Hypervolemia: symptoms and treatment. Hypervolemia

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Hypervolemia- a condition in which the volume of blood circulating in the vascular bed increases. There are simple, oligocythemic and polycythemic hypervolemia, which differ in hematocrit.

Isolated hypervolemia the small circle of blood circulation is called.

The experience gained over the entire period of the development of medicine has established certain limits for various laboratory parameters, beyond which it is regarded as a disease. The same framework defines the amount of blood at one time inside our vessels.

The norm for an adult is such a condition when a total amount of blood circulates inside the vessels of the whole organism, equal by weight from 6 to 8 percent of body weight or 1/13 of it. That is, a person weighing 75 kilograms contains about 5 liters of blood at a time inside the vessels.

Causes and types of hypervolemia

An increase in the volume of blood circulating in the vascular bed at a time is called hypervolemia. This condition is not an independent disease and is regarded as a syndrome - a complex of manifestations (symptoms) of a disease. Blood is represented by two main components: plasma (the liquid part) and formed elements (the totality of all blood cells). The ratio of the total volume of blood cells to the total blood volume is called hematocrit and normally it is 36% - 48%, that is, in one liter of blood from 360 to 480 milliliters of cells, and the rest is plasma.

Depending on the change in the number, hypervolemia is divided into three types:

  • Simple hypervolemia;
  • Oligocythemic hypervolemia;
  • Polycythemic hypervolemia.

blood in polycythemic hypervolemia

Each of the listed types of hypervolemia has its own separate cause, which is the reason for the different approaches to treatment and diagnosis.

Simple hypervolemia

Simple hypervolemia - such a state when there is a proportional increase in the amount of circulating blood, that is, the ratio of all cells and the liquid part in a unit of blood volume remains within normal values. This condition is observed quite rarely, its causes are:

  1. (transfusion) of excessive amounts of blood;
  2. High ambient temperature;
  3. Acute lack of oxygen (hypoxia).

In the first case, hypervolemia develops as a result of the intake of an excessive amount of blood that is normal in terms of hematocrit from the outside, in the rest, the same blood corresponding to the norm enters the vascular bed from the depot (reserves) of one's own body.

Oligocythemic hypervolemia

In a situation oligocythemic hypervolemia an increase in the amount of circulating blood is associated with an increase in the amount of the liquid component of the blood, while the hematocrit becomes below normal. This condition is called hydremia, it leads to:

  • Pregnancy - hydremia during childbearing is the norm and contributes to an adequate metabolism between the body of the mother and child;
  • Increasing the flow of fluid into the vascular bed (excessive drinking, transfusion of plasma and its substitutes, fluid transfer during edema from tissues to vessels);
  • Decreased excretion of fluid from the body (acute and chronic renal failure, increased formation of antidiuretic hormone, sodium retention).

Polycythemic hypervolemia

Polycythemic hypervolemia - develops in cases where an increase in blood volume in the vascular bed is achieved due to the cellular component, which is accompanied by an increase in hematocrit. Lead to this state:

  1. Chronic hypoxia: heart defects, chronic lung diseases with insufficient lung function, prolonged stay in high altitude conditions, etc.;
  2. Blood diseases - malignant and benign tumors, hereditary anomalies, accompanied by increased formation of blood cells.

Clinical manifestations, diagnosis and treatment of hypervolemia

Signs of hypervolemia and treatment 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 restore its normal state on its own.

If hypervolemia is caused by any chronic or acute disease, treatment tactics are primarily aimed at the disease itself, which causes 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:

  • Increased blood pressure;
  • An increase in the load on the heart can lead to manifestations of heart failure, angina pectoris;
  • unexplained weight gain;
  • swelling;
  • Dyspnea;
  • Feeling of dry skin and dry mouth;
  • urination disorders;
  • Increased respiratory rate and a feeling of heaviness when breathing;
  • General weakness;
  • Headache;
  • Pain in the lumbar region;
  • Increased 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, those methods that are used have proven themselves well in experimental science, explained this pathological process and laid the scientific foundations for the treatment of hypervolemia. Only hematocrit remains available for practical use., which is of great importance in determining the type of hypervolemia and the causes that caused it.

Therapeutic tactics is based on two directions:

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

  1. Fight against kidney diseases;
  2. Operative, as early as possible, treatment of heart defects;
  3. Treatment of endocrine diseases;
  4. Fight against tumors and congenital diseases of the blood system;
  5. Treatment of acute and chronic lung diseases;
  6. Careful control of the volume of intravenous infusions.

Symptomatic (aimed at combating the 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 requires, first of all, a decrease in the load on the heart and only then the use of antianginal drugs;
  3. One of the leading elements of helping with hypervolemia is placing the patient in comfortable conditions with normal ambient temperature and a sufficient amount of oxygen in the inhaled air.

Also, traditional medicine can be considered effective and sparing methods of treatment:

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

Treatment and especially the diagnosis of hypervolemia requires a careful integrated approach by a qualified doctor, because behind the seeming simplicity and harmlessness of this condition, the initial manifestations of a serious illness can be hidden, the early and timely diagnosis of which can save the health and even life of a person.

Hypervolemia of the pulmonary circulation

The blood inside the vascular bed is unevenly distributed: approximately 70% of all blood is constantly in the veins, about 15% in the arteries, 12% is in the thinnest vessels that perform the direct function of metabolism - capillaries, 3% inside the heart. The entire circulatory system is divided into large (includes the vessels of all organs and tissues with the exception of the vessels of the lungs) and small (captures only the vessels of the lungs) circulation circles.

About 75-80% of the total volume of circulating blood is simultaneously in the systemic circulation, and only 20-25% is in the small one.

Isolated hypervolemia of the pulmonary circulation, or hypervolemia of the lungs, is called in medicine, since signs of high pressure in the vessels of the lungs come to the fore in the clinic.

Causes of hypervolemia of the small circle

Hypervolemia of the lungs has a fairly large number of various factors in its causes, and not all of them are well studied, and some have not yet been established. Known reasons include:

  1. Long-term insufficient oxygen content (hypoxia) inside the terminal sections of the respiratory tract - the alveoli. Chronic bronchitis (including smoker's bronchitis), emphysema, bronchiolitis, bronchiectasis, chronic obstructive pulmonary disease, silicosis, anthracosis and other diseases of the lungs and respiratory tract lead to it.
  2. Acute reflexogenic narrowing of the small arteries of the lungs. It develops with a strong emotional shock, pulmonary embolism (even small branches), mitral valve stenosis.
  3. Increased pressure within the airways. Occurs with an intense cough, an increase in external barometric pressure, errors in artificial lung ventilation.
  4. Lack of function of the left ventricle, which occurs with a heart attack, arrhythmia, myocarditis.
  5. Increased blood viscosity.
  6. Increased ejection of blood from the right ventricle.
  7. Narrowing of the blood vessels that carry blood from the lungs. It can be caused by a tumor, aneurysm, adhesions, malformations, and more.
  8. Chronic intoxication - psychostimulant drugs (cocaine, amphetamine).
  9. Hereditary diseases and defects in enzyme systems.
  10. Portal hypertension is an increase in pressure in the portal vein of the liver (cirrhosis, Budd-Chiari disease and syndrome).
  11. HIV infection.
  12. Sleep apnea is a relatively short-term stoppage of breathing during sleep, more common with snoring.

Also, do not discount idiopathic - unknown causes that lead to primary pulmonary hypervolemia.

Signs of pulmonary hypervolemia

At the initial stages of its course, pulmonary hypervolemia does not have any pronounced manifestations, which is its danger - being undiagnosed, it slowly progresses and manifests itself only at the stages of a far advanced and, alas, already irreversible pathological process:

  • Asthenization - increased fatigue, mood lability, weight loss, sleep disturbances, etc.;
  • Shortness of breath, up to suffocation, aggravated by physical exertion;
  • Frequent bouts of dizziness;
  • Unexplained fainting, especially during physical exertion;
  • Severe, unproductive cough, sometimes, in advanced cases, with an admixture of streaks of blood;
  • Pain in the region of the heart;
  • Cyanosis (cyanosis) of the skin at the beginning of the disease is barely distinguishable, with the progress of the disease it becomes more pronounced;
  • Edema, in severe cases, ascites (fluid in the abdominal cavity);
  • Pain in the right hypochondrium (in the region of the liver);
  • Heart rhythm disorders.

