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The pathophysiology of shock

H Haljamäe1

  • 1Department of Anaesthesiology, University of Göteborg, Sweden.

Acta Anaesthesiologica Scandinavica. Supplementum
|January 1, 1993
PubMed
Summary

Trauma causes significant blood loss, leading to hypovolemia and shock. The body initiates a defense response to maintain circulation, but metabolic disturbances like acidosis can impair organ function and lead to failure.

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Area of Science:

  • Physiology
  • Trauma Pathophysiology

Background:

  • Trauma and hemorrhage cause significant blood and plasma loss, potentially leading to hypovolemia and shock.
  • The body's initial response involves a neuroendocrine defense reaction to maintain circulatory homeostasis and substrate availability for vital organs.

Purpose of the Study:

  • To describe the body's physiological and metabolic responses to trauma and hemorrhage.
  • To elucidate the mechanisms of fluid shifts and metabolic consequences of impaired tissue perfusion.

Main Methods:

  • Review of physiological and metabolic adaptive mechanisms in response to trauma and hemorrhage.
  • Analysis of the impact of hypovolemia and shock on cellular metabolism and organ function.

Main Results:

  • Endogenous fluid is mobilized via glucose osmotic and neurogenic mechanisms to maintain vascular volume.
  • Insufficient tissue perfusion results in anaerobic glycolysis, acidosis, impaired mitochondrial function, and altered cellular homeostasis.
  • Organ-specific metabolic alterations occur, with early impact on kidneys and liver, and later on heart and brain. Skeletal muscle produces lactic acid, potentially disturbing central circulation upon reperfusion.

Conclusions:

  • Trauma-induced hypovolemia and shock trigger complex physiological and metabolic responses.
  • These responses, while aimed at homeostasis, can lead to significant metabolic derangements and organ dysfunction.
  • Early recognition and management of these alterations are crucial to prevent multiorgan failure.

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