Hypotension


Etiology

Cardiogenic Shock (see Cardiogenic Shock)

Arrhythmia/Conduction Disturbance

Cardiomyopathy (see Congestive Heart Failure)

Increased Afterload

  • Aortic Coarctation (see Aortic Coarctation)
    • Epidemiology
      • Congenital: most cases
      • Acquired: few cases
    • Physiology
      • Narrowing of Descending Aorta (Typically at the Insertion of the Ductus Arteriosus Distal to the Left Subclavian Artery), Resulting in Left Ventricular Pressure Overload
  • Hypertrophic Obstructive Cardiomyopathy (HOCM) (see Hypertrophic Cardiomyopathy)
  • Malignant Hypertension (see Hypertension)
    • Physiology
      • Left Ventricular Pressure Overload
  • Severe Aortic Stenosis (see Aortic Stenosis)

Intracardiac Shunt

  • Atrial Septal Defect (ASD) (see Atrial Septal Defect)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt
  • Ruptured Sinus of Valsalva Aneurysm (see Sinus of Valsalva Aneurysm)
    • Physiology
      • Ruptured Sinus of Valsalva Aneurysm May Produce Aortic Insufficiency, Tricuspid Regurgitation, Left-to-Right or Right-to-Left Shunt, and/or Sudden Cardiac Death
  • Ventricular Septal Defect (VSD) (see Ventricular Septal Defect)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt
  • Ventricular Septal Rupture (see Ventricular Septal Rupture)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt

Valvular Heart Disease/Cardiac Mechanical Disturbance/Intracardiac Shunt

  • Aortic Insufficiency (AI) (see Aortic Insufficiency)
    • Epidemiology
      • Aortic Insufficiency May Be Acute in the Setting of Ascending Aortic Dissection
    • Physiology
      • Portion of Left Ventricular Stroke Volume Regurgitates Back from the Aorta into the Left Ventricle, Resulting in Increased Left Ventricular End-Diastolic Volume and Increased Left Ventricular Wall Stress
  • Aortic Stenosis (AS) (see Aortic Stenosis)
    • Physiology
      • Increased Left Ventricular Afterload
  • Atrial Myxoma (see Atrial Myxoma)
    • Physiology
      • Symptomatic Left Atrial Tumors Typically Result in Obstruction to Blood Flow, Mitral Regurgitation, and/or Systemic Embolization
  • Atrial Septal Defect (ASD) (see Atrial Septal Defect)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt
  • Atrial Thrombus (see Intracardiac Thrombus)
    • Physiology
      • May Result in Systemic Embolization (or Less Commonly, Obstruction to Blood Flow)
  • Constrictive Pericarditis (see Constrictive Pericarditis)
    • Physiology
      • Early Diastolic Ventricular Filling is More Rapid Than Normal
      • However, Starting in Mid-Diastole, Inelastic Pericardium Results in Compression, Impairing Further Ventricular Filling and Compromising Stroke Volume
  • Hypertrophic Obstructive Cardiomyopathy (HOCM) (see Hypertrophic Cardiomyopathy)
    • Physiology
      • Left Ventricular Outflow Tract Obstruction
  • Left Ventricular Aneurysm (see Left Ventricular Aneurysm)
    • Physiology
      • Bulging of Left Ventricular Wall, Resulting in Decreased Stroke Volume
      • In Rare Cases Where Left Ventricular Aneurysm Rupture Occurs, Tamponade May Occur
  • Left Ventricular Pseudoaneurysm (see Left Ventricular Pseudoaneurysm)
    • Physiology
      • Cardiac Rupture is Contained by Adherent Pericardium or Scar Tissue (Pseudoaneurysm Contains No Endocardium or Myocardium), Resulting in Decreased Stroke Volume
      • In Cases Where Left Ventricular Pseudoaneurysm Rupture Occurs, Tamponade May Occur
  • Left Ventricular Thrombus (see Left Ventricular Thrombus)
    • Physiology
      • May Result in Systemic Embolization (or Less Commonly, Obstruction to Blood Flow)
  • Mitral Regurgitation (MR) (see Mitral Regurgitation)
    • Epidemiology
      • Mitral Regurgitation May Be Acute in the Setting of Myocardial Infarction-Associated Papillary Muscle Dysfunction/Rupture or Chordae Tendineae Rupture
    • Physiology
      • Decreased Effective Forward Flow
  • Mitral Stenosis (see Mitral Stenosis)
    • Physiology
      • Impaired Left Ventricular Filling
  • Pulmonic Stenosis (see Pulmonic Stenosis)
    • Physiology
      • Right Ventricular Pressure Overload
  • Restrictive Cardiomyopathy (see Congestive Heart Failure)
    • Physiology
      • Diastolic Dysfunction (Restricted Filling)
  • Ruptured Sinus of Valsalva Aneurysm (see Sinus of Valsalva Aneurysm)
    • Physiology
      • May Produce Aortic Insufficiency, Tricuspid Regurgitation, Left-to-Right or Right-to-Left Shunt, and/or Sudden Cardiac Death
  • Tamponade (see Tamponade)
    • Physiology
      • Diastolic Dysfunction
  • Tricuspid Regurgitation (TR) (see Tricuspid Regurgitation)
    • Physiology
      • Right Ventricular Pressure/Volume Overload, Resulting in Right Ventricular Systolic Dysfunction
  • Tricuspid Stenosis (see Tricuspid Stenosis)
    • Physiology
      • Impaired Right Ventricular Filling
  • Ventricular Septal Defect (VSD) (see Ventricular Septal Defect)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt
  • Ventricular Septal Rupture (see Ventricular Septal Rupture)
    • Physiology
      • Left-to-Right or Right-to-Left Intracardiac Shunt