Diagnosis of hypervolemia of the small circle

The diagnosis of pulmonary hypervolemia is based on the above clinical manifestations and a number of laboratory and instrumental methods:


Treatment of pulmonary hypervolemia

Medical tactics for hypervolemia of the lungs is primarily aimed at treating the pathology that caused it, since pulmonary hypertension itself is only a manifestation of the underlying disease. The greatest difficulty, or rather the almost complete ineffectiveness of therapeutic measures, is primary (with an unknown cause) pulmonary hypertension, since the primary source of the disease is not known.

For the treatment of hypervolemia of the pulmonary circulation, all drugs and methods that are used to treat the usual are effective. A feature is a more pronounced effectiveness of aminophylline and oxygen therapy against the background of a slightly reduced effectiveness of antihypertensive therapy.

The thyroid gland plays an important role in the functioning of the body. With its participation, metabolism takes place, iodine is produced, bone tissue grows. Under the influence of various factors, thyroid diseases are becoming more common.

Hypovolemia is a disease that occurs due to large blood loss and disruption of the thyroid gland. Its dimensions correspond to the parameters of 20-40-20 mm, but the organ depends on body weight and changes in volume at certain stages of life: it increases during pregnancy, puberty and decreases upon reaching old age.

signs

Clinical manifestations of hypovolemia are determined by its type.

The main symptoms of normocythemic hypovolemia:

  • weakness;
  • dizziness;
  • lowering blood pressure;
  • tachycardia;
  • weak pulse impulse;
  • decrease in diuresis;
  • cyanosis of mucous membranes and skin;
  • decrease in body temperature;
  • fainting;
  • cramps in the muscles of the lower extremities.

Oligocythemic hypovolemia is characterized by signs of impaired blood supply to organs and tissues, a decrease in the oxygen capacity of the blood, and increasing hypoxia.

Signs of polycythemic hypovolemia:

  • a significant increase in blood viscosity;
  • severe disorders of microcirculatory circulation;
  • disseminated microthrombosis; and etc.

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

Degrees of hypovolemia

The highest degree of manifestation of hypovolemia is replaced by hypovolemic shock. There are the following degrees of exacerbation of the disease:

  • Easy. Blood loss is about 15% of the total volume. There is a drop in blood pressure, rapid pulse, tachycardia, pale skin, insufficient blood supply to the extremities, dry mouth, weakness.
  • Average. Blood loss is approaching 40%, the patient is in a serious condition, blood pressure is up to 90 mm, the pulse is rapid, breathing is irregular, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are pronounced. Sometimes - vomiting, fainting, a decrease in the amount of urine.
  • Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is poorly audible, tachycardia is pronounced, impaired consciousness, convulsions, and heavy breathing. The condition is unsafe for life, can lead to death.

Diagnostics

Identification of hypervolemia is a rather difficult task that confronts doctors. There are no specific symptoms of the disorder, and it is quite difficult to calculate the total volume of blood in the body. Therefore, the diagnosis of hypervolemia is reduced to the determination of hematocrit parameters. This study makes it possible not only to detect hypervolemia itself, but also to determine its type, as well as to clarify the cause of the development of this condition.

The initial admission of the patient consists of taking an anamnesis, examination, prescribing laboratory tests of blood, urine, which will help determine the number of red blood cells in the blood plasma and urine. The results of the research will make it possible to draw up a complete picture of the disease, determine the stage, cause, and prescribe the necessary treatment.

An important step in the treatment is the identification and elimination of the etiological factor that provoked the development of hypervolemia. Basically, treatment is symptomatic and is prescribed individually for each patient. Equally important in the treatment is diet, proper and healthy lifestyle. A person should take as little liquid as possible, exclude any physical and psychological stress, completely stop smoking and drinking alcohol. In case of hypervolemia, it is recommended to consult with other specialists: a cardiologist, an infectious disease specialist, a gastroenterologist, a urologist.

Only an integrated approach to solving the problem will help to get good results from treatment.

The following laboratory tests are indicated for patients with suspected adipsia:

  • Determination of electrolytes, nitrogen and serum creatinine:
  1. adipsia often leads to electrolyte disturbances in the blood serum;
  2. hypernatremia is a hallmark of clinically significant water deficiency, which may be associated with adipsia;
  3. water deficiency associated with adipsia also causes high creatinine levels and an increase in the creatinine to BUN ratio.
  • The result of water deficiency is often markedly increased serum osmolality;
  • Urinary electrolyte levels and osmotic pressure:
  1. Simultaneous measurements of urinary electrolytes and osmolality are critical in identifying central rather than renal causes of water homeostasis disorders;
  2. In adipsia, fractional sodium excretion is less than 1% if the defect coexists with impaired vasopressin function;
  3. Urinary osmolality is very high unless defects due to vasopressin deficiency are observed;
  4. In diabetes insipidus, urine concentration is submaximal, even under conditions of high serum osmolality. With salt intoxication, the concentration in the urine of sodium is very high, and its fractional excretion is more than 1%;
  5. Difficulties in diagnosis may arise when adipsia and diabetes insipidus coexist. In these patients, initial test results may show suggestive diabetes insipidus. However, administration of vasopressin increases urine osmolarity and reduces the tendency to hypernatremia. The patient's history of not being thirsty indicates the coexistence of adipsia.
  • Hormone levels in the blood;
  • In isolated adipsia, circulating vasopressin levels should be high, reflecting the corresponding pituitary response to hyperosmolarity. Patients who have defects in thirst regulation and vasopressin secretion have very low or absent serum levels of this hormone;
  • Elevated levels of plasma renin and aldosterone may indicate secondary hypovolemia.

Of the methods of visual diagnostics, brain studies are most often used, such as computed tomography and MRI, which are highly indicated if the main cause of the development of adipsia can be an anatomical and physiological defect in the brain area - an empty Turkish saddle or a tumor. Methods can also help rule out complications of hypernatremia, such as intracranial hemorrhage.

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

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. The required minimum includes:

  • determination of hematocrit;
  • general blood analysis;
  • blood biochemistry;
  • general urine analysis;
  • determination of blood group and Rh factor.

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

Diagnosis

Diagnosis is based on the data of the clinical picture. The list of studies is assigned depending on the characteristics of the pathology that led to a drop in the volume of blood circulating in the body.

The basis of diagnosis involves:

  • determination of hematocrit;
  • blood chemistry;
  • general blood analysis;
  • determination of the blood group.

If hypovolemia provoked by internal bleeding is confirmed, diagnostic laparoscopy is performed.

Hypervolemia: causes of the disease, main symptoms, treatment and prevention

A pathological condition caused by an increase in the volume of circulating blood and plasma, which can be caused by various reasons.

The reasons

An increase in circulating blood volume can be observed for various reasons. Hypervolemia develops against the background of excessive fluid intake, edema, fluid retention in the vascular bed, transfusion of significant volumes of blood, acute hypoxic conditions, lesions of the cardiovascular system, impaired functioning of the kidneys and respiratory system, and heavy physical exertion.

Symptoms

This pathological condition is manifested by an increase in body weight, impaired urination and sweating, edematous syndrome, hypertensive syndrome, dry skin, dry mouth, shortness of breath, weakness, headaches, shortness of breath.

Normocythemic hypervolemia is manifested by an equivalent increase in the volume of formed elements and the liquid part of the volume of circulating blood. In this condition, the hematocrit is within the normal range. Oligocythemic hypervolemia is characterized by an increase in total blood volume, while the hematocrit in such patients is below normal.

Polycythemic hypervolemia is also manifested by an increase in the total blood volume, an increase in the number of its formed elements and is characterized by hematocrit values ​​above normal.

Diagnostics

Diagnosis of hypervolemia occurs against the background of a general examination of the patient, the collection of an anamnesis of the disease and a thorough analysis of the patient's complaints.

During a physical examination, it is necessary to establish by palpation whether the patient has peripheral edema.

In addition, the patient is required to carry out general and biochemical blood tests, as well as a general urine test.

Treatment

The result of the treatment of this pathological condition largely depends on the patient's willingness to comply with all medical recommendations, as well as follow the diet prescribed by the specialist. Also, for the duration of treatment, such patients are advised to limit the amount of fluid consumed.

Treatment is aimed at removing excess fluid from the patient's body. The treatment regimen for the disease is selected taking into account the reasons that caused this pathological condition.

If the condition is due to sodium retention in the body, it is necessary to limit the intake of sodium from food.

As prescribed by the doctor, use diuretics, hormones to improve the condition of the kidneys, drugs to maintain cardiac function.

Prevention

Prevention of hypervolemia is based on the timely treatment of diseases of the cardiovascular and urinary systems. To reduce the risk of hypervolemia, you will need to abandon excessive fluid intake and limit the intake of foods containing sodium, as well as smoked meats and preservatives.

