Hypervolemia: types, causes, symptoms and treatment. Hypervolemia. What you need to know about excess fluid in the body Pulmonary hypervolemia

The thyroid gland is important in the functioning of the body. With its participation, metabolism occurs, iodine is produced, and growth occurs. bone. Under the influence of various factors, thyroid diseases are becoming increasingly common.

Hypovolemia is a disease that occurs due to large blood loss and disruption of the thyroid gland. Its dimensions correspond to the parameters 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;
• decreased blood pressure;
• tachycardia;
• weak pulse impulse;
• decreased diuresis;
• cyanosis of mucous membranes and skin;
• decrease in body temperature;
• fainting;
• muscle cramps lower limbs.

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 polycythaemic hypovolemia:

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

Hypovolemic shock manifests itself with a pronounced clinical picture and a rapid increase in symptoms.

Degrees of hypovolemia

The highest degree 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, and weakness.

• Average. Blood loss is approaching 40%, the condition is serious, blood pressure is up to 90 mm, the pulse is rapid, breathing is arrhythmic, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are expressed. Sometimes - vomiting, fainting, decreased amount of urine.
• Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is hard to hear, tachycardia is pronounced, impaired consciousness, convulsions, heavy breathing. The condition is life-threatening and can lead to death.

Diagnostics

Detecting hypervolemia is a rather difficult task that doctors face. Specific symptoms There are no violations, and it is quite difficult to calculate the total volume of blood in the body. Therefore, the diagnosis of hypervolemia comes down to determining hematocrit values. 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 patient appointment consists of collecting anamnesis, examination, and ordering laboratory tests of blood and urine, which will help determine the number of red blood cells in the blood plasma and urine. The research results will allow you to create a complete picture of the disease, determine the stage, cause, and prescribe the necessary treatment.

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

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

Next laboratory research indicated for patients with suspected adipsia:

• Determination of electrolytes, nitrogen and serum creatinine levels:

1. adipsia often leads to disturbances in serum electrolytes;
2. hypernatremia is distinctive feature 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 a 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 disturbances in fluid homeostasis;
2. In adipsia, fractional sodium excretion is less than 1% if the defect coexists with impaired vasopressin function;
3. Urine osmolality is very high unless defects due to vasopressin deficiency are observed;
4. In diabetes insipidus, urine concentration is submaximal, even in conditions of high serum osmolality. With salt intoxication, the concentration of sodium in the urine 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 toward hypernatremia. The patient's history of lack of thirst indicates the coexistence of adipsia.

• Blood hormone levels;
• In isolated adipsia, circulating levels of vasopressin should be high, reflecting the appropriate response of the pituitary gland to hyperosmolarity. In patients who have defects in the regulation of thirst and vasopressin secretion, serum levels of this hormone are very low or absent;
• Increased levels plasma renin and aldosterone may indicate secondary hypovolemia.

From methods visual diagnostics the most commonly used brain tests are such as CT scan and MRI, which are highly indicated if the main cause of the development of adipsia may be an anatomical and physiological defect in the brain area - an empty sella turcica or a tumor. The techniques can also help rule out complications of hypernatremia, such as intracranial hemorrhage.

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

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

• 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 carried out based on the clinical picture. The list of studies is prescribed depending on the characteristics of the pathology that has caused a drop in the volume of blood circulating in the body.

The basis of diagnosis involves:

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

If hypovolemia caused by internal bleeding, perform diagnostic laparoscopy.

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.

Causes

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

Symptoms

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

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

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

Diagnostics

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

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

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

Treatment

The result of treatment for this pathological condition largely depends on the patient’s willingness to follow all medical recommendations, as well as follow the diet prescribed by the specialist. It is also recommended for such patients to limit the amount of fluid consumed during treatment.

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 caused by sodium retention in the body, it is necessary to limit sodium intake from food.

As prescribed by your doctor, use diuretics, hormones to improve kidney condition, and drugs to maintain cardiac function.

Prevention

Prevention of hypervolemia is based on timely treatment of diseases of the cardiovascular and urinary systems. To reduce the risk of developing hypervolemia, you will need to avoid overuse liquids and limit the consumption of foods containing sodium, as well as smoked foods and preservatives.

Prevention of hypovolemia includes:

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

To prevent hypovolemia, it is necessary to monitor the condition of the heart, blood vessels, and kidneys. Correctly provided assistance is of great importance heavy blood loss. It must be borne in mind that incorrect actions can lead to the death of the patient.

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

Therapy problems

During 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 disrupts the microflora of the gastrointestinal mucosa.

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

Consequences

Hypovolemia severe Without medical intervention goes into hypovolemic shock, which is life-threatening.

A decrease in blood volume leads to disruption of the functioning 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 in the development of hypovolemic shock - life-threatening condition. In addition, against the background of a decrease in circulating blood volume, functional failure 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 to replenish water are hypertonicity based on blood osmotic pressure and hypovolemia. Adipsia is often a congenital pathology; additional social stimuli that arise during 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 are mediators of the osmotic regulation of thirst, which regulate the secretion of vasopressin, a factor of osmotic thirst.

Hypovolemia and hypotension can also stimulate thirst through 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 medulla, and from there to the hypothalamus. In addition, the hypothalamus is directly stimulated by angiotensin II. In general, hypovolemic thirst occurs due to depletion of plasma volume by at least 4-8%.