Obstructive Shock (Cardiac Pump Failure Due to an Extracardiac Etiology)

Mechanical

  • Aortocaval Compression (Due to Positioning or Surgical Retraction)
    • Physiology
      • Compression of Aorta, Resulting in Increased Afterload
      • Compression of Inferior Vena Cava, Resulting in Impaired Right-Sided Venous Return
  • Increased Intrathoracic Pressure (with Impaired Right-Sided Venous Return)
    • Abdominal Compartment Syndrome (see Abdominal Compartment Syndrome)
      • Physiology
        • Increased Intraabdominal Pressure, Resulting in Transmission with Intrathoracic Pressure, Culminating in Impaired Right-Sided Venous Return
        • Increased Intraabdominal Pressure, Resulting in Impaired Right-Sided Venous Return
        • Increased Intraabdominal Pressure, Resulting in Increased Afterload
    • Dynamic Hyperinflation Associated with High Positive End-Expiratory Pressure (PEEP)/Auto-PEEP (see PEEP + Auto-PEEP)
      • Physiology
        • Increased Intrathoracic Pressure, Resulting in Impaired Right-Sided Venous Return
    • Hemothorax (see Pleural Effusion-Hemothorax)
      • Physiology
        • Increased Intrathoracic Pressure, Resulting in Impaired Right-Sided Venous Return
    • Herniation of Abdominal Viscera Into Thorax
      • Physiology
        • Due to Movement of Abdominal Visceral Contents into the Thoracic Cavity, there is Increased Intrathoracic Pressure, Resulting in Impaired Right-Sided Venous Return
    • Positive-Pressure Ventilation with High Airway Pressures (see Acute Respiratory Distress Syndrome)
      • Physiology
        • Increased Intrathoracic Pressure, Resulting in Impaired Right-Sided Venous Return
    • Tension Pneumothorax (see Pneumothorax
      • Physiology
        • Increased Intrathoracic Pressure, Resulting in Impaired Right-Sided Venous Return

Pulmonary Vascular

Distributive Shock (Vasodilatory Shock)

Anaphylaxis/Anaphylactic Shock

  • Anaphylaxis (see Anaphylaxis)
    • Physiology
      • Peripheral Vasodilation (Due to Histamine and Other Vasoactive Substances)

Infection

  • Anaplasmosis Sepsis-Like or Toxic Shock-Like Syndrome (see Anaplasmosis)
  • Ehrlichiosis Sepsis-Like or Toxic Shock-Like Syndrome (see Ehrlichiosis)
  • Sepsis/Septic Shock (see Sepsis)
    • Epidemiology
      • Sepsis is the Most Common Etiology of Distributive Sshock
    • Physiology
      • Third-Spacing of Fluids (with Decreased Intravascular Volume) and Peripheral Vasodilation
  • Toxic Shock Syndrome (TSS)

Systemic Inflammatory Response Syndrome (SIRS) (see Sepsis)