Prevention of hypovolemia includes:

  • injury prevention;
  • timely treatment of acute intestinal infections;
  • sufficient intake of water into the body, correction of the water regime under changing environmental conditions;
  • Refusal to self-medicate with diuretics.

To prevent hypovolemia, it is necessary to control the condition of the heart, blood vessels, and kidneys. Properly rendered assistance in case of profuse blood loss is of great importance. It must be borne in mind that incorrect actions can lead to the death of the patient.

As a preventive measure, one can indicate the prevention of injuries, the timely detection of intestinal diseases, compliance with the water regime and control of water intake when the environment changes, the use of diuretics only on the recommendation of a doctor.

Therapy problems

In the course of treatment, patients are forced to face problems such as the consequences of drug therapy, and improvement is accompanied by the development of other diseases or side effects.

An equally difficult circumstance is the short-term effect of drugs of considerable cost, as well as the peculiarity of the effect of the drug: the drug taken orally violates the microflora of the gastrointestinal mucosa.

As for the patient's condition, due to the instability of the hormonal background, his mood does not allow him to fully relax in order to enjoy life.

Effects

Severe hypovolemia in the absence of medical intervention turns into hypovolemic shock, which poses a threat to life.

A decrease in blood volume entails a disruption in the activity of internal organs, which, in the presence of diseases, complicates the patient's condition and treatment.

In the absence of emergency treatment, severe hypovolemia ends with 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.

Pathophysiological basis of adipsia

In humans, the thirst center is located in the anterior part of the hypothalamus. The main physiological stimuli for the manifestation of signs of the need for replenishment with water are hypertonicity, based on the osmotic pressure of the blood and hypovolemia. Adipsia is often a congenital pathology, additional social stimuli that have arisen in the process of life, as a rule, are primary in relation to failures in the regulation of water in the body.

Osmoreceptors, located in the anterior wall of the third ventricle, mediate the osmotic regulation of thirst, which regulate the secretion of vasopressin, an osmotic thirst factor.

Hypovolemia and hypotension can also stimulate thirst through the activation of low or high blood pressure through stretch receptors - hypovolemic thirst. Impulses from these receptors are transmitted by the vagus and glossopharyngeal nerves to the medulla oblongata, and from there to the hypothalamus. In addition, the hypothalamus is directly stimulated by angiotensin II. In general, hypovolemic thirst occurs due to the depletion of blood plasma volume by at least 4-8%.

Thirst anomalies can be caused by specific functional lesions of the hypothalamus that prevent activation of the regulation of osmotic or hypovolemic processes. Often these two phenomena occur in combination, interfering with the cognitive processes necessary to perceive thirst.

Any lesion, congenital or acquired, that affects the anterior hypothalamus can result in a lack of thirst. Disorders in the regulation of antidiuretic hormone, produced in the hypothalamus and responsible for the production, storage and excretion of urine, leads to a violation of the ability to form urine.

Key points in the treatment of adipsia:

  • Treatment of the underlying cause of the disease can take years, since the pathology has a high tendency to relapse.
  • Most of the true causes of adipsia are incurable - patients will have to take symptomatic treatment for life.
  • The underlying damage to the hypothalamic region is 99% irreversible, leading to the condition described above.
  • The goal of medical care is to teach the patient to maintain adequate fluid intake regardless of the manifestations of thirst.

Treatment options:

  • Pharmacological therapy is not provided for the treatment of this disease at present.
  • The main direction in therapy is the consumption of water regularly and regardless of the requirements of the body.
  • Electroconvulsive therapy has been used with mixed results among patients in whom a psychogenic factor is the underlying cause.
  • When behavioral therapy fails, the only option left is long-term administration of fluids through a nasogastric tube in especially advanced cases.
  • The appointment of desmopressin acetate is relevant if it is necessary to limit the output of urine. The method is especially useful in patients with coexisting central diabetes insipidus.
  • In case of adipsia in case of diabetes insipidus, recovery of thirst function, after exclusion of the underlying cause, can be assessed using a visual analog scale after infusion of hypertonic saline.
  • surgical removal of tumors, hematomas or cysts that suppress the activity of the thirst center;
  • dietary restrictions are not provided;
  • frequent and regular intake of water should be maintained;
  • activity restrictions are not required.

Symptoms and causes of the disease

No physical signs are specific for adipsia. The most obvious symptoms of the disorder are best attributed to changes in water regulation due to hypernatremia. These changes include the following:

  • hyperpnea;
  • muscle weakness;
  • increased mobility;
  • active verbal signs of arousal;
  • insomnia;
  • lethargy;
  • coma;
  • convulsions - rarely, except in cases of excessively rapid rehydration;
  • loss of skin turgor and dry mucous membranes. These symptoms occur relatively frequently, but may not be commensurate with the degree of dehydration.

Physical signs indicating underlying disorders are often obvious. Examples of such physical features include:

  • cleft palate;
  • other midline defects of the face;
  • hydrocephalus.

The objective reasons for the development of adipsia are often:

  • tumor lesions - germinomas, histiocytomas and gliomas;
  • microcephaly;
  • cleft lip, cleft palate;
  • empty Turkish saddle;
  • malformations of the transparent septum;
  • meningoencephalitis;
  • subarachnoid hemorrhage;
  • hydrocephalus;
  • pseudotumor state;
  • psychogenic disorders.

a condition characterized by an increase in the total volume of blood and most often a violation of the ratio of formed elements and plasma.

    Simple (normocythemic) hypervolemia- an increase in the total blood volume while maintaining a normal percentage of plasma and formed elements. It occurs for a short time when large amounts of donor blood are transfused, during heavy physical exertion, during acute hypoxia, at the beginning of high ambient temperature, when deposited blood enters the bloodstream from the depot, and intercellular fluid from the tissues. This condition can lead to a decrease in vascular tone, heart overload, and the development of heart failure.

    Oligocythemic hypervolemia (hydremia)- an increase in blood volume due to the predominant increase in its liquid part, while the hematocrit is below 36%. Occurs when there is a violation of the excretory function of the kidneys and fluid retention in the bloodstream, pathological thirst, excessive administration of saline or blood substitutes, with hyperproduction of antidiuretic hormone. As a result, circulatory disorders may occur due to overstretching of blood vessels, heart cavities and microcirculation disorders.

    Polycythemic hypervolemia- a condition in which the volume of circulating blood increases mainly due to formed elements (erythrocytes), in connection with which the hematocrit exceeds 48%. It occurs with heart defects, chronic circulatory failure, alveolar hypoventilation, a decrease in the oxygen capacity of the blood and the efficiency of biological oxidation, exogenous (hypo- and normobaric) hypoxia, as well as in erythremia (Vakez's disease) - leukemia with a primary lesion of the red germ of the bone marrow. The disease is accompanied by an increase in blood viscosity, blood pressure, an increase in the load on the heart, followed by left ventricular hypertrophy, etc.

hypovolemia

a condition characterized by a decrease in the total blood volume and a violation of the ratio of formed elements and plasma.

    Simple (normocythemic) hypovolemia characterized by a decrease in BCC with normal hematocrit. The causes are acute bleeding, shock conditions, vasodilatory collapse. In the last two cases, a significant amount of blood is deposited in the venous (capacitive) vessels and a significant decrease in BCC, the hematocrit has not yet changed. The danger of the condition lies in a decrease in blood pressure, impaired peripheral blood flow, leading to hypoxia and metabolic disorders in tissues.

    Oligocythemic hypovolemia characterized by a decrease in the total blood volume with a predominant decrease in the number of formed elements and a decrease in hematocrit below 36%. It is observed immediately after the loss of blood, when its intake from the depot and tissue fluid does not yet eliminate hypovolemia, and the release of blood cells from the hematopoietic organs is a deficiency of red blood cells. It is manifested by a circulatory disorder in various vessels, an excess of the need for organs and tissues in blood supply above its level, a decrease in the oxygen capacity of the blood due to erythropenia.

    Polycythemic hypovolemia(anhydremia) is observed with a decrease in total blood volume due to a predominant decrease in plasma volume, while the hematocrit level exceeds normal. The most common causes of this condition are various forms of dehydration: indomitable vomiting, profuse diarrhea, polyuria, increased sweating, extensive burns, water starvation, hyperthermia, diabetes insipidus, etc. Disorders of the central, organ tissue and microcirculation are observed.

ACTIVITY 18

PATHOLOGY OF TOTAL BLOOD VOLUME. BLOOD LOSS.

Pathology of the total blood volume. Classification of violations (according to the nature of the violation of the volume of circulating blood and the hematocrit index).