Thirst abnormalities can be caused by specific functional lesions of the hypothalamus, which prevent the 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 region of the hypothalamus can result in a lack of thirst. Regulatory disorders antidiuretic hormone, produced in the hypothalamus and responsible for the production, storage and excretion of urine, leads to disruption of the ability to form urine.

Key points in the treatment of adipsia:

• Treatment of the main cause of the disease can take years, since the pathology has a high tendency to relapse.
• Majority true reasons adipsia is incurable - patients will have to take it for life symptomatic treatment.
• The underlying damage to the hypothalamic region is irreversible in 99% of cases, which leads to the condition described above.
• Target medical care- teach the patient to maintain adequate fluid intake regardless of the manifestations of thirst.

Treatment options:

• Pharmacological therapy is not available for the treatment of this disease at present.
• The main direction in therapy is the consumption of water regularly and regardless of the body's requirements.
• Electroconvulsive therapy has been used with mixed results among patients in whom the underlying cause is psychogenic.
• When behavioral therapy fails, the only option left is long-term administration of fluids through a nasogastric tube in particularly advanced cases.
• The use of desmopressin acetate is relevant if it is necessary to limit urine output. The method is especially useful in patients with coexisting central diabetes insipidus.
• For adipsia in the case of diabetes insipidus, restoration of thirst function, after ruling out the underlying cause, can be assessed using a visual analogue scale after infusion of a hypertonic solution.

• surgical removal of tumors, hematomas or cysts that suppress the activity of the thirst center;
• There are no dietary restrictions;
• frequent and regular intake of water should be maintained;
• no restrictions on activities are 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 are rare, except in cases of excessively rapid rehydration;
• loss of skin turgor and dry mucous membranes. These symptoms appear relatively often, but cannot be commensurate with the degree of dehydration.

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

• cleft palate;
• other defects midline faces;
• hydrocephalus.

Objective reasons for the development of adipsia are often:

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

CHANGES IN BLOOD VOLUME AND HEMATOCRIT

The total blood volume is usually calculated based on body weight (approximately 6-8%). So, in an adult man, the blood volume is about 5 liters. In this case, 3.5-4 l usually circulates in the vascular bed and cavities of the heart (circulating blood fraction), and 1-1.5 l is deposited in the vessels of the organs abdominal cavity, lungs, subcutaneous tissue and other tissues (deposited fraction). Formed elements make up 36-48% of the total blood volume. Hematocrit (Ht, or hematocrit number) - the ratio of the volume of blood cells to the volume of total blood - is normally 0.41-0.50 for men, 0.36-0.44 for women.

Changes in blood volume

In various pathological processes, diseases and painful conditions, both the total volume of blood and the ratio between its formed elements and plasma can change. Depending on the total blood volume, three groups of typical forms of disorders are distinguished: normovolemia, hypovolemia, hypervolemia.

Depending on the hematocrit level, normocythemic (simple), oligocythemic and polycythemic varieties of typical forms of blood volume disorders are distinguished.

NORMOVOLEMIA

Normovolemia is a condition characterized by a normal total blood volume, combined with a decreased or increased Ht.

There are oligocythemic and polycythemic normovolemia. Oligocythemic normovolemia is a condition with a normal total blood volume with a decrease in the number of its formed elements (mainly red blood cells); accompanied by a decrease in hematocrit value below normal.

The main reasons: massive hemolysis of red blood cells, prolonged and pronounced inhibition of hematopoiesis, mainly erythropoiesis, conditions after acute significant blood loss.

Manifestations: anemia, thrombocytopenia, decreased blood clotting, often combined with hemorrhagic syndrome, leukopenia, decreased blood viscosity.

Polycythemic normovolemia is a condition characterized by a normal total blood volume with an increase in the number of its formed elements, which is accompanied by an increase in Ht above normal.

The most common causes: infusion of fractions of blood cells (erythrocyte, leukocyte or platelet mass) into patients, chronic hypoxia, erythremia.

Manifestations: increased blood viscosity, development of thrombotic syndrome, microcirculation disorders, arterial hypertension.

HYPERVOLEMIA

Hypervolemia is a condition characterized by an increase in total blood volume and, usually, a change in Ht.

There are normocythemic, oligocythemic and polycythemic hypervolemia.

Manifestations of hypervolemia. Hypervolemia is characterized by an increase cardiac output, increased blood pressure; a significant increase in blood viscosity, aggregation and agglutination of blood cells, disseminated thrombus formation (with polycythemic hypervolemia); microcirculation disorders.

Normocythemic hypervolemia

Normocythemic hypervolemia (simple) is a condition manifested by an equivalent increase in the volume of formed elements and the liquid part of the bcc. Ht remains within the normal range. The main reasons: large volume of blood transfusion, acute hypoxic conditions, prolonged significant physical activity leading to hypoxia.

Oligocythaemic hypervolemia

Oligocythemic hypervolemia (hydremia, hemodilution) is a condition characterized by an increase in the total volume of blood due to an increase in its liquid part. The Ht indicator is below normal. The main reasons: excessive intake of fluid into the body due to pathological thirst or 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 excretory function of the kidneys, overproduction of ADH, hyperosmolarity of blood plasma.

Polycythemic hypervolemia

Polycythemic hypervolemia is 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 reasons:

♦ Secondary polycythemia (for example, erythrocytosis due to overproduction of erythropoietins).

♦ Primary (true) polycythemia (erythremia, Vaquez disease) - chronic leukemia. The disease is accompanied by significant erythrocytosis and, as a consequence, increased Ht.

♦ Chronic hypoxia of any type.

