is defined as a syndrome of hemodynamic and metabolic disturbances. Impairment of macro- and microcirculation initiated by different causes is followed by a reversible and later on by an irreversible disturbance of cell metabolism. Breakdown of organ function may be the consequence. The shock specific discomposure of the hemostatic system is characterized by an inactivation of blood coagulation. This leads first to hypercoagulability accompanied by a tendency to thrombosis; later on the impairment of the hemostatic balance is followed by the consumption of coagulation factors and by hypocoagulability with a more or less pronounced bleeding tendency. Treatment of shock is the main prerequisite to avoid and overcome shock induced coagulation disorder. Heparin administration, fresh blood and fresh plasma are adjuvant measures. Substitution of concentrates of clotting factors are indicated only in states of total consumption of the coagulation system.