Normally, the total blood volume is 6-8% (1/13) of body weight, and 1/3 of this volume is deposited in the capillaries and venous section of the vascular bed of the skeletal muscles, mesentery, liver, spleen, and, if necessary (physical activity, blood loss and etc.) enters the circulatory bed.

The relative density of blood is 1050-1060 c.u., and the plasma density is 1025-1034 c.u., and the density of formed elements is 1090 c.u.

The volume of circulating blood (CBV) is an important indicator of hemodynamics, which determines the magnitude of blood pressure. Its constancy is ensured by a complex regulatory system, including nervous and humoral mechanisms.

About 70% of the total bcc is in the veins, 15% in the arteries, 12% in the capillaries, 3% in the chambers of the heart). Up to 75-80% of the BCC is in the systemic circulation, and 20-25% in the small.

Hematocrit (conditionally "hematocrit" - Hct) - the volume percentage of formed elements from blood volume. Normal Hct is 36% - 48%. In the SI system, hematocrit (Ht) is expressed as 0.36-0.48.

Under various pathological conditions, both the total blood volume and Hct can change.

There are three groups of typical forms of violations: normovolemia, hypovolemia and hypervolemia (plethora, plethora).

normovolemia

Hypervolemia

hypovolemia- a condition characterized by a decrease in BCC below the relevant standards.

Depending on the nature of the change in Hct the following types of hypo-, hyper- or normovolemia are distinguished:

·

· polycythemic (Hct > 0.48),

· oligocythemic (Hct< 0,36).

Consequences of changes in hematocrit:

A decrease in hematocrit is accompanied by a decrease in blood viscosity, in hypovolemic conditions - by the development of hemic hypoxia.

Polycythemic conditions, regardless of the nature of the BCC change, are characterized by the formation of erythrocyte aggregates (sludge syndrome), thrombosis, deterioration of the rheological properties of the blood, which leads to a decrease in capillary bed perfusion, impaired microcirculation, and the development of multiple organ failure.

Change in circulating blood volume

The shaded part of the strips corresponds to hematocrit, and their total length corresponds to the total blood volume. 1-9 - the main typical changes:

1 - simple normovolemia,

2 - oligocythemic normovolemia,

3 - polycythemic normovolemia,

4 - simple hypervolemia,

5 - oligocythemic hypervolemia,

6 - polycythemic hypervolemia,

7 - normocythemic hypovolemia,

8 - oligocythemic hypovolemia,

9 - polycythemic hypovolemia.

Normovolemia. Types, causes, consequences for the body.

normovolemia- a condition in which the BCC corresponds to the average statistical norm characteristic of individuals of a given body weight, gender and age.

Depending on the nature of the change in Hct, the following types of normovolemia are distinguished:

· simple (normocythemic) (Hct is normal),

· polycythemic (Hct > 0.48),

· oligocythemic (Hct< 0,36).

Simple normovolemia observed in the normal state in a healthy person.

Norvolemic disorders include conditions in which BCC remains normal, but Hct changes .

Oligocythemic normovolemia characterized by a decrease in Hct against the background of normal BCC. Most often it is a consequence of the destruction of erythrocytes, inhibition of erythropoiesis, and is also noted in the 2nd (hydraemic) stage of compensation for acute blood loss, when the BCC normalizes relatively quickly as a result of the transition of fluid from the tissue space to the blood, and the number of blood cells still remains reduced.

Manifestations of oligocythemic normovolemia are determined mainly by the degree of reduction in the number of erythrocytes and the severity of hemic hypoxia.

Polycythemic normovolemia characterized by an increase in the number of formed elements against the background of normal BCC, and, consequently, hematocrit. This violation can develop during the transfusion of erythrocyte mass, as a result of the activation of erythropoiesis (in residents of the highlands, Wakez disease).

Polycythemic normovolemia is manifested by an increase in blood pressure due to an increase in blood viscosity and peripheral resistance.


Hypervolemia. Types, causes of development, consequences for the body.

Hypervolemia- a condition in which the BCC exceeds the average statistical norms.

Depending on the nature of the change in Hct, the following types of hypervolemia are distinguished:

· simple (normocythemic) (Hct is normal),

· polycythemic (Hct > 0.48),

· oligocythemic (Hct< 0,36).

Hypervolemia is characterized by an increase in cardiac output and blood pressure, which can lead to heart failure.

Simple hypervolemia is rare and is the result of a proportional increase in the volume of formed elements and the liquid part of the blood, and therefore the hematocrit remains within the normal range. It is observed during physical exertion, and can also develop with the transfusion of large amounts of donor blood, acute hypoxic conditions due to the release of blood from the depot.

Oligocythemic hypervolemia represents an increase in BCC due to a predominant increase in plasma volume and a decrease in Hct. The physiological state in which oligocythemic hypervolemia develops is pregnancy. During pregnancy, BCC increases by 30-40% of the original, while the hematocrit decreases to 28-32%, which improves microcirculation and ensures normal transplacental exchange.

As a pathological condition, oligocythemic hypervolemia is the result of either excessive fluid intake into the body (pathological thirst, hyperinfusion of plasma or plasma substitutes), or a decrease in fluid excretion from the body (as a result of impaired renal excretory function, with hyperproduction of antidiuretic hormone, etc.).

The introduction of saline in a volume that is 15 times greater than the BCC does not lead to an increase in blood pressure due to the inclusion of compensation mechanisms.

Polycythemic hypervolemia characterized by an increase in BCC due to a predominant increase in the number of red blood cells, in connection with which the hematocrit rises, blood viscosity increases, which leads to an increase in blood pressure and causes a violation of microcirculation, and also increases cardiac output and contributes to the development of heart failure. Polycythemic hypervolemia develops with erythremia (Wakez's disease), some types of chronic hypoxia (heart defects, etc.).

What is hypovolemia (definition)

Hypovolemia is a condition characterized by a decrease in the total volume of blood and, as a rule, a violation of the ratio of its formed elements and plasma. There are normocythemic, oligocythemic and polycythemic hypovolemia.

The volume of blood in our body is quite static, changing only slightly under the influence of various factors.

However, in certain cases, the blood level can decrease quite strongly. This condition is called hypovolemia.

note

There are many factors that can provoke its development, and their timely identification and subsequent correction play a very important role. Let's try to understand in more detail the causes that can provoke hypovolemia, as well as determine the symptoms of this pathological condition, and consider the methods used to correct it.

Thyroid hypovolemia is a diagnosis that is made in cases where not only the level of fluid in the body is significantly reduced, but also the production of thyroid hormones. Usually observed after prolonged blood loss.

Causes (etiology) of hypovolemia

Normocythemic hypovolemia is a condition manifested by a decrease in the total blood volume while maintaining Ht within the normal range.

The most common causes of normocythemic hypovolemia: acute blood loss, shock conditions, vasodilatation collapse. In the last two cases, normocythemic hypovolemia develops as a result of the deposition of a large volume of blood in the venous (capacitive) vessels and a significant decrease in the BCC in connection with this.

Manifestations of normocythemic hypovolemia are determined by the nature of the cause that caused it (blood loss, shock, collapse), as well as the inclusion of compensation mechanisms aimed at eliminating acute hypoxia.

Oligocythemic hypovolemia

Oligocythemic hypovolemia is a condition characterized by a decrease in the total blood volume with a predominant decrease in the number of its formed elements. Ht is below normal.

The most common causes of oligocythemic hypovolemia.

Conditions after acute blood loss (at the stage when the transport of fluid from the tissues and the release of deposited blood into the vascular bed still do not eliminate hypovolemia, and the flow of blood cells from the organs of hematopoiesis does not eliminate the deficiency of red blood cells).

Erythropenia as a result of massive hemolysis of erythrocytes (for example, with burns of a large body surface, when hemolysis is combined with the loss of the body's liquid part of the blood due to plasmorrhagia) and suppression of erythropoiesis (for example, with aplastic or regenerative conditions).

Polycythemic hypovolemia

Polycythemic hypovolemia is a condition in which a decrease in the total volume of blood in the body is mainly due to a decrease in plasma volume. The Ht index in this condition is above the normal range.

The most common causes of polycythemic hypovolemia.

Conditions that cause increased body fluid loss: repeated vomiting (eg, in pregnant women or as a result of exogenous intoxication), prolonged diarrhea (eg, in violation of membrane digestion, intestinal toxic infections), polyuria (eg, in renal failure), increased and prolonged sweating ( for example, in hot climates or in hot workshops in production) and extensive skin burns (accompanied by plasmorrhagia).

Conditions that prevent sufficient fluid intake in the body (water "starvation"): lack of drinking water and the inability to drink water (for example, as a result of muscle spasm in tetanus or rabies).

