Hypervolemia - what is it and how to treat it?

Hypovolemia is a pathological condition, manifested by a decrease in the volume of circulating blood, in some cases accompanied by a violation of the ratio between plasma and uniform elements (red blood cells, platelets, white blood cells).

For information, normal in adult women, the total blood volume is 58–64 ml per 1 kg of body weight, in men - 65–75 ml / kg.

The development of hypovolemia leads to:

  • acute blood loss
  • significant loss of body fluid (with large area burns, diarrhea, indomitable vomiting, polyuria),
  • vasodilation collapse (sharp expansion of blood vessels, as a result of which their volume ceases to correspond to the volume of circulating blood),
  • shock conditions
  • insufficient intake of fluid in the body with its increased losses (for example, at high ambient temperature).

Against the background of a decrease in the volume of circulating blood, functional insufficiency of a number of internal organs (brain, kidney, liver) may occur.

Depending on the hematocrit (an indicator of the ratio of the formed elements of blood and plasma), the following types of hypovolemia are distinguished:

  1. Normocytemic. It is characterized by a general decrease in blood volume while maintaining the ratio of plasma and uniform elements (hematocrit within normal limits).
  2. Oligocytemic. Preferably, the content of blood cells decreases (the value of hematocrit decreases).
  3. Polycythemic. To a greater extent, there is a decrease in plasma volume (hematocrit is above normal).

The most severe manifestation of hypovolemia is called hypovolemic shock.

The clinical manifestations of hypovolemia are determined by its type.

The main symptoms of normocytemic hypovolemia:

  • weakness,
  • dizziness,
  • lowering blood pressure
  • tachycardia,
  • weak pulse push,
  • decreased urine output,
  • cyanosis of the mucous membranes and skin,
  • decrease in body temperature
  • fainting
  • muscle cramps of the lower extremities.

Oligocytemic hypovolemia is characterized by signs of impaired blood supply to organs and tissues, decreased oxygen capacity of the blood, and increasing hypoxia.

Signs of polycythemic hypovolemia:

  • a significant increase in blood viscosity,
  • severe microcirculatory circulatory disorders,
  • disseminated microthrombosis, etc.

Hypovolemic shock is manifested by a pronounced clinical picture, a rapid increase in symptoms.

Diagnostics

The diagnosis and degree of hypovolemia is based on clinical symptoms.

Normally, in adult women, the total blood volume is 58–64 ml per 1 kg of body weight, in men - 65–75 ml / kg.

The volume of laboratory and instrumental studies depends on the nature of the pathology that led to a decrease in the volume of circulating blood. Mandatory minimum includes:

  • hematocrit determination,
  • general blood analysis,
  • blood biochemistry
  • general urine analysis,
  • determination of blood type and Rh factor.

If hypovolemia caused by bleeding into the abdominal cavity is suspected, a diagnostic laparoscopy is performed.

The goal of therapy is to restore normal circulating blood volume as soon as possible. For this, infusion of dextrose solutions, saline and polyionic solutions is carried out. In the absence of a lasting effect, intravenous administration of artificial plasma substitutes (solutions of hydroxyethyl starch, gelatin, dextran) is indicated.

In parallel, the therapy of the main pathology is carried out to prevent the increase in the severity of hypovolemia. So, in the presence of a source of bleeding, surgical hemostasis is performed. If the decrease in the volume of circulating blood is due to a shock condition, appropriate anti-shock therapy is prescribed.

In the serious condition of the patient and the appearance of signs of respiratory failure in him, the question of the advisability of tracheal intubation and transfer of the patient to mechanical ventilation is resolved.

In the absence of emergency therapy, severe hypovolemia results in the development of hypovolemic shock, a life-threatening condition.

Prevention

Prevention of hypovolemia includes:

  • injury prevention
  • timely treatment of acute intestinal infections,
  • sufficient intake of water in the body, correction of the water regime under changing environmental conditions,
  • refusal of self-medication with diuretics.

Consequences and Complications

In the absence of emergency therapy, severe hypovolemia results in the development of hypovolemic shock, a life-threatening condition. In addition, against the background of a decrease in the volume of circulating blood, functional insufficiency of a number of internal organs (brain, kidneys, liver) may occur.