Endocrine/Metabolic/Nutritional Deficiency-Associated Hypotension

  • Acidemia
  • Adrenal Insufficiency (see Adrenal Insufficiency)
    • Physiology
      • Peripheral Vasodilation
  • Hyperthyroidism (see Hyperthyroidism)
    • Physiology
      • XXXX
  • Hypocalcemia (see Hypocalcemia)
    • Epidemiology
      • Cases of Hypocalcemia-Associated Hypotension Have Been Extensively Reported (Am J Kidney Dis, 1994) [MEDLINE] (Am J Kidney Dis, 2015) [MEDLINE] (Hemodial Int, 2016) [MEDLINE]
      • Hypocalcemia-Associated Hypotension is Most Commonly Seen When it is Rapidly Induced by Ethylenediaminetetraacetic Acid (EDTA), Transfusion of Citrated Blood, Products, or with the Use of Low Calcium Dialysate in Patients Undergoing Dialysis
  • Hypothyroidism/Myxedema (see Hypothyroidism)
    • Physiology
      • Peripheral Vasodilation
  • Pheochromocytoma (see Pheochromocytoma)
    • Epidemiology
      • Occurs in Some Cases
    • Clinical Patterns
      • Episodic Hypotension: in rare cases where the tumor secretes only epinephrine
      • Pattern of Rapid Cyclic Fluctuation Between Hypertension and Hypotension (Cycling Every 7-15 min): unclear mechanism
      • Orthostatic Hypotension: due predominantly to decreased plasma volume
  • Thiamine Deficiency (Beriberi) (see Thiamine)
    • Physiology
      • Peripheral Vasodilation

Hematologic Disease-Associated Hypotension

Neurogenic Shock (see Neurogenic Shock)

  • Acute Spinal Cord Injury (SCI) (see Acute Spinal Cord Injury)
    • Physiology
      • Interruption of Autonomic Pathways, Resulting in Decreased Systemic Vascular Resistance and Altered Vagal Tone: probably the predominant mechanism
      • Myocardial Depression: may also play a role
      • Acute Blood Loss: may also play a role in some cases
  • Brain Herniation (Due to Foramen Magnum Herniation) (see Increased Intracranial Pressure)
    • Physiology
      • Compression of Brainstem and/or Upper Cervical Spinal Cord
  • Chronic Spinal Cord Injury (SCI) (see Acute Spinal Cord Injury)
  • Guillain-Barre Syndrome (GBS) (see Guillain-Barre Syndrome)
    • Epidemiology
      • Autonomic Dysfunction is Common in GBS (Occurs in Approximately 66% of Cases)
    • Clinical
      • Arrhythmias
      • Blood Pressure Fluctuations
      • Bradycardia/Tachycardia
      • Gastrointestinal Dysfunction
  • Multiple Sclerosis (see Multiple Sclerosis)
    • Epidemiology
      • Autonomic Dysfunction Can Occur
    • Clinical
  • Neuraxial (Spinal) Anesthesia (see Spinal Anesthesia)
    • Physiology
      • XXXX
  • Transverse Myelitis (see Transverse Myelitis)
    • Physiology
      • XXXX
  • Traumatic Brain Injury (TBI) (see Traumatic Brain Injury)
    • Physiology
      • XXXX