Pathogenesis

Hypovolemia of any type leads to a compensatory hemodynamic response. The resulting deficiency of BCC causes a decrease in plasma volume and venous return, since fixation of the cardiac and pulmonary veins occurs and sympathetically mediated vasoconstriction occurs. This protective mechanism allows you to maintain blood circulation for brain and heart activity.

Pronounced hypovolemia reduces cardiac output and thus reduces systemic blood pressure. This reduces the blood supply to tissues and organs.

Blood pressure is normalized due to an increase in venous return, cardiac contractility and frequency of its contractions, as well as an increase in vascular resistance due to an increase in the secretion of renin by the kidneys and a sympathetic effect.

With a mild decrease in BCC, activation of the sympathetic nervous system, accompanied by a slight tachycardia, is sufficient to normalize blood pressure.

In severe hypovolemia, vasoconstriction is more pronounced due to the influence of the hormone angiotensin II and the activity of the sympathetic nervous system. This hormone helps to maintain blood pressure in the supine position, but hypotension (manifested by dizziness) may occur when the position changes.

Continued fluid loss in severe hypovolemia leads to severe hypotension even in the supine position. Shock may develop.

Symptoms (clinical picture) of hypovolemia

Manifestations of oligocythemic hypovolemia.

A decrease in the oxygen capacity of the blood (as a result of erythropenia).
Signs of hypoxia (for example, a decrease in the oxygen content in the blood, acidosis, a decrease in p02 of venous blood, etc.).

Disorders of organ tissue circulation and microcirculation of varying degrees, due, among other factors, to a decrease in BCC.

Manifestations of polycythemic hypovolemia.

Violations of organ tissue microcirculation due to hypovolemia and polycythemia.
Increased blood viscosity, aggregation of blood cells in microvessels of organs and tissues, and disseminated microthrombosis.

Signs of an underlying pathology causing polycythemic hypovolemia (for example, shock, diabetes insipidus, renal failure, burn disease, etc.).

With normocythemic hypovolemia, symptoms appear depending on the amount of blood lost:

Mild hypovolemia is observed with an average degree of blood loss (from 11 to 20% of BCC).

At the same time, there is a decrease in blood pressure by 10%, moderate tachycardia, slightly increased pulse and respiration.

The skin becomes pale, the limbs become cold, there is dizziness, a feeling of weakness, dry mouth and nausea. Possible inhibited reaction, fainting and a sharp decline in strength.

Hypovolemia of moderate severity is observed with a large degree of blood loss (from 21 to 40% of the BCC). Blood pressure drops to 90 mm Hg. Art., the pulse quickens, breathing is arrhythmic, superficial and rapid.

note

The presence of cold sticky sweat, cyanosis of the nasolabial triangle and lips, pointed nose, progressive pallor, drowsiness and yawning as a sign of lack of oxygen are noted.

There may be obscuration of consciousness, apathy, increased thirst, vomiting is possible, the appearance of a bluish coloration of the skin and a decrease in the amount of urine.

Severe hypovolemia is observed with massive blood loss (up to 70% of BCC). Arterial pressure in this case does not exceed 60 mm Hg, the threadlike pulse reaches 150 beats/min.

There is a sharp tachycardia, complete apathy, confusion or lack of consciousness, delirium and deathly pallor, anuria. The features are sharpened, the eyes become dull and sunken, convulsions are possible.

Breathing becomes periodic (Cheyne-Stokes type).

Hypovolaemia in newborns

One of the causes of shock in children may be a relative or absolute lack of fluid in the vascular system.

The main clinical symptoms of hypovolemic shock: lowering blood pressure, rapid pulse, pallor of the skin, cold sweat, coldness of the upper and lower extremities, oliguria.

However, not all patients have severe hypotension and oliguria, and this must be taken into account when diagnosing shock.

When shock occurs due to hypovolemia, urgent measures should be taken, since it subsequently causes severe metabolic disorders, the functions of the central nervous system and almost all internal organs.

Treatment begins with intravenous administration of fresh whole blood at the rate of 5-30 ml / kg or blood plasma in the same amounts or blood substitutes (polyglucin, polyvinylpyrrolidone, etc.).

If these solutions are not available, then a small amount of hypertonic sodium chloride solution (10-25 ml) is injected intravenously, then Ringer's solution with sodium lactate and 5% glucose solution is immediately injected at the rate of 10-30 ml / kg of this mixture of solutions (1: 1) .

In the future, the type and amount of transfused fluids depend on the course of the disease, clinical and laboratory data. Repeated transfusions of the above fluids are acceptable.

Assign parenterally vasopressors: adrenaline, norepinephrine in the age dosage; drinking plenty of water, to which add one teaspoon of table salt, half a teaspoon of baking soda and three teaspoons of granulated sugar (for 250 ml of water).

The patient is given complete rest. oxygen therapy. Warming. Intensive treatment of the underlying cause of shock.

In the treatment of dehydration in children with transfusions of various saline solutions, complications may occur, the main of which are hypokalemia, alkalosis, acidosis, hypocalcemia, hypoxemia, and water intoxication.

It is necessary to ensure that fresh air is constantly supplied to the ward, and any cooling of a sick child is unacceptable.

Diagnosis of hypovolemia

For diagnostics it is used:

  • clinical picture.
  • In rare cases, the determination of plasma osmolality and biochemical analysis of urine.
  • Hypovolaemia is suspected in patients at risk, most often with a history of insufficient fluid intake, excessive fluid loss, diuretics, or kidney and adrenal disease.

Diagnosis is based on symptoms. If the cause is clear and correctable, laboratory tests are not necessary; in other cases, determine the content of electrolytes in the serum, urea nitrogen and creatinine. When metabolic alkalosis is detected, the content of C1 in the urine is also determined.

Invasive diagnostic procedures sometimes have to be performed on patients in whom even a small additional volume increase can be dangerous.

The following should be kept in mind when interpreting urinary electrolyte levels and osmolality.

  • With hypovolemia, healthy kidneys retain the ability to retain Na.
  • With a combination of hypovolemia with metabolic alkalosis, the concentration of Na in the urine may increase, since a large amount of HCO3 enters the urine and excretion of Na is necessary to maintain its electrical neutrality. In such cases, a more reliable indicator of volume reduction is the concentration of C1 in the urine.

Hypervolemia causes, symptoms, treatment. Directory of diseases symptoms of hypervolemia Hypervolemia

Hypervolemia

Hypervolemia is an increase in the size of the circulating blood and plasma.

Root causes of origin

This position will be able to spin because:

  • Excessive use of water
  • Edema
  • Hitch water in the venous bed
  • Blood transfusion of the largest amount of blood
  • Acute hypoxic conditions accompanied by the release of blood from the depot
  • Hitch sodium in the body
  • Diseases of the cardiovascular system, respiratory organizations or kidneys
  • Polycythemia, polycythemia vera
  • Decent bodily overload

    • Signs of pervolemia

    Typical severe manifestations of hypervolemia: weight gain, damage to urination and separation of the trace, flabby eunuchoidism, slightly hypertensive eunuchoidism, dry skin, dry mouth, shortness of breath, impotence, headaches, shortness of breath.

    Normocythemic hypervolemia is revealed by an equivalent increase in the size of the purest parts and a weak fraction of the size of the circulating blood. The hematocrit (Ht) is about the generally accepted standards. Oligocythemic hypervolemia is characterized by an increase in the total blood volume. The Ht indicator is below the generally accepted standards.

    Polycythemic hypervolemia is also revealed by an increase in the total size of the blood, an increase in the number of its purest parts. Ht is above conventional standards.

    Diagnostics

    Diagnosis of hypervolemia is based on the effects of a selective survey of the patient, laboratory blood tests (to determine the proportion of red blood cells and plasma), urine analysis.

    Disease options

    The following variants of hypervolemia are distinguished:

  • normocythemic (uncomplicated)
  • oligocythemic (liquefaction, hemodilution)
  • polycythemic

    • Patient's efforts

    When signs specific to hypervolemia appear, you need to proceed to a hematologist or anesthesiologist.

    Treatment of hypervolemia

    Treatment is determined by the reason that caused hypervolemia. When the situation is caused by a hitch of sodium in the body, you need to limit the intake of sodium with food. On the recommendation of the doctor, use diuretics, hormones to improve the condition of the kidneys, substances to maintain mental function.

    Weights

    The increase in hypervolemia threatens with lightweight edema. Hypervolemia is very dangerous in the perspective of full parenteral administration of medications, intravenous or tube feeding. It is shown that hypervolemia has a toxic effect on the functions of internal organizations and contributes to an increase in the mortality of seriously ill patients.