Education: graduated from the Tashkent State Medical Institute with a degree in medical care in 1991. Repeatedly took advanced training courses.

Work experience: anesthetist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is compiled and provided for informational purposes only. See your doctor at the first sign of illness. Self-medication is dangerous to health!

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Causes and types of hypervolemia

Hypervolemia is not an independent disease, but a symptom complex of various pathologies.

The following blood components are distinguished:

liquid part, or plasma,

shaped elements, or all blood cells.

Hematocrit is the ratio of the sum of blood cells to the total blood volume in the vascular system. Its norm is from 36 to 48%, that is, in 100 ml of blood there are 36-48 ml of blood cells, the remaining 52-64 ml are in plasma. The classification of the disease depends on the hematocrit index.

Simple hypervolemia

In this type of pathology, the hematocrit indicator remains within the normal range, but the volume of blood circulating in the vascular system increases.

Transfusion of the amount of blood for which the volume of blood vessels is not designed,

High physical activity

Significant increase in ambient temperature,

In all cases, except the first, blood replenishes the circulatory system, entering there from its own depots.

Oligocytemic hypervolemia

The hematocrit number indicator drops below standard values, the blood volume rises due to an increase in plasma volume, hydremia is formed.

Factors Leading to Hydremia:

pregnancy - changes in the composition of the blood contribute to the successful course of metabolic processes between the fetus and the body of a pregnant woman,

intensive transport of fluid into the vascular system: transfusion of plasma and substitutes, impregnation of the liquid component from surrounding tissues with edema through the walls of blood vessels, heavy drinking,

violation of the dehydration process: sodium retention, renal failure, increased secretion of antidiuretic hormone.

Polycythemic hypervolemia

With this type of hypervolemia, the hematocrit index increases due to an increase in the proportion of the cellular component in the vascular system.

hematological pathologies: tumors of any etiology, genetically determined developmental abnormalities,

hypoxia caused by a prolonged stay in the highlands, heart and lung failure.

Symptoms, diagnosis and treatment of hypervolemia

Symptoms and prescribed treatment tactics depend on the type of pathology. If the disease is caused by causes to which the body can adapt, and its symptoms are short-lived, the circulatory system will recover on its own.

If the disease is based on acute or chronic dysfunction of organs and systems, therapy is aimed at reducing the volume of circulating blood, at correcting the symptoms of the disease.

Manifestations of angina pectoris, heart failure,

A feeling of heaviness during breathing, an increase in its frequency,

Lower back pain

Weight gain

Dry skin and mucous membranes,

Modern medicine does not have in its arsenal of methods for determining the volume of circulating blood. Diagnostic methods available today are applicable only in experimental medicine and do not have practical value. To determine the type of pathology and its causes in hematology, the hematocrit indicator is used.

Therapy of the disease is carried out in two directions:

Etiotropic treatment - eliminates the cause of hypervolemia,

Symptomatic treatment - stops manifestations of pathology.

What is etiotropic treatment aimed at:

Therapy of diseases of the endocrine, urinary system,

Genetically caused diseases of the circulatory system,

Tumors of any etiology,

Monitoring the volume of infusion with intravenous infusions.

Directions of symptomatic treatment:

Relief of high blood pressure by antihypertensive drugs in combination with diuretics,

Reduced heart load due to the use of drugs for the treatment of angina,

The patient is placed in an environment with a comfortable temperature, saturated with oxygen.

Recipes of traditional medicine:

Hirudotherapy (treatment with leeches): reduces blood volume, dilutes it and slightly reduces the number of shaped elements,

Plant-based diuretics: fennel, horsetail, bearberry, dill, viburnum.

It is important that diagnostic and therapeutic measures are carried out under the guidance of an experienced doctor, because a harmless, at first glance, condition can mask the initial stages of a complex pathology.

Hypervolemia of the pulmonary circulation

The human circulatory system consists of large and small circles of blood circulation. The large circle includes vessels that feed all organs and tissues except the vessels that feed the bronchopulmonary system, and the small circle contains only the vessels of the lungs.

Blood distribution in the circulatory system:

in capillaries - 12%,

inside the heart muscle - 3%.