HYPOVOLEMIA

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.

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

The most common reasons: acute blood loss, shock states, vasodilation 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 volume of blood volume due to this.

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

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

The most common causes: conditions after acute blood loss, erythropenia.

Manifestations: decreased oxygen capacity of the blood, signs of hypoxia, disorders of organ-tissue and microcirculation of varying degrees.

Polycythemic hypovolemia is a condition in which a decrease in the total volume of blood in the body is caused mainly by a decrease in plasma volume. The Ht value in this condition is above the normal range.

The most common causes: conditions that cause increased loss of fluid from the body (repeated vomiting, prolonged diarrhea, polyuria, increased and prolonged sweating, extensive skin burns); conditions that prevent sufficient fluid intake into the body (water “starvation”): lack or impossibility of drinking drinking water.

Manifestations: disorders of organ-tissue and microhemocirculation, increased blood viscosity, aggregation of blood cells and disseminated microthrombosis.

Blood loss

Blood loss is a condition characterized by the body's loss of part of the blood.

In this case, a complex of pathogenic and adaptive reactions of the body develops, the totality of which is called the state after blood loss. This condition is manifested by a disorder of the body's vital functions of varying degrees (depending on the amount of blood loss and the reactivity of the body).

Bleeding (hemorrhage) is the outpouring of blood from the blood vessels or cavities of the heart into external environment(external bleeding) or in the body cavity (internal, cavitary bleeding).

Bleeding should be distinguished from hemorrhage and hematoma.

Hemorrhage is focal or diffuse soaking of tissues (for example, subcutaneous tissue, muscles) with blood.

Hematoma is a local accumulation of blood in tissue.

In case of hemorrhage and hematoma, a relatively small volume of blood comes out of the vascular bed and no significant disorders of the systemic circulation are observed.

ETIOLOGY The most common causes of blood loss

♦ Violation of the integrity of the walls of blood vessels or the heart due to mechanical impact (for example, their cut or rupture), purulent melting or destruction by a growing tumor, rupture of the walls of the ventricles or atria in the area of ​​myocardial infarction or aneurysm.

♦ Significant increase in the permeability of vascular walls, especially the microvasculature. Observed in cases of radiation sickness, extramedullary foci of hematopoiesis (for example, in patients with leukemia), infectious processes(For example, typhus, sepsis), vitamin C deficiency (scurvy).

♦ Significant reduction in blood clotting.

Conditions affecting the course and outcome of blood loss

Features of blood loss.

♦ Volume of blood lost. The release of up to 20% of the blood volume from the vascular bed is, as a rule, not dangerous and is compensated due to the inclusion of emergency compensation mechanisms. A loss of 25-35% of bcc is accompanied by significant disorders of the central, organ-tissue and microcirculation. A loss of 50% or more of total blood volume (especially rapid) is lethal.

♦ Rate of blood loss.

A decrease in the activity or content of coagulation factors or an increase in the anticoagulation and fibrinolytic systems can cause an increase in the rate and volume of blood loss.

Body reactivity. The course and consequences of blood loss largely depend on gender (women are less sensitive to blood loss), age (adults tolerate blood loss more easily than children), current state body (if overheated or cooled, the consequences of blood loss are more severe than at normal temperature).

PATHOGENESIS At the initial stage of blood loss, BCC decreases while maintaining normal Ht, i.e. normocythemic hypovolemia develops. In this regard, the inflow is decreasing venous blood to the heart, its shock and minute emission. This leads to a drop in blood pressure and, as a consequence, perfusion pressure in the vessels of organs and tissues. As a result, the transport of oxygen and metabolic substrates from the blood to the cells, and from the latter - carbon dioxide and metabolic products, decreases. Capillary-trophic insufficiency, intoxication of the body with products of impaired metabolism, and hypoxia develop. This, in turn, causes disorders in the energy supply of cells and plastic processes in them. The function of organs and tissues is disrupted, which is often accompanied by more or less pronounced insufficiency. The vital functions of the body as a whole are significantly disrupted. The extreme degree of these disorders is referred to as post-hemorrhagic shock. Impaired systemic hemodynamics and decreased intensity biological oxidation in cells causes the activation of adaptive mechanisms.

An increase in the volume of blood circulating in the body does not occur by itself. Hypervolemia is always accompanied by a certain disorder in the body. Therefore, hypervolemia is not an independent pathology. It has a direct relationship with such a concept as hematocrit. Hematocrit characterizes the volume of red blood cells in the blood relative to the total volume of blood.

Hypervolemia, depending on the cause of its development, can be of 3 types:

• Oligocythemic.

  Polycythemic.

Approaches to diagnosing and treating each type of hypervolemia will vary.

Simple hypervolemia develops when not only the volume of red blood cells increases in parallel, but also the level of blood plasma increases. The relationship between them is not violated.

Simple hypervolemia is not often diagnosed. The following reasons may lead to its development:

Large volume blood transfusions.

Excessive physical activity.

Exposure of a person to high temperatures.

Oxygen starvation.

If a person is transfused with a lot of blood, this naturally provokes an increase in its volume in the body. With increased physical activity, exposure to heat, and hypoxia, blood volumes increase due to the body’s own reserves.

The development of hypervolemia of the pulmonary circulation can occur for the following reasons:

Hypoxia of the alveoli to which oxygen will not reach. The reason for such a violation is chronic bronchitis, chronic pulmonary obstruction, silicosis, anthracosis, bronchiectasis, etc.