    Pharmacoprophylaxis of hypervolemia

    Pharmacoprophylaxis of hypervolemia is based on the appropriate treatment of diseases of the cardiovascular system. To reduce the risk of hypervolemia, forgo excess water intake and limit the use of food that retains the element (sharp foods, fast food, seasoning (includes baking soda), hard cheese, etc.).

    Hypervolemia

    Hypervolemia

    The main reasons for downtime hypervolemia

    Polycythemia

    For hypervolemia

    Treatment is symptomatic

    Hypervolemia

    Hypervolemia- conditions characterized by an increase in total blood volume and usually a change in Ht. There are normocythemic, oligocythemic and polycythemic hypervolemia.

    What causes Hypervolemia:

    Normocythemic hypervolemia(simple) - a state manifested by an equivalent increase in the volume of shaped elements and the liquid part of the bcc. Ht remains within the normal range.

    The main reasons for downtime hypervolemia: transfusion of a large volume of blood, acute hypoxic conditions, accompanied by the release of blood from its depot, as well as significant physical activity, leading to hypoxia.

    Oligocythemic hypervolemia

    Oligocythemic hypervolemia(hydremia, hemodilution) - a condition characterized by an increase in the total volume of blood due to an increase in its liquid part. The Ht index is below the norm.

    The main causes of oligocythemic hypervolemia.

    • Excessive intake of fluid in the body with pathological thirst (for example, in patients with diabetes) and the introduction of a large amount of plasma substitutes or blood plasma into the vascular bed.
    • Decreased excretion of fluid from the body as a result of insufficiency of the excretory function of the kidneys (for example, in renal failure), hyperproduction of ADH, hyperosmolality of blood plasma.

    Polycythemic hypervolemia- a condition manifested by an increase in the total volume of blood due to a predominant increase in the number of its formed elements. In this regard, Ht exceeds the upper limit of normal.

    The main causes of polycythemic hypervolemia.

    • Polycythemia (erythrocytosis) is a group of pathological conditions characterized by an increase in the number of red blood cells (regardless of the number of white blood cells, platelets).
    • True polycythemia (polycythemia vera, Wakez's disease) is a chronic leukemia with a lesion at the level of a myelopoiesis precursor cell with an unlimited proliferation of this cell characteristic of a tumor, which retained the ability to differentiate into four germs, mainly red. Erythremia is accompanied by significant erythrocytosis and, as a consequence, elevated Ht.
    • Chronic hypoxia of any type (hemic, respiratory, circulatory, tissue, etc.).

    Polycythemia at the same time, it reflects the hyperregenerative state of the bone marrow, which is accompanied by increased proliferation of blood cells, mainly erythrocytes, and their release into the vascular bed.

    Polycythemic hypervolemia is detected in chronic circulatory failure, alveolar hypoventilation, a decrease in the oxygen capacity of the blood and the efficiency of biological oxidation, and in exogenous (normal and hypobaric) hypoxia.

    Hypervolemia symptoms:

    For hypervolemia characterized by an increase in cardiac output and an increase in blood pressure.

    • An increase in cardiac output is the result of compensatory hyperfunction of the heart due to an increase in blood volume. However, with decompensation of the heart and the development of its insufficiency, cardiac output, as a rule, decreases.
    • The increase in blood pressure is mainly due to an increase in cardiac output, as well as BCC and resistance vascular tone.
    • Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood cells, disseminated thrombosis, and microcirculation disorders.

    Hypervolemia Treatment:

    Treatment is symptomatic

    Which doctors should you contact if you have Hypervolemia:

    Anesthesiologist

    Hypervolemia: causes of the disease, main symptoms, treatment and prevention

    A pathological condition caused by an increase in the volume of circulating blood and plasma, which can be caused by various reasons.

    The reasons

    An increase in circulating blood volume can be observed for various reasons. Hypervolemia develops against the background of excessive fluid intake, edema, fluid retention in the vascular bed, transfusion of significant volumes of blood, acute hypoxic conditions, lesions of the cardiovascular system, impaired functioning of the kidneys and respiratory system, and heavy physical exertion.

    Symptoms

    This pathological condition is manifested by an increase in body weight, impaired urination and sweating, edematous syndrome, hypertensive syndrome, dry skin, dry mouth, shortness of breath, weakness, headaches, shortness of breath.

    Normocythemic hypervolemia is manifested by an equivalent increase in the volume of formed elements and the liquid part of the volume of circulating blood. In this condition, the hematocrit is within the normal range. Oligocythemic hypervolemia is characterized by an increase in total blood volume, while the hematocrit in such patients is below normal.

    Polycythemic hypervolemia is also manifested by an increase in the total blood volume, an increase in the number of its formed elements and is characterized by hematocrit values ​​above normal.

    Diagnostics

    Diagnosis of hypervolemia occurs against the background of a general examination of the patient, the collection of an anamnesis of the disease and a thorough analysis of the patient's complaints.

    During a physical examination, it is necessary to establish by palpation whether the patient has peripheral edema.

    In addition, the patient is required to carry out general and biochemical blood tests, as well as a general urine test.

    Treatment

    The result of the treatment of this pathological condition largely depends on the patient's willingness to comply with all medical recommendations, as well as follow the diet prescribed by the specialist. Also, for the duration of treatment, such patients are advised to limit the amount of fluid consumed.

    Treatment is aimed at removing excess fluid from the patient's body. The treatment regimen for the disease is selected taking into account the reasons that caused this pathological condition.

    If the condition is due to sodium retention in the body, it is necessary to limit the intake of sodium from food.

    As prescribed by the doctor, use diuretics, hormones to improve the condition of the kidneys, drugs to maintain cardiac function.

    Prevention

    Prevention of hypervolemia is based on the timely treatment of diseases of the cardiovascular and urinary systems. To reduce the risk of hypervolemia, you will need to abandon excessive fluid intake and limit the intake of foods containing sodium, as well as smoked meats and preservatives.

    Hypovolemia of the thyroid gland - what is it

    Hypovolemia of the thyroid gland (hypovolemia) is a decrease in the organ of the endocrine system, an extremely rare pathology diagnosed by endocrinologists. The disease is characterized by a change in the size of a vital organ. The thyroid gland decreases in size.

    Change in size leads to weak production of hormones. Insufficient levels of trace elements cause pathological diseases.

    The thyroid gland has a fixed size. Data on normal volumes of the thyroid gland can be found in medical sources, endocrinology textbooks.

    Normal size of the thyroid gland (healthy organ):

    • weight - from 20 to 40 grams;
    • height - 20 mm;
    • width - 40 mm;
    • thickness - 20 mm;
    • the volume of the isthmus connecting the lobes of the thyroid gland is 20 mm (4 * 5).

    The size and volume of the thyroid gland correlate with the weight of the human body. In some periods, there is a change in volumes that is not associated with diseases.

    These are the following periods:

  • Pregnancy.
  • Puberty.

    • When these processes are completed, the thyroid gland returns to normal.

    Medical data suggests several reasons for the development of pathology:

    • hypoplasia;
    • atrophy;
    • damage to the pituitary gland;
    • age.

    The most common cause is hypoplasia. A reduced thyroid gland cannot produce the norm of hormonal elements. Their deficiency provokes diseases.

    Underdevelopment of the thyroid gland in a child often occurs due to disorders in the mother's body. In women with iodine deficiency and untreated pathologies that entered the period of gestation, there is a decrease in hormone production. The child does not receive the necessary trace elements. hypoplasia begins to develop.

    It is dangerous for the baby with the consequences:

    • mental retardation;
    • deviations from the physical norms of maturation and growth;
    • neurological disorders.

    Pathology of a hypovolemic nature is explained by a decrease in the normal amount of fluid in the cells of thyroid tissue formations. The rate of hormone synthesis decreases. Usually, the detection of the disease is preceded by profuse blood loss and a violation of the functionality of the thyroid gland.

    Causes of hypovolemia:

    • dehydration of the body;
    • big blood loss;
    • loss of plasma on the background of extensive burns;
    • osmotic diuresis;
    • diabetes insipidus;
    • bleeding;
    • vomit;
    • diarrhea.

    There are three types of hypovolemia:

    • normocythemic;
    • oligocythemic;
    • polycythemic.

    The first type is a reaction to blood loss, misuse of medical devices, severe infectious intoxication, shock injuries, excess histamine intake.

    The oligocythemic type is diagnosed with blood loss at the stage of untreated hypovolemia during the period of blood output, but before it enters new cells. This species is the result of plasmorrhagia, erythropoiesis.

