Hypovolemic shock in pediatric patients

Hypovolemic shock is a common disease treated in pediatric ICUs and emergency departments worldwide. A wide variety of etiologic factors may cause this disease, with the common net result of decreased intravascular volume leading to decreased venous return to the heart and decreased stroke volume. Inadequate perfusion results in impairment of delivery of nutrients and oxygen to vital end organs. With the advent of pediatric critical care and pediatric emergency medicine as specialties, deaths from hypovolemic shock have become increasingly rare in the United States. The physical signs of hypovolemic shock in children must be quickly recognized, and aggressive volume resuscitation must be administered before irreversible end-organ dysfunction occurs. This is best accomplished by large peripheral or central intravenous access, with intraosseous access an alternative option in the pediatric patient. The amount as well as the type of volume administered must be tailored for each individual patient, taking into account the amount of intravascular depletion and the disease state in which the shock has occurred. It is not uncommon for children to require large amounts of fluid for resuscitation, and close attention must be paid to children with fluid-refractory shock, who may require catecholamine and/or exogenous steroid support in combination with aggressive fluid resuscitation.