Spasm of the small arteries of the lungs. Stress, pulmonary embolism, stenosis can lead to the development of such a disorder mitral valve.

High blood pressure respiratory tract what does it lead to coughing, jump in barometric pressure, violations of technology when performing mechanical ventilation.

Malfunction of the left ventricle of the heart, which is observed during myocardial infarction, against the background of arrhythmia and myocarditis.

Blood thickening.

Excessive ejection of blood from the right ventricle of the heart.

Tumors, aneurysms, adhesions and other disorders that interfere with the blood vessels that carry blood from the lungs.

Chronic poisoning of the body with narcotic substances.

Genetic disorders, leading to enzymatic failures.

Increased pressure in the portal vein system, which can occur due to cirrhosis, syndrome and Budd-Chiari disease.

AIDS virus.

Short-term pauses in breathing during night rest.

In addition, there is a type of hypervolemia of the pulmonary circulation, which develops for unknown reasons.

When the disorder first begins to develop, the person will not experience any symptoms.

As hypervolemia of the pulmonary circulation progresses, the following health problems are possible:

A person gets tired quickly, has mood swings, loses weight, and suffers from insomnia.

The patient often experiences dizziness.

Shortness of breath increases, it will be very difficult to breathe during severe physical exertion.

IN severe cases fainting conditions are possible.

A person begins to suffer from paroxysmal coughing, accompanied by sputum and blood.

Periodically there are attacks of heart pain.

The skin is pale, and as the disease progresses, cyanosis increases.

Possible development of ascites.

Painful sensations begin to disturb the liver area.

The heart works intermittently.

A preliminary diagnosis is made based on symptoms of hypervolemia. To confirm it, the doctor refers the patient to the following examinations:

An electrocardiogram can detect abnormalities in the heart.

A chest x-ray provides information about the condition of the lungs; with hypervolemia, their vascular pattern increases. The heart increases in size.

Carrying out a CT scan.

Ultrasound of the heart allows you to assess its size, clarify the speed of blood flow and the volume of pumped blood.

The level of pressure in the pulmonary system can be determined using the pulmonary trunk catheterization method. This is an invasive procedure during which special sensors are inserted into the lumen of the lung vessels. This study makes it possible to detect hypervolemia with a high degree of probability, even at the earliest stages of its development.

How to treat?

To eliminate hypervolemia of the pulmonary circulation, you will need to direct efforts to the cause that provoked such a disorder. It makes no sense to treat hypervolemia without identifying the etiological factor.

Most often, drugs that are effective in correcting high blood pressure are used in therapy. A drug such as Eufillin has proven itself well. It is also necessary to take measures aimed at eliminating tissue hypoxia (oxygen therapy).

Education: In 2013, he graduated from Kursk State Medical University and received a diploma in General Medicine. After 2 years, he completed his residency in the specialty “Oncology”. In 2016, she completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.

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What is Hypervolemia -

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

Hypovolemia of the thyroid gland 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 discrepancy 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 it synthesizes.

Problems related to blood have serious consequences. Among the many blood diseases, blood pathologies associated with plasma volume are also common.

The essence of hypovolemia

The thyroid gland is important in the functioning of the body. With its participation, metabolism occurs, iodine is produced, and bone tissue grows. Under the influence of various factors, thyroid diseases are becoming increasingly common.

Hypovolemia is a disease that occurs due to large blood loss and disruption of the thyroid gland. Its dimensions correspond to the parameters 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 shrink due to age-related reasons.

Causes of hypovolemia:

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

The most common cause of hypovolemia is hypoplasia: the gland synthesizes fewer 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 condition, dry skin, and menstrual irregularities in women. If left untreated, there is a risk of infertility.

A fetus that does not receive enough thyroid hormones and iodine during development will suffer from hypovolemia of the thyroid gland, and a congenital disease is possible.

Autoimmune thyroiditis is a disease that can cause hypovolemia; this manifests itself as a cessation of thyroid hormone production and is used as a main indicator in diagnosing the extent of the disease.

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

Symptoms

Signs of hypovolemia are not identified with the disease in everyone; patients explain it by 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;
• decreased diuresis;
• instability nervous system;
• apathy, lethargy, fainting;
• digestive system disorder;
• metabolic disease;
• dry skin;
• low hemoglobin;
• voice change;
• compaction in the thyroid gland;
• weakening of the immune system and frequent illnesses;
• decreased libido, infertility;
• slowdown in child development.

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

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

1. Normocythemic hypovolemia. This is a general decrease in blood volume with a stable level of elements per plasma volume. Causes: acute blood loss, shock, vasodilatory collapse. This condition typical for the first time after blood loss.
2. Oligocythemic: the percentage of formed elements drops significantly. Causes: state of weakness due to blood loss, erythropenia due to burns. The condition leads to the cessation of oxygen access to the body. You cannot do without an urgent blood transfusion.
3. 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, water regime disturbances, the blood becomes viscous.

Hypovolemia can be acute, which occurs during blood loss, and chronic, which develops after treatment. medical care to the victim.

Degrees of hypovolemia

The highest degree 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, and weakness.

• Average. Blood loss is approaching 40%, the condition is serious, blood pressure is up to 90 mm, the pulse is rapid, breathing is arrhythmic, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are expressed. Sometimes – vomiting, fainting, decreased amount of urine.
• Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is hard to hear, tachycardia, impaired consciousness, convulsions, and heavy breathing are pronounced. The condition is life-threatening and can lead to death.