    The polycythemic form is a consequence of dehydration. It can occur after repeated vomiting processes (toxicosis), prolonged diarrhea and polyuria, increased sweating. Such a course develops with spasmodic contractions of the muscles: tetanus, rabies. Fluid loss can cause hypovolemic shock.

    Symptoms of pathology

    Hypovolemia occurs against the background of a number of unpleasant changes that worsen the state of human health:

  • Disorders of the nervous system and mental processes.
  • Sharp and frequent worsening of bowel movements: constipation or flatulence.
  • Decreased temperature and blood pressure.
  • Swelling of the face and body (especially the limbs).
  • Deterioration of the general tone: drowsiness, lethargy and apathy.
  • Voice change.
  • Decreased hemoglobin.
  • Lack of skin moisture.
  • Deterioration (slowdown) of the metabolic process.
  • The formation of seals in the thyroid gland.

    • For children, pathology is dangerous due to the appearance of an incorrect reaction to stimuli, a lag in development compared to peers.

    Symptoms of the disease depend on the quantitative indicator of blood loss:

  • Easy degree. Reduced pressure, dizziness, dry mouth. The patient's reaction to external stimuli is inhibited, frequent fainting, loss of physical strength occur.
  • Average degree. The pressure drops, the pulse becomes arrhythmic, sticky sweat appears. A person feels a lack of oxygen (yawning, drowsiness and pallor). Sometimes the disease is accompanied by increased thirst, decreased urine output, blurred awareness.
  • Severe degree. The pressure reaches a critically low level. The person practically loses consciousness, convulsions, periodic loss of breath are observed.

    • Treatment of hypovolemia

    The main task of the therapeutic complex is to increase hormones. Doctors seek to normalize the production of hormones necessary for the proper functioning of the body. The specialist will conduct diagnostics, laboratory tests. A nutritionist will select the right food.

    The endocrinologist will select medications, determine the dose and prescribe a course of treatment. The course involves the duration of medication. Often it will continue throughout life.

    Medical advances cannot find a development or technology capable of returning lost thyroid cells. Neither the pharmaceutical industry nor medical professionals have the means to restore gland tissue. Only blocking the development of pathology is possible.

    Endocrinologists seek to stop the development of diseases of the gland, which lead to a decrease in its size.

    Hypervolemia: types, causes, symptoms and treatment

    Hypervolemia - the main symptoms:

    • Headache
    • mood swings
    • Lower back pain
    • Weakness
    • Dizziness
    • Cardiopalmus
    • Dyspnea
    • Fainting
    • Heartache
    • Dry mouth
    • Dry skin
    • Insomnia
    • High blood pressure
    • Hard breath
    • Decreased performance
    • Obesity
    • General swelling
    • Weight loss
    • Accumulation of fluid in the abdominal cavity
    • Urination disorder

    Hypervolemia is a violation of the circulating volume of blood through the blood vessels in the direction of increasing. In medicine, this condition is divided into simple, oligocythemic and polycythemic. They differ depending on the level of hematocrit. There is also hypervolemia in the pulmonary circulation - this is an isolated type of hypervolemia, which is also called pulmonary hypertension.

    Etiology

    The reasons for the development of this condition differ depending on the type of pathology.

    In a simple view, they are as follows:

    • transfusion of too much blood - this process is called transfusion;
    • too hot climate;
    • lack of oxygen in the body.

    In the first case, this happens because too much blood enters the body from the outside. In the other three cases, because blood enters the vessels from the "reserves" of the body itself.

    Oligocythemic appearance has the following etiology of development:

    • The period of bearing a baby is the norm, since an increased volume of blood contributes to normal metabolism between the fetus and the woman.
    • Increased volume of fluid entering the body. The first is excessive drinking. Also, fluid can flow from the tissues into the vessels. In other words, when there is a violation of the water balance in the body.
    • Violation of the fluid withdrawal process. Occurs with renal failure, sodium retention in the body.

    The polycythemic appearance is manifested for such reasons:

    • Chronic lack of oxygen in the body. Occurs with chronic diseases of the upper respiratory tract, heart disease. It can also happen during a long stay in a mountainous area.
    • Blood diseases are neoplasms of a different nature, congenital pathologies in which many cells are formed in the blood.

    One or another type of pathology is determined during diagnostic procedures.

    Hypervolemia of the small circle has its own etiology of development:

    • chronic bronchitis, emphysema, silicosis and other pathologies;
    • increased pressure in the airways - occurs during improper ventilation of the lungs and with a strong cough;
    • poor work of the left ventricle with arrhythmia and heart attack;
    • chronic drug poisoning;
    • apnea that occurs at night.

    What is apnea

    In some cases, it is not possible to determine the cause of the development of the disease.

    Classification

    As mentioned earlier, there are three types of hypervolemia:

    • Simple. This type of pathology is extremely rare. It differs in that the volume of circulating blood increases proportionally. That is, the number of cells and the liquid part remains within acceptable limits.
    • Oligocythemic. This species is characterized by an increase in only the liquid part of the blood, and the hematocrit level decreases. This condition is called hydremia.
    • Polycythemic. Occurs with an increase in the cellular component of the blood and the level of hematocrit.

    Since the etiology of each species is different, the method of diagnosis and treatment methods are also selected on an individual basis.

    It should be noted that a violation of the circulating blood volume can also occur in the direction of decrease: this condition is called hypovolemia. It also has three main types.

    Symptoms

    note

    If the symptoms are short-term, and the changes do not exceed the norm, then the body can independently cope with such a situation. In the case when hypervolemia was caused by a chronic or acute disease, the treatment is selected to eliminate it.

    In general, this pathology is manifested by various non-specific signs, namely:

    • increased blood pressure;
    • rapid heart rate;
    • obesity;
    • swelling;
    • dyspnea;
    • dryness of the oral mucosa and skin;
    • violation of urination;
    • hard breath;
    • weakness;
    • pain in the head and in the lumbar region;
    • decrease in performance.

    Separately, it should be noted the signs of such a state of the respiratory system. At the initial stage of development, the clinical picture is absent, which leads to a belated diagnosis.

    In general, as the pathological process worsens, the clinical picture will be supplemented by the following signs:

    • mood swings;
    • a sharp decrease in body weight;
    • insomnia;
    • dizziness;
    • fainting during physical exertion;
    • heartache;
    • accumulation of fluid in the abdominal cavity;
    • pain in the liver;
    • disruption of the heart.

    Since the symptoms of this disease manifest themselves in different ways, it is better to consult a doctor when they appear.

    Diagnostics

    To date, it is difficult to diagnose such a condition, because there are no methods for determining the circulating blood volume. Be sure to set the level of hematocrit. It is he who can indicate the type of developing pathology and its cause.

    An initial examination is carried out at the doctor's appointment, which includes:

    • visual examination of the patient;
    • medical history taking.

    Additionally, the following procedures are prescribed:

    • general and detailed biochemical blood test;
    • general urine analysis;
    • determination of hematocrit;
    • determination of blood group and Rh factor.

    Pulmonary pathology is diagnosed through instrumental diagnostics:

    • electrocardiogram - will indicate the presence of a heart attack, arrhythmia and much more;
    • x-ray - will show dilated vessels, especially in the later stages of the disease;
    • computed tomography - if it is carried out with the help of contrast, then the result can say more than an x-ray;
    • ultrasound examination of the heart - will show congenital pathologies, the speed and volume of blood flow in the vessels.

    How is an ECG performed?

    Diagnosis of this condition is carried out in a complex. A thorough examination makes it possible to accurately diagnose, and on the basis of this, prescribe an effective treatment.

    When hypervolemia is detected, treatment is carried out in two directions:

    • Etiotropic, that is, eliminate the cause of the development of the pathological process. Therapy of kidney diseases, operations of heart defects, therapy of thyroid diseases, the fight against blood neoplasms are carried out. They also treat chronic and acute lung diseases and strictly control the volume of intravenous infusions.
    • Symptomatic - helps to cope with the signs of the disease. For example, high blood pressure is reduced by antihypertensive drugs. Diuretics are also prescribed. Angina pectoris, which was caused by this particular pathology, is treated with antianginal drugs, but only after a decrease in cardiac load.

    Treatment is carried out in a hospital. Most often, the pathological process is eliminated through conservative measures, but surgical intervention is not excluded, followed by a period of rehabilitation.

    In addition, traditional medicine in the treatment of such a disease can also be used.

    The doctor may prescribe:

    • Hirudotherapy - the use of leeches. They will help reduce blood volume. In addition, its viscosity and the number of formed elements will decrease. Thus, the hematocrit level is normalized.
    • herbal diuretics. These are dill, fennel, viburnum, horsetail and many others.

    But it must be taken into account that diuretics will not help with severe kidney disease. In this situation, hemodialysis and hemofiltration should be performed.