Drug/Toxin-Associated Hypotension

  • Abacavir-Hypersensitivity Reaction (see Abacavir)
    • Pharmacology: peripheral vasodilation
  • Alcohol Intoxications
    • Ethanol (see Ethanol)
      • Pharmacology: peripheral vasodilation
    • Ethylene Glycol Intoxication (see Ethylene Glycol)
      • Pharmacology
        • Peripheral Vasodilation
    • Isopropanol Intoxication (see Isopropanol)
      • Pharmacology
        • Peripheral Vasodilation
    • Methanol Intoxication (see Methanol)
      • Pharmacology: peripheral vasodilation
  • Amiodarone (Cordarone) (see Amiodarone)
    • Pharmacology
      • Peripheral Vasodilation
      • Negative Inotropy Can Also Occur in Patients with Preexisting Left Ventricular Dysfunction with EF <35%)
  • Atypical Antipsychotics (see Antipsychotic Agents)
  • Benzodiazepines (see Benzodiazepines)
    • Pharmacology
      • Peripheral Vasodilation
  • Capsaicin (see Capsaicin)
    • Pharmacology
      • Peripheral Vasodilation
  • Cholinergic Intoxication (see Cholinergic Intoxication)
  • Cigua Toxin Poisoning (see Cigua Toxin Poisoning)
    • Physiology
      • Dysfunction of Calcium and Sodium channels, Resulting in Peripheral Vasodilation
  • Cyanide Intoxication (see Cyanide)
    • Pharmacology
      • Mitochondrial Dysfunction
    • Clinical: hypotension occurs late in the course
  • Cytokine Release Syndrome (see Cytokine Release Syndrome)
    • Associated Agents
      • Alemtuzumab (Campath, MabCampath, Campath-1H, Lemtrada) (see Alemtuzumab): anti-CD52 monoclonal antibody
      • Anti-Thymocyte Globulin (ATG) (see Antithymocyte Globulin)
      • Basiliximab (Simulect) (see Basiliximab)
      • Bi-Specific Antibodies in Treatment of Leukemia
      • Chimeric Antigen Receptor T-Cells (CAR-T) (see Chimeric Antigen Receptor T-Cells)
      • Haploidentical Mononuclear Cells in Treatment of Refractory Leukemia
      • Lenalidomide (Revlimid) (see Lenalidomide)
      • Muromonab-CD3 (Orthoclone OKT3) (see Muromonab-CD3): anti-CD3 monoclonal antibody
      • Oxaliplatin (Eloxatin, Oxaliplatin Medac) (see Oxaliplatin)
      • Rituximab (Rituxan) (see Rituximab): chimeric monoclonal anti-CD20 antibody
      • Tisagenlecleucel (Kymriah) (see Tisagenlecleucel): CAR-T (CD19-directed T-cell medication) therapy
    • Pharmacology
      • Peripheral Vasodilation
  • Defibrotide (Defitelio) (see Defibrotide)
  • Dexmedetomidine (Precedex) (see Dexmedetomidine)
    • Pharmacology
      • Peripheral Vasodilation
  • Differentiation Syndrome (Retinoic Acid Syndrome) (see Tretinoin)
    • Epidemiology
    • Pharmacology
      • Peripheral Vasodilation
  • Dobutamine (Dobutrex) (see Dobutamine)
    • Pharmacology
      • Myocardial β1-Adrenergic Receptor Agonist (Chronotropic/Inotropic Effects) and Vascular β2-Adrenergic/α1-Adrenergic Receptor Agonist (if Vascular β2-Adrenergic Effects exceed α1-Adrenergic Receptor Agonist Effects, Some Peripheral Vasodilation May Occur)
  • Eltrombopag (Promacta, Revolade)
    • Pharmacology
      • XXXXX
  • Endothelin Receptor Antagonists (ERA’s) (see Endothelin Receptor Antagonists)
    • Pharmacology
      • Peripheral Vasodilation
  • Envenomations
  • Estrogen (see Estrogen)
    • Pharmacology
      • Peripheral Vasodilation
  • Glyphosate Ingestion (see Glyphosate)
    • Pharmacology
      • Peripheral Vasodilation
  • Hemoglobinopathies
  • Hexoprenaline (Gynipral) (see Hexoprenaline)
    • Pharmacology
      • β2-Adrenergic Receptor Agonist
  • Hydrogen Sulfide Gas Inhalation (see Hydrogen Sulfide Gas)
  • Intravenous Immunoglobulin (IVIG) (see Intravenous Immunoglobulin)
  • L-Arginine (see L-Arginine)
    • Pharmacology
      • Nitric Oxide Induction, Resulting in Peripheral Vasodilation
  • Magnesium Sulfate (see Magnesium Sulfate)
    • Epidemiology
      • Hypotension May Occur with Rapid Infusion
  • Metal Intoxications
    • Agents
    • Pharmacology
      • Peripheral Vasodilation
  • N-Acetylcysteine (Mucomyst, Acetadote, Fluimucil, Parvolex) (see N-Acetylcysteine)
    • Epidemiology
      • Associated with Oral Administration
    • Pharmacology
      • Peripheral Vasodilation
  • Nerium Oleander Intoxication (see Nerium Oleander)
  • Neuroleptic Malignant Syndrome (NMS) (see Neuroleptic Malignant Syndrome)