Diagnosis

Diagnosis is carried out based on the clinical picture. The list of studies is prescribed depending on the characteristics of the pathology that has caused a drop in the volume of blood circulating in the body.

Normocythemic hypervolemia (simple) is a condition manifested by an equivalent increase in the volume of formed elements and the liquid part of the bcc. Ht remains within normal limits.

The main causes of simple 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 (hydremia, hemodilution) is a condition characterized by an increase in the total volume of blood due to an increase in its liquid part. The Ht indicator is below normal.

The main causes of oligocythemic hypervolemia.

• Excessive intake of fluid into the body due to 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 excretory function of the kidneys (for example, in renal failure), overproduction of ADH, hyperosmolality of blood plasma.

Polycythemic hypervolemia is 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 erythrocytes (regardless of the number of leukocytes and platelets).
• Polycythemia vera (polycythemia vera, Vaquez's disease) is a chronic leukemia with damage at the level of the myelopoiesis precursor cell with the unlimited proliferation of this cell characteristic of the tumor, which retains the ability to differentiate along four lineages, mainly red. Erythremia is accompanied by significant erythrocytosis and, as a consequence, increased Ht.
• Chronic hypoxia of any type (hemic, respiratory, circulatory, tissue, etc.).

Polycythemia reflects a hyperregenerative state 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 (normo- and hypobaric) hypoxia.

Hypervolemia is characterized by an increase in cardiac output and an increase in blood pressure.

• The increase in cardiac output is the result of compensatory hyperfunction of the heart due to increased blood volume. However, with cardiac decompensation and the development of cardiac failure, cardiac output usually decreases.
• The increase in blood pressure is caused mainly by an increase in cardiac output, as well as volumetric blood volume and the tone of resistive vessels.
• Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood cells, disseminated thrombus formation, and microcirculatory disorders.

Hypervolemia: concept, forms, causes, symptoms, diagnosis, how to treat

Hypervolemia is 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 of the pulmonary circulation is called pulmonary hypertension.

The experience accumulated over the entire period of development of medicine has established certain limits for various laboratory indicators, exceeding the limits of which is regarded as a disease. The same framework determines the amount of blood simultaneously located inside our vessels.

The norm for an adult is a state where blood circulates inside the vessels of the whole body. total blood equal by weight from 6 to 8 percent of body weight or 1/13 part. That is, a person weighing 75 kilograms simultaneously contains about 5 liters of blood inside the vessels.

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

Clinical manifestations, diagnosis and treatment of hypervolemia

Therapy for hypervolemia should be aimed at the cause that provoked this disorder:

Treatment of kidney pathology.

Treatment of heart defects.

Therapy for disorders of the endocrine glands.

Operational and drug treatment tumor neoplasms.

Treatment of blood diseases.

Therapy of diseases of the respiratory system.

Performing blood transfusions in accordance with existing medical protocols, without violating the rules of the procedure.

To get rid of the symptoms of hypervolemia and alleviate the patient’s condition, the following measures may be recommended:

Taking medications to lower blood pressure. Diuretics are prescribed for this purpose.

Reducing the load on the heart muscle.

Controlling the ambient temperature, ensuring sufficient oxygen supply to the tissues, which is aimed at eliminating hypoxia.

Alternative medicine methods can also be used in the treatment of hypervolemia:

Treatment with leeches, which helps to reduce the volume of circulating blood in the body, reduce its viscosity, and normalize the qualitative composition.

Taking diuretics plant origin. Bearberry, horsetail, viburnum, dill, and fennel have such properties.

Hypervolemia should be treated by a doctor. Self-therapy can lead to serious health problems and even be life-threatening.

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

In the case of physiological and functional reasons, which 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 aimed primarily at the disease itself causing an increase in the amount of intravascular blood, and also, if necessary, at relieving the immediate symptoms of hypervolemia, which manifests itself in a variety of ways and nonspecifically:

• Increased blood pressure;
• An increase in the load on the heart can lead to manifestations of heart failure and angina pectoris;
• unexplained weight gain;
• Edema;
• Dyspnea;
• Feeling of dry skin and dry mouth;
• Urinary disorders;
• Increased breathing rate and feeling of heaviness when breathing;
• General weakness;
• Headache;
• Pain in the lumbar region;
• Increased fatigue.

Diagnosis of a hypervolemic state in practical medicine is difficult, due to the lack of clinical practice objective, reliable, and most importantly safe ways to determine the volume of circulating blood. In other words, the methods that are used have proven themselves in experimental science, explained this pathological process and laid the scientific foundations for the treatment of hypervolemia.

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

1. Fighting kidney diseases;
2. Surgical treatment of heart defects as early as possible;
3. Treatment of endocrine diseases;
4. Fighting tumors and congenital diseases blood systems;
5. Treatment of acute and chronic lung diseases;
6. Carefully monitor the volume of intravenous infusions.

Symptomatic (aimed at combating the manifestations of pathology) treatment:

1. High blood pressure is treated with the use of antihypertensive drugs with an emphasis on diuretics;
2. Angina caused by hypervolemia requires, first of all, a reduction in the load on the heart and only then the use of antianginal drugs;
3. One of the leading elements of help with hypervolemia is placing the patient in comfortable conditions with normal ambient temperature and a sufficient amount of oxygen in the inhaled air.

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

• Hirudotherapy (use of leeches) has a direct effect 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;
• Herbal diuretics: fennel, dill, viburnum, bearberry, horsetail and others.

