Shock laboratory findings: Difference between revisions
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{{ | {{Shock}} | ||
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==Overview== | ==Overview== | ||
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Laboratory investigations may be helpful in establishing diagnosis and directing management of shock. | Laboratory investigations may be helpful in establishing diagnosis and directing management of shock. | ||
==Laboratory Findings== | |||
* ''Complete blood count'' | * ''Complete blood count'' | ||
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:* [[Acute kidney injury|Prerenal azotemia]] and/or [[acute tubular necrosis]] may be associated with conditions of [[hypovolemia]] or reduced [[cardiac output]]. | :* [[Acute kidney injury|Prerenal azotemia]] and/or [[acute tubular necrosis]] may be associated with conditions of [[hypovolemia]] or reduced [[cardiac output]]. | ||
:* [[Oliguria|Oliguria (urine output <0.5 mL/kg/h)]] is usually evident. | :* [[Oliguria|Oliguria (urine output <0.5 mL/kg/h)]] is usually evident. | ||
* ''Lactate'' | |||
:* [[Lactate|Hyperlactatemia]] generally reflects the development of anaerobic metabolism in hypoperfused tissue and/or imparied hepatic clearance. | |||
:* [[Lactate]] level could decrease within hours with effective therapy.<ref name="Vincent-2013">{{Cite journal | last1 = Vincent | first1 = JL. | last2 = De Backer | first2 = D. | title = Circulatory shock. | journal = N Engl J Med | volume = 369 | issue = 18 | pages = 1726-34 | month = Oct | year = 2013 | doi = 10.1056/NEJMra1208943 | PMID = 24171518 }}</ref> | |||
* ''Arterial blood gas'' | * ''Arterial blood gas'' | ||
:* [[Lactic acidosis]] may be an indicator of [[hypoperfusion|tissue hypoperfusion]] typically seen in [[septic shock]]. | :* [[Lactic acidosis]] may be an indicator of [[hypoperfusion|tissue hypoperfusion]] typically seen in [[septic shock]]. | ||
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{{reflist|2}} | {{reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 19:46, 10 April 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory investigations may be helpful in establishing diagnosis and directing management of shock.
Laboratory Findings
- Complete blood count
- In acute blood loss, hemoglobin and hematocrit levels may remain normal until volume repletion.
- Leukocytosis with or without a left shift of neutrophils suggests sepsis.
- Thrombocytopenia with alterations in coagulation panel indicates disseminated intravascular coagulation (DIC), which may be a complication of sepsis.
- Electrolytes
- Decreased bicarbonate levels may be the primary deficit in metabolic acidosis or the compensatory change in respiratory alkalosis.
- Hyperkalemia due to transcellular shift is commonly associated with metabolic acidosis.
- Coagulation panel (PT, PTT, INR, etc.)
- Abnormalities in coagulation panel may be caused by disseminated intravascular coagulation (DIC), over-anticoagulation, or hepatic failure.
- Cardiac markers
- Check troponin and CK-MB levels when suspecting myocardial infarction.
- Elevation in cardiac markers may be associated with both cardiac and extracardiac etiologies.
- Liver function
- Increased levels of conjugated bilirubin, alkaline phosphatase, and hepatic aminotransferases are typically seen in ischemic hepatitis ("shock liver") due to cardiogenic shock.
- Renal function
- Prerenal azotemia and/or acute tubular necrosis may be associated with conditions of hypovolemia or reduced cardiac output.
- Oliguria (urine output <0.5 mL/kg/h) is usually evident.
- Lactate
- Hyperlactatemia generally reflects the development of anaerobic metabolism in hypoperfused tissue and/or imparied hepatic clearance.
- Lactate level could decrease within hours with effective therapy.[1]
- Arterial blood gas
- Lactic acidosis may be an indicator of tissue hypoperfusion typically seen in septic shock.
- Combined acid-base disorders are fequently encountered in different stages of shock.
- Severe acidosis could blunt the effectiveness of vasopressors and potentiate the development of arrhythmias.
- Cultures
- Samples of blood, urine, and/or sputum should be sent for culture before administering antibiotics if sepsis is concerned.
- Nasogastric aspirate
- A negative nasogastric aspirate does not rule out upper gastrointestinal bleeding.
- Pregnancy test
- A pregnancy test should be performed on hypotensive women of childbearing age presenting with lower abdominal pain.