In the large circle of blood circulation circulates from 75 to 80% of the total volume of the bloodstream, in the small circle - 20-25%.

Hypervolemia of the pulmonary circulation is based on high pressure in the vessels of the broncho-pulmonary system, which is why it is called pulmonary hypertension.

Causes of Small Circle Hypervolemia

Factors Leading to Pulmonary Hypertension:

Reflex narrowing of small vessels of the lungs. It occurs with severe stress, mitral valve stenosis, embolism.

Prolonged alveolar hypoxia. It occurs as a result of silicosis, chronic bronchitis, emphysema, obstructive pulmonary disease, anthracnosis, bronchiolitis, bronchiectasis.

Left ventricular failure. It occurs with cardiac arrhythmia, as a result of a heart attack, myocarditis.

Increased blood density.

Increased airway pressure. It occurs with severe cough, increased barometric pressure of the external environment, violations of mechanical ventilation.

The narrowing of blood vessels that remove blood from the lungs. It occurs with aortic aneurysm, tumors, adhesions, congenital malformation.

Genetically determined pathology of the enzyme system.

Increased ejection of blood by the right ventricle.

Narcotic intoxication with psychostimulants.

Portal hypertension. Reasons: cirrhosis, Budd-Chiari syndrome.

Apnea, or respiratory arrest during a night's sleep amid snoring.

In addition to the above factors, there are also idiopathic (unknown) causes leading to primary pulmonary hypertension.

Signs of pulmonary hypervolemia

The primary stage of the disease may go unnoticed by the patient. When the symptoms of the disease clearly indicate the presence of dangerous changes, most often the process has gone far and is already irreversible.

shortness of breath, passing into suffocation with an increase in load,

asthenia, its symptoms: insomnia, weight loss, decreased performance, instability of mental state,

fainting on exertion

severe cough without sputum production, in advanced cases with hemoptysis,

pain in the projection of the liver.

Pulmonary Hypervolemia Treatment

The main direction of the therapy of pathology is the elimination of the cause that caused it, since hypervolemia is not an independent disease. Pulmonary hypervolemia provokes pathological processes that occur in various systems of the human body. The most difficult to treat primary hypertension, since its cause is not established, the source of negative symptoms is unknown.

In the treatment of pulmonary hypervolemia, drugs and methods used in standard treatment regimens for hypertension are used. With a decrease in the effectiveness of antihypertensive treatment, Eufillin and oxygen therapy are used.

Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the educational and scientific medical center for managing the affairs of the President of the Russian Federation.

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Clinical manifestations, diagnosis and treatment of hypervolemia

Signs of hypervolemia and therapeutic tactics largely depend on its type and the causes that caused this condition.

In the case of physiological and functional causes that do not go beyond the adaptive abilities of our body, the manifestations are short-term and without any special medical manipulations, the body will independently restore its normal state.

If hypervolemia is caused by any chronic or acute disease, the treatment tactics are aimed primarily at the disease itself, causing an increase in the amount of intravascular blood, and also, if necessary, at stopping the immediate symptoms of hypervolemia, which manifests itself in a variety of and non-specific ways:

  • High blood pressure
  • An increase in heart load can lead to manifestations of heart failure, angina pectoris,
  • unexplained weight gain
  • Swelling
  • Dyspnea,
  • Dry skin and dry mouth
  • Urination disorders
  • Increased respiratory rate and a feeling of heaviness while breathing,
  • General weakness
  • Headache,
  • Pain in the lumbar region,
  • Fatigue.

Diagnosis of the hypervolemic state in practical medicine is difficult, due to the lack of objective, reliable, and most importantly safe methods for determining the volume of circulating blood in clinical practice. In other words, the methods that are used have proven themselves in experimental science, explained this pathological process and laid the scientific foundations for the treatment of hypervolemia. Only the hematocrit indicator remains available for practical use., which is of great importance in determining the type of hypervolemia and the causes of it.

Therapeutic tactics are based on two areas:

Etiotropic (aimed at the cause of the pathology) treatment:

  1. Kidney disease
  2. Surgical treatment of heart defects as early as possible
  3. Endocrine disease treatment,
  4. The fight against tumors and congenital diseases of the blood system,
  5. Treatment of acute and chronic lung diseases,
  6. Careful control of intravenous infusion volume.