Treatment and especially diagnosis of hypervolemia requires a careful, comprehensive approach on the part of a qualified doctor, since the apparent simplicity and harmlessness of this condition may hide the initial manifestations of a serious illness, early and timely diagnosis which can save human health and even life.

The initial patient appointment consists of collecting anamnesis, examination, and ordering laboratory tests of blood and urine, which will help determine the number of red blood cells in the blood plasma and urine. The research results will allow you to create a complete picture of the disease, determine the stage, cause, and prescribe the necessary treatment.

Diagnosis and treatment of hypervolemia

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

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

Patent ductus arteriosus (PDA) is the presence of a communication between the aorta and the pulmonary artery, which is considered an anomaly in the postnatal period.

The frequency of this defect ranges from 5 to 34%, more often in females (2-4:1).

As a rule, PDA is combined with other congenital heart defects - coarctation of the aorta, VSD.

For ductus-dependent heart defects (TMA, extreme form of tetralogy of Fallot, critical aortic stenosis and pulmonary artery, interruption of the aortic arch, left ventricular hypoplasia syndrome) this cardiac anomaly is vital.

The PDA, unlike vessels of the main type of blood circulation, is a muscular type vessel with powerful vagal innervation, which ensures its ability to contract in the early neonatal period.

Hemodynamics.

IN prenatal period Patent ductus arteriosus and patent foramen ovale are physiological fetal communications.

Due to the fact that the pulmonary circulation does not function, about 2/3 of the volume of oxygenated blood enters the descending aorta through the patent ductus arteriosus. Normally, soon after birth, a spasm of smooth muscle fibers occurs in the patent ductus arteriosus, which leads to functional closure of the duct. Anatomical closure or obliteration occurs during the first 2 weeks of postnatal life.

Such pathological conditions of the newborn period as respiratory distress syndrome, congenital pneumonia, and asphyxia during childbirth prevent the closure of the PDA. Physiological closure of the duct is delayed in premature infants, and the lower the gestational age of the child, the longer the time required for closure of the PDA. Thus, with a body weight of less than 1000 g, in 80% of children the ductus arteriosus functions within several months.

For the development of hemodynamic disorders, the size of the duct, the angle of its origin from the aorta, and the pressure difference in the systemic and pulmonary circulation are important. With a thin, long and tortuous duct leaving the aorta at an acute angle, resistance to blood flow is created and pronounced violations hemodynamics do not occur; Over time, the duct may become obliterated.

The short and wide ductus arteriosus is accompanied by a significant discharge of blood from the aorta into the pulmonary artery. Such ducts are not capable of obliteration. The additional volume of blood discharged from the aorta into the pulmonary artery will lead to the development of diastolic overload and dilatation of the left parts of the heart, especially the left atrium, hypervolemia in the lungs with the formation pulmonary hypertension.

Clinical picture will depend on the size of the duct.

In the neonatal period, the child has a systolic murmur with r. swing - in the 2nd intercostal space to the left of the sternum. The diastolic component of the murmur is absent due to neonatal pulmonary hypertension characteristic of this period of life. For the same reason, in the neonatal period, cross-discharge of blood may occur through the PDA, which will be clinically expressed in the appearance of cyanotic coloration of the skin during the child’s screaming, sucking, and straining. As the pressure in the pulmonary circulation decreases, left-to-right shunting of blood occurs both in systole and diastole, which leads to the phenomenon of systole-diastolic noise with a “machine” component. In older age, as pulmonary hypertension progresses, the diastolic component of the noise weakens again until it disappears completely. Auscultatory features of the PDA also include intensification and splitting of the second sound above the pulmonary artery. At the final stage of the natural course of the defect, one can note the appearance of a diastolic murmur of pulmonary artery insufficiency - a Graham-Still murmur.

X-ray There is an increase in the size of the cardiothoracic index (from minimal to cardiomegaly), signs of diastolic overload of the left sections (smoothness of the waist, immersion of the apex of the heart in the diaphragm, bulging of the ascending aorta). Enlargement of the left chambers of the heart is clearly visible in lateral and oblique projections with simultaneous contrasting of the esophagus with barium. In the lungs there is an increase in the pulmonary pattern.

At electrocardiography in the initial stages of PDA. signs of left atrium overload and left ventricular hypertrophy are recorded. Later they are joined by signs of overload and hypertrophy of the right sections.

EchoCG allows you to determine indirect signs of the presence of a PDA and visualize it directly, measure the size of the duct, and determine the degree of pulmonary hypertension.

In its natural course, the life expectancy of patients is 20-25 years. After 12 months of age, spontaneous closure of the ductus arteriosus rarely occurs. Main complications of PDA are heart failure, pulmonary hypertension, infective endocarditis, aortic and/or pulmonary artery aneurysm.

Surgical treatment involves ligation or intersection with suturing of the aortic and pulmonary ends of the duct, but in Lately Catheter endovascular duct occlusion is also used. The therapeutic method of treatment involves the use of prostaglandin inhibitors in the neonatal period. Indomethacin can be administered either enterally or intravenously. In the latter case, the effectiveness of treatment is 88-90%. The drug is administered at a rate of 0.1-0.2 mg/kg body weight in 1-2 doses over 1-3 days. The course dose should not exceed 0.6 mg/kg. This method is not widely used, as it has significant limitations and contraindications. Indomethacin has antiaggregation properties, which can lead to intracranial hemorrhage, gastrointestinal bleeding, transient renal dysfunctions.

Ventricular septal defect

Ventricular septal defect (VSD) is the most common, both in isolated form and as part of many other heart defects. Among congenital heart diseases, the frequency of this defect varies from 27.7 to 42%. It is equally common in both boys and girls.

The interventricular septum is divided into 3 sections:

the upper part is membranous, adjacent to the central fibrous body,

middle part - muscular,

and the lower one is trabecular.

Accordingly, these sections are also called ventricular septal defects, but most of them have perimembranous localization (up to 80%). Per share muscular VSD accounts for 20%. Based on size, defects are divided into large, medium and small. For correct assessment The size of the defect must be compared with the diameter of the aorta. Small defects measuring 1-2 mm located in the muscular part of the IVS are called Tolochinov–Roger disease. Due to the good auscultatory picture and the absence of hemodynamic disturbances, the expression “much ado about nothing” is appropriate to characterize them. Separately, multiple large defects IVS, “Swiss cheese” type, having an unfavorable prognostic value.

Intracardiac hemodynamic disturbances with VSD begin to form some time after birth, usually on days 3-5 of life. In the early neonatal period, a heart murmur may be absent due to equal pressure in the right and left ventricles due to the so-called neonatal pulmonary hypertension. A gradual drop in pressure in the pulmonary artery system and in the right ventricle creates a pressure difference (gradient) between the ventricles, resulting in a left-to-right discharge of blood (from the area of ​​high pressure to the area low pressure). The additional volume of blood entering the right ventricle and pulmonary artery leads to overflow of the vessels of the pulmonary circulation, where pulmonary hypertension develops.

There are three stages of pulmonary hypertension according to V.I. Burakovsky. Stagnation of blood ( hypervolemic stage of pulmonary hypertension) can lead to pulmonary edema, frequent infection, and the development of pneumonia that manifests in early life, has a severe course and is difficult to treat. If hypervolemia cannot be managed with conservative methods, in such cases a palliative operation is performed - narrowing of the pulmonary artery according to Muller. The essence of the operation is to create a temporary artificial stenosis of the pulmonary artery, which prevents excess blood from entering the ICC. However increased load, falling on the right ventricle, dictates in the future (after 3-6 months) the need for radical surgery.

During the natural course of the defect, over time, the Kitaev reflex (spasm in response to overstretching) is triggered in the vessels of the pulmonary circulation, which leads to the development transitional stage of pulmonary hypertension. During this period, the child stops getting sick, becomes more active, and begins to gain weight. The stable condition of the patient in this phase is the best period for radical surgery. The pressure in the pulmonary artery (and accordingly in the right ventricle) during this phase ranges from 30 to 70 mmHg. The auscultatory picture is characterized by a decrease in noise intensity with the appearance of an accent of the second tone above the pulmonary artery.

Subsequently, if surgical correction of congenital heart disease is not performed, processes of hardening of the pulmonary vessels begin to form ( high pulmonary hypertension - Eisenmenger syndrome). This pathological process does not develop back and leads to a significant increase in pressure in the pulmonary artery (sometimes up to 100-120 mmHg). On auscultation, you can hear a pronounced accent of the second tone over the pulmonary artery (“metallic” tint). Systolic murmur becomes weakly intense, and in some cases may be completely absent. Against this background, it is possible to record the appearance of a new diastolic murmur caused by insufficiency of the pulmonary valves (Graham-Still murmur). The clinical picture of the disease shows many pathological signs: cardiac “hump”, expansion of the boundaries of relative cardiac dullness, more to the right. Areas of weakened and harsh breathing can be heard over the lungs, and wheezing may occur. The most characteristic sign of Eisenmenger syndrome is a gradual increase in cyanosis, first peripheral, and later diffuse. This occurs due to cross-discharge of blood in the area of ​​the ventricular septal defect, which, when the pressure in the right ventricle exceeds, becomes right-left, i.e. changes its direction. The presence of stage 3 pulmonary hypertension in a patient may be the main reason for cardiac surgeons to refuse to perform an operation.

Clinical picture with VSD consists of a symptom complex of heart failure, which usually develops at 1-3 months of life (depending on the size of the defect). In addition to signs of heart failure, VSD can manifest with early and severe pneumonia. When examining a child, you can identify tachycardia and shortness of breath, expansion of the boundaries of relative cardiac dullness, and a displacement of the apex impulse down and to the left. In some cases, the symptom of “cat purring” is identified. Systolic murmur, as a rule, is intense, dries over the entire area of ​​the heart, is well carried out on the right side of the chest and on the back with a punctum maximum in the 4th intercostal space to the left of the sternum. Palpation of the abdomen reveals an enlarged liver and spleen. Changes in peripheral pulsation are not typical. Children with VSD and NK usually quickly develop malnutrition.

Diagnostics any heart defect consists of an X-ray examination of the chest organs, electrocardiography and two-dimensional Doppler echocardiography.

At X-ray examination of the chest cavity organs describes the shape of the heart and the state of the pulmonary pattern, and determines the size of the cardiothoracic index (CTI). All these indicators have their own characteristics when different degrees pulmonary hypertension. In the first (hypervolemic) stage, a flattened waist and immersion of the apex into the diaphragm, an increase in the CTI, are revealed. From the side of the pulmonary pattern, its intensification, indistinctness, and blurriness are noted. The extreme degree of hypervolemia in the lungs is pulmonary edema. In the transitional stage of pulmonary hypertension, normalization of the pulmonary pattern and some stabilization of the size of the CTI are noted. The sclerotic stage of pulmonary hypertension is characterized by a significant increase in the size of the heart, mainly due to the right sections, enlargement of the right atrium (formation of a right atrio-vasal angle), bulging of the pulmonary artery arch (Moore index more than 50%), elevation of the apex of the heart, which forms a aperture acute angle. In terms of the pulmonary pattern, the symptom of a “cut tree” is often described: bright, clear, enlarged roots, against the background of which the pulmonary pattern can be traced only to a certain level. On the periphery there are signs of emphysema. The chest has a swollen shape, the course of the ribs is horizontal, the diaphragm is flattened and stands low.