    • Physiology
      • Autonomic Instability
  • Nitrites and Nitrates (see Nitrites and Nitrates)
    • Pharmacology: nitric oxide induction, resulting in Peripheral Vasodilation
  • Ocrelizumab (Ocrevus) (see Ocrelizumab)
    • Epidemiology: may occur as a component of infusion reaction
  • Opiates (see Opiates)
    • Pharmacology
      • Peripheral Vasodilation
  • Papaverine (see Papaverine)
    • Pharmacology
      • Peripheral Vasodilation
  • Phenytoin (Dilantin)Fosphenytoin (Cerebyx) (see Fosphenytoin and (see Phenytoin)
    • Pharmacology
      • Peripheral Vasodilation
  • Phosphodiesterase Type 5 (PDE5) Inhibitors (see Phosphodiesterase Type 5 Inhibitors)
    • Pharmacology: inhibits phosphodiesterase 5/PDE5 (the enzyme which degrades cGMP), resulting in enhanced NO-mediated smooth muscle relaxation and therefore, peripheral vasodilation
  • Propofol (Diprivan) (see Propofol)
    • Pharmacology
      • Peripheral Vasodilation
  • Prostaglandins with Vasodilatory Properties
    • Agents
    • Pharmacology
      • Peripheral Vasodilation
  • Protamine (see Protamine)
    • Pharmacology
      • Peripheral Vasodilation
  • Rasburicase (Elitek) (see Rasburicase)
    • Pharmacology
      • Peripheral Vasodilation
  • Ruxolitinib (Jakafi) Withdrawal Syndrome (see Ruxolitinib)
    • Epidemiology: occurs 1 day-3 wks after drug withdrawal
  • Salicylate Intoxication (see Acetylsalicylic Acid)
    • Pharmacology
      • Peripheral Vasodilation
    • Clinical
      • Pseudosepsis with Fever, Tachypnea, Metabolic Acidosis, and Hypotension
  • Scombroid (see Scombroid)
    • Pharmacology
      • Peripheral Vasodilation
  • Serotonin Syndrome (see Serotonin Syndrome)
    • Pharmacology
      • Peripheral Vasodilation
  • Sevelamer (Renagel, Renvela) (see Sevelamer)
  • Tetrahydrocannabinol (THC) (see Tetrahydrocannabinol)
    • Pharmacology
      • Peripheral Vasodilation
  • Tetrodotoxin
    • Epidemiology
      • Associated with Ingestion of Tetrodotoxin-Contaminated Pufferfish
    • Physiology
      • Tetrodotoxin Inhibits Sodium Channels on Vascular Smooth Muscle
  • Theobromine (see Theobromine)
    • Pharmacology
      • Peripheral Vasodilation
  • Thrombolytics (see Thrombolytics
  • Transfusion-Associated Acute Lung Injury (TRALI) (see Transfusion-Associated Acute Lung Injury)
  • Tricyclic Antidepressant Intoxication (see Tricyclic Antidepressants)
    • Pharmacology
      • Peripheral Vasodilation
  • Vancomycin-Associated Red Man Syndrome (see Vancomycin)
    • Pharmacology
      • Peripheral Vasodilation
  • Vasodilator Antihypertensives
    • Agents
      • α-Adrenergic Receptor Antagonists (see α-Adrenergic Receptor Antagonists)
        • Pharmacology: α2-adrenergic receptor antagonism, resulting peripheral vasodilation
      • α-Methyldopa (Aldomet, Aldoril, Dopamet, Dopegyt) (see α-Methyldopa)
        • Pharmacology: α2-adrenergic receptor agonist, resulting in peripheral vasodilation
      • Angiotensin Converting Enzyme (ACE) Inhibitors (see Angiotensin Converting Enzyme (ACE) Inhibitors)
        • Pharmacology: angiotensin converting enzyme inhibition, resulting in peripheral vasodilation
      • Angiotensin II Receptor Blockers (ARB) (see Angiotensin II Receptor Blockers)
        • Pharmacology: angiotensin II receptor inhibition, resulting in peripheral vasodilation
      • β-Adrenergic Receptor Antagonists (β-Blockers) (see β-Adrenergic Receptor Antagonists)
        • Pharmacology: β-adrenergic receptor antagonism, resulting in decreased cardiac output and peripheral vasodilation
      • Calcium Channel Blockers (see Calcium Channel Blockers)
        • Pharmacology: calcium channel antagonism, resulting in peripheral vasodilation (and additionally decreased cardiac output with some of the agents)
      • Clonidine (Catapres, Kapvay, Nexiclon) (see Clonidine)
        • Pharmacology: α2-adrenergic receptor agonism, resulting in peripheral vasodilation
      • Hydralazine (see Hydralazine)
        • Pharmacology: peripheral vasodilation
      • Minoxidil (see Minoxidil)
        • Pharmacology: direct relaxation of arteriolar smooth muscle (possibly mediated by cAMP), resulting in peripheral vasodilation