    Possible Complications

    This pathological process can cause the development of serious complications if therapy is not started in a timely manner:

    • pulmonary edema with an increase in blood volume;
    • toxic effect on the work of internal organs.

    In seriously ill patients, this disease increases the risk of death.

    Prevention

    Preventive measures of this pathology are as follows:

    • diagnosis and timely treatment of cardiovascular pathologies;
    • a decrease in the amount of fluid consumed, especially its amount should be monitored in children, the elderly and hypertensive patients, because fluid stagnation affects the functioning of many organs and systems;
    • proper nutrition;
    • exclusion of excessive alcohol consumption.

    It is also worth abandoning bad habits and excessive physical exertion.

    Hypovolemia - what is it? Causes, symptoms and treatment of the disease

    Thyroid hypovolemia is a rare diagnosis in endocrinology. This is a disease characterized by a decrease in blood volume, which is a pathological condition.

    Hypovolemia, by definition, is a mismatch in the volume of blood needed by the body, a decrease in the level of fluid in the thyroid tissue and the amount of hormones synthesized by it.

    Blood problems are dangerous with serious consequences.

    Among the many diseases of the blood, its pathologies associated with plasma volume are also common.

    The essence of hypovolemia

    The thyroid gland plays an important role in the functioning of the body. With its participation, metabolism takes place, iodine is produced, bone tissue grows. Under the influence of various factors, thyroid diseases are becoming more common.

    Hypovolemia is a disease that occurs due to large blood loss and disruption of the thyroid gland.

    Its dimensions correspond to the parameters of 20-40-20 mm, but the organ depends on body weight and changes in volume at certain stages of life: it increases during pregnancy, puberty and decreases upon reaching old age.

    Causes of hypovolemia

    The thyroid gland does not necessarily decrease due to age.

    Causes of hypovolemia:

    • diseases of the pituitary gland;
    • underdevelopment of the thyroid gland (hypoplasia);
    • organ atrophy;
    • vasodilatory collapse (vasodilation that does not correspond to the mass of circulating blood);
    • high vascular permeability;
    • increase in hydrostatic pressure in arterioles;
    • increased venous pressure;
    • insufficient intake of fluid in the body;
    • prolonged significant blood loss;
    • blood loss from burns;
    • states of shock.

    The most common cause of hypovolemia is hypoplasia: the gland synthesizes less hormones, which causes disturbances in the body.

    It happens that with a decrease in blood volume, the content of thyroid hormones decreases. This type of hypovolemia is accompanied by weight gain, deterioration of hair, dry skin, menstrual irregularities in women. If left untreated, there is a risk of infertility.

    A fetus that receives less thyroid hormones and iodine during the period of development will suffer from hypovolemia of the thyroid gland, a congenital disease is not excluded.

    A baby predisposed to the disease is characterized by increased body weight, it is characterized by lethargy and calmness, slow weight gain, and preservation of infant jaundice.

    Hormone deficiency will affect the development of the fetus, both mentally and physically. Therefore, monitoring and timely treatment of the disease is necessary.

    Autoimmune thyroiditis is a disease on the basis of which hypovolemia is possible; this manifests itself as a cessation of thyroid hormone production and is used as the main indicator in diagnosing the extent of the disease.

    The prerequisites for the development of the disease are: chronic stress, physical overwork, poor-quality food (the presence of carcinogens), iodine deficiency, unfavorable ecology, genetic characteristics.

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    Symptoms

    Signs of hypovolemia are not identified with the disease in everyone, patients explain it with fatigue and normal condition. The disease has similar symptoms to dehydration.

    Symptoms of hypovolemia are:

    • swelling of the face and body;
    • low temperature and pressure;
    • tachycardia;
    • decrease in diuresis;
    • instability of the nervous system;
    • apathy, lethargy, fainting;
    • disorder of the digestive system;
    • metabolic disease;
    • dry skin;
    • low hemoglobin;
    • voice change;
    • compaction in the thyroid gland;
    • weakened immunity and frequent illnesses;
    • decreased sexual desire, infertility;
    • slowdown in child development.

    Additional signs of hypovolemia can be: cyanosis of the mucous membranes and skin, cramps of the limbs, dizziness, weak pulse.

    Kinds

    Depending on the proportionality of the elements and plasma, they speak of several types of disease.

  • normocythemic hypovolemia. This is a general decrease in blood volume at a stable level of elements per plasma volume. Causes: acute blood loss, shock, vasodilatory collapse. This condition is typical for the first time after the loss of blood.
  • Oligocythemic: the percentage of formed elements falls to a large extent. Causes: a state of weakness due to blood loss, erythropenia with burns. The condition leads to a cessation of oxygen supply to the body. Do not do without an urgent blood transfusion.
  • Polycythemic. This is hypovolemia, characterized by a decrease in plasma volume, the causes of which are dehydration due to prolonged diarrhea and vomiting, polyuria, increased sweating, impaired water regime, the blood becomes viscous.

    • Hypovolemia is acute, which occurs in the process of blood loss, and chronic, which develops after the provision of medical assistance to the victim.

    Degrees of hypovolemia

    The highest degree of manifestation of hypovolemia is replaced by hypovolemic shock. There are the following degrees of exacerbation of the disease:

    • Easy. Blood loss is about 15% of the total volume. There is a drop in blood pressure, rapid pulse, tachycardia, pale skin, insufficient blood supply to the extremities, dry mouth, weakness.
    • Average. Blood loss is approaching 40%, the patient is in a serious condition, blood pressure is up to 90 mm, the pulse is rapid, breathing is irregular, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are pronounced. Sometimes - vomiting, fainting, a decrease in the amount of urine.
    • Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is poorly audible, tachycardia is pronounced, impaired consciousness, convulsions, and heavy breathing. The condition is unsafe for life, can lead to death.

    Diagnosis

    Diagnosis is based on the data of the clinical picture. The list of studies is assigned depending on the characteristics of the pathology that led to a drop in the volume of blood circulating in the body.

    The basis of diagnosis involves:

    • determination of hematocrit;
    • blood chemistry;
    • general blood analysis;
    • determination of the blood group.

    If hypovolemia provoked by internal bleeding is confirmed, diagnostic laparoscopy is performed.

    Treatment

    When hypovolemia is diagnosed, hormonal therapy in combination with diet and iodine intake is necessary to stabilize the condition. Patients will have a long-term treatment, and if it is impossible to improve thyroid function, it persists throughout life.

    The primary goal of treating hypovolemia is to restore the norm of the circulating blood volume with proteins, electrolytes, and donated blood. To do this, produce an infusion of dextrose solutions, saline, polyionic solutions. If a stable effect does not occur, intravenous administration of plasma substitutes (dextran, gelatin, hydroxyethyl starch) is used.

    With a non-critical loss of fluid, oral medication is prescribed, and with a severe degree of hypovolemia, intravenous. Usually, the patient is given an isotonic saline solution appropriate for shock and hypotension.

    Further measures to restore blood volume are carried out independently by preparing sugar-salt solutions, providing access to fresh air and maintaining an acceptable temperature in the room.

    To stop the subsequent destruction of the organ, it is necessary to concentrate treatment on autoimmune thyroiditis, the hypothalamic-pituitary system, and iodine deficiency.

    If there is a source of bleeding, surgical hemostasis is performed. If a state of shock has become the cause of insufficient blood volume, anti-shock therapy is carried out. In case of respiratory failure, the patient is provided with artificial ventilation of the lungs.

    Therapy problems

    In the course of treatment, patients are forced to face problems such as the consequences of drug therapy, and improvement is accompanied by the development of other diseases or side effects.

    An equally difficult circumstance is the short-term effect of drugs of considerable cost, as well as the peculiarity of the effect of the drug: the drug taken orally violates the microflora of the gastrointestinal mucosa.

    As for the patient's condition, due to the instability of the hormonal background, his mood does not allow him to fully relax in order to enjoy life.

    Effects

    Severe hypovolemia in the absence of medical intervention turns into hypovolemic shock, which poses a threat to life.

    A decrease in blood volume entails a disruption in the activity of internal organs, which, in the presence of diseases, complicates the patient's condition and treatment.

    Prevention

    To prevent hypovolemia, it is necessary to control the condition of the heart, blood vessels, and kidneys. Properly rendered assistance in case of profuse blood loss is of great importance. It must be borne in mind that incorrect actions can lead to the death of the patient.

    As a preventive measure, one can indicate the prevention of injuries, the timely detection of intestinal diseases, compliance with the water regime and control of water intake when the environment changes, the use of diuretics only on the recommendation of a doctor.