ECG has its own patterns, closely related to the phase of the course of congenital heart disease and the degree of pulmonary hypertension. First, signs of left ventricular overload are revealed - an increase in its activity, then the development of its hypertrophy. Over time, signs of overload and hypertrophy of the right parts of the heart - both the atrium and the ventricle - appear - this indicates high pulmonary hypertension. The electrical axis of the heart is always deviated to the right. Conduction disturbances may occur - from signs incomplete blockade right bundle branch until complete atrioventricular block.

At Doppler EchoCG The location of the defect and its size are specified, and the pressure in the right ventricle and pulmonary artery is determined. In the first stage of pulmonary hypertension, the pressure in the pancreas does not exceed 30 mmHg, in the second stage – from 30 to 70 mmHg, in the third – more than 70 mmHg.

Treatment of this vice implies conservative therapy heart failure and surgical correction of heart disease. Conservative treatment consists of inotropic support drugs (sympathomimetics, cardiac glycosides), diuretics, cardiotrophics. In cases of high pulmonary hypertension, angiotensin-converting enzyme inhibitors - capoten or captopril - are prescribed. Surgical interventions are divided into palliative operations (in the case of VSD - the operation of narrowing of the pulmonary artery according to Muller) and radical correction of the defect - plastic surgery of the ventricular septal defect with a patch of pericardial leaves under conditions of artificial circulation, cardioplegia and hypothermia.

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 certain factors.

However, in certain cases, blood levels can drop quite significantly. 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 reasons that can provoke hypovolemia, and also determine the symptoms of this pathological condition, and consider the methods used for its correction.

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

Causes (etiology) of hypovolemia

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

The most common causes of normocythemic hypovolemia: acute blood loss, shock conditions, vasodilatory 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 volume of blood volume due to 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.

Oligocythaemic hypovolemia

Oligocythemic hypovolemia is a condition characterized by a decrease in 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 does not yet eliminate hypovolemia, and the supply of blood cells from the hematopoietic organs does not eliminate the deficiency of erythrocytes).

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

Polycythaemic hypovolemia

Polycythemic hypovolemia is a condition in which a decrease in the total volume of blood in the body is caused mainly by a decrease in plasma volume. The Ht value in this condition is above the normal range.

The most common causes of polycythaemic hypovolemia.

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

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

Pathogenesis

Hypovolemia of any type leads to a compensatory hemodynamic reaction. The resulting deficiency of circulating blood volume causes a decrease in plasma volume and venous return, as the cardiac and pulmonary veins are fixed and sympathetically mediated vasoconstriction occurs. The defense mechanism allows you to maintain blood circulation for brain and cardiac activity.

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

Blood pressure is normalized due to increased venous return, cardiac contractility and heart rate, as well as increased vascular resistance due to increased secretion of renin by the kidneys and the sympathetic effect.

With a mild degree of decrease in blood volume, activation of the sympathetic nervous system, accompanied by slight tachycardia, is sufficient to bring blood pressure back to normal.

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 maintain blood pressure in a supine position, but when changing position, hypotension may appear (manifested by dizziness).

Sustained fluid loss during severe hypovolemia leads to severe hypotension even in a supine position. Shock may develop.

Symptoms (clinical picture) of hypovolemia

Manifestations of oligocythemic hypovolemia.

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

Disorders of organ tissue circulation and microhemocirculation of varying degrees, caused, among other factors, by a decrease in blood volume.

Manifestations of polycythemic hypovolemia.

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

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

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

Mild hypovolemia is observed with medium degree blood loss (from 11 to 20% of bcc).

In this case, there is a decrease in blood pressure by 10%, moderate tachycardia, slightly increased pulse and breathing.

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

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

note

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

There may be darkness of consciousness, apathy, increased thirst, possible vomiting, bluish discoloration of the skin and a decrease in the amount of urine.

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

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

Breathing becomes periodic (Cheyne-Stokes type).

Neonatal hypovolemia

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: decreased blood pressure, rapid pulse, pale 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.

If shock occurs due to hypovolemia, urgent measures should be taken, as it subsequently causes severe violations metabolism, functions of the central nervous system and almost all internal organs.

Treatment begins with intravenous administration of fresh whole blood at a rate of 5-30 ml/kg or blood plasma in the same quantities 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 administered at the rate of 10-30 ml/kg of this mixture of solutions (1: 1) .

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

Vasopressor drugs are prescribed parenterally: adrenaline, norepinephrine in an age-specific dosage; drink plenty of water, to which add one teaspoon of table salt, half a teaspoon of baking soda and three teaspoons of granulated sugar (per 250 ml of water).

The patient is provided with complete rest. Oxygen therapy. Warming. Intensive treatment of the underlying cause of shock.

When treating 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 room, and any cooling of the sick child is unacceptable.

Diagnosis of hypovolemia

For diagnostics the following is used:

• Clinical picture.
• In rare cases, determination of plasma osmolality and biochemical analysis of urine.