Other

  • Cirrhosis/End-Stage Liver Disease (see Cirrhosis)
    • Physiology
      • Characteristically Produces a High Cardiac Output (CO)/Low Systemic Vascular Resistance (SVR) State
  • Hepatic Veno-Occlusive Disease (see Hepatic Veno-Occlusive Disease)
  • Hypercapnia (see Hypercapnia and Respiratory Failure)
    • Physiology
      • Hypercapnia-Induced Venodilation
  • Hypoxemia (see Hypoxemia and Respiratory Failure)
    • Physiology
      • Hypoxia-Induced Systemic Vasodilation (Which Attempts to Maintain Tissue Perfusion with Oxygen Delivery)
        • In Contrast, in the Pulmonary Circulation, Hypoxia Results in Hypoxic Pulmonary Vasoconstriction
  • Pregnancy (see Pregnancy)
    • Physiology: pregnancy increases plasma volume, increases cardiac output, increases stroke volume, increases heart rate, decreases blood pressure, and decreases SVR
  • Purpura Fulminans (see Purpura Fulminans)
  • Systemic Arteriovenous Fistula (see Systemic Arteriovenous Fistula)
    • Types
      • Femoral Arteriovenous Fistula: most common type of acquired arteriovenous fistula (due to the frequency of using the femoral site for percutaneous arterial or venous access)
      • Hemodialysis Arteriovenous Fistula (see Hemodialysis Arteriovenous Fistula)
    • Clinical: high output heart failure may occur
  • Systemic Mastocytosis (see Systemic Mastocytosis)
    • Physiology
      • Peripheral Vasodilation
  • Vasoplegic Syndrome (Post-Cardiac Surgery Vasodilation) (see Vasoplegic Syndrome)
    • Physiology
      • Peripheral Vasodilation Following Cardiac Surgery
  • Vasovagal Syncope (see Vasovagal Syncope)
    • Physiology
      • Peripheral Vasodilation

Hemorrhagic Shock (see Hemorrhagic Shock)

Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage)

Hemoperitoneum (see Hemoperitoneum)

  • Various Etiologies

Intramuscular Hemorrhage (Into Thigh)

  • Various Etiologies

Intraoperative/Postoperative Hemorrhage

  • Various Etiologies

Retroperitoneal Hemorrhage (see Retroperitoneal Hemorrhage)

Severe Hemolysis (see Hemolytic Anemia)

Trauma with External Hemorrhage

  • Motor Vehicle Accident (MVA)
  • Traumatic Fall/Assault

Uterine/Vaginal Hemorrhage

Other

Hypovolemic Shock (see Hypovolemic Shock)

Dermal Fluid Loss

  • Altered Mental Status with Inadequate Fluid Intake
    • Intoxication
  • Burns (see Burns)
  • Diaphoresis (see Diaphoresis)
  • Heat Stroke/Environmental Exposure (see Heat Stroke)

Gastrointestinal Fluid Loss

Renal Fluid Loss

  • Excessive Diuresis
  • Hypoaldosteronism (see Hypoaldosteronism)
    • Epidemiology: although aldosterone normally acts to increase sodium retention, hypoaldosteronism is not usually associated with significant sodium wasting (except in young children)
      • This is due to the compensatory action of other sodium-retaining stimuli (such as angiotensin II and norepinephrine)
  • Pheochromocytoma (see Pheochromocytoma)
    • Epidemiology: occurs in some cases
    • Clinical Patterns
      • Episodic Hypotension: in rare cases where the tumor secretes only epinephrine
      • Pattern of Rapid Cyclic Fluctuation Between Hypertension and Hypotension (Cycling Every 7-15 min): unclear mechanism
      • Orthostatic Hypotension: due predominantly to decreased plasma volume
  • Salt-Wasting Nephropathy

Third-Space Fluid Loss


Diagnostic

Arterial Line (see Arterial Line)

Bedside Ultrasound

Clinical Efficacy

Echocardiogram (see Echocardiogram)


Clinical Manifestations

Cardiovascular Manifestations

Neurologic Manifestations

Renal Manifestations


Treatment

Vasopressors


References