Symptomatic (aimed at combating manifestations of pathology) treatment:

  1. High blood pressure is stopped by the use of antihypertensive drugs with an emphasis on diuretics,
  2. Angina pectoris caused by hypervolemia, first of all requires reducing the load on the heart and only then using antianginal drugs,
  3. One of the leading elements in helping with hypervolemia is to place the patient in comfortable conditions with normal, ambient temperature and enough oxygen in the inhaled air.

Alternative medicine can also be considered effective and gentle treatment methods:

  • Hirudotherapy (the use of leeches) has a direct effect directly on the blood volume, reducing it, and also reduces blood viscosity and slightly reduces the number of shaped elements, which can normalize the hematocrit in case of polycythemic hypervolemia,
  • Plant diuretics: fennel, dill, viburnum, bearberry, horsetail and others.

The treatment and especially the diagnosis of hypervolemia requires a careful integrated approach by a qualified doctor, since the apparent simplicity and harmlessness of this condition may hide the initial manifestations of a serious illness, the early and timely diagnosis of which can save a person's health and even life.

1. General information

Many visitors to sites with popular educational medical content probably came across the concept of “hypovolemic shock” - recall that this is a life-threatening emergency condition due to massive simultaneous blood loss and a sharp decrease in BCC (circulating blood volume). However, the opposite situation - when there is too much blood in the body - is unhealthy or at least abnormal. Literally translated hypervolemia means precisely “excessive volume”, meaning an excessive amount of liquid blood fractions, which creates an overload for the cardiovascular system and is manifested by many violations.

Another term that is important for understanding this material is the hematocrit index, or hematocrit number (denoted by Ht), which reflects the specific volume of red blood cells in the blood. Various types of hypervolemia are distinguished (see below), and in different cases the hematocrit may deviate from the norm in one direction or another, or retain a conditionally normative value.

There are normocytemic, oligocytemic and polycythemic forms of hypervolemia.

Normocytemic or simple hypervolemia is usually associated with transfusion of significant volumes of blood, states of oxygen starvation (hypoxia) with the release of all blood reserves in the body, and physical overload. The hematocrit number in this case, as a rule, corresponds to the norm.

Oligocytemic hypervolemia is caused either by the consumption of excess, abnormally large volumes of liquid (due to which the liquid fraction of the blood increases), for example, in states of polydipsia, unquenchable thirst in diabetes mellitus, or by impaired excretion of fluid from the body, which occurs, in particular, in renal failure, some endocrine disorders, etc. Hematocrit with this form of hypervolemia is reduced.

The main causes of polycythemic hypervolemia are erythrocytosis (a group of pathological conditions and diseases in which an excess of red blood cells is produced), as well as a state of chronic oxygen starvation. The hematocrit number in this case is increased.

3. Symptoms

The classic signs of hypervolemia include overweight, a tendency to swelling, persistently high blood pressure, dysuria (disorders of urination), sweating, or, conversely, dry skin. Patients complain of headaches, shortness of breath and shortness of breath, general weakness, fatigue.

The diagnosis is made clinically, confirmed and specified in the laboratory: thorough and reliable studies of the composition of blood and urine are necessary.

Since various forms of hypervolemia are due to significantly different reasons, there can be no single therapeutic response scheme. In some cases, the primary task is to normalize the content and metabolism of sodium in the body, in other cases, they begin with examination and treatment of kidney diseases, etc. A separate most important area is the prevention of severe complications from the cardiovascular system, pulmonary edema with rapidly progressing hypervolemia. Hypervolemia is especially dangerous for severe somatic patients undergoing inpatient treatment and receiving transfusions, droppers, parenteral nutrition: data are published that hypervolemia in this case is one of the factors of intoxication and, ultimately, increased mortality.

The easiest, most accessible and affordable way for anyone to avoid the development of hypervolemia (as well as many other problems) is to consciously limit the intake of foods with a high sodium content: pastries, fast food products, salty dishes, etc.

Watch the video: Hypervolemia (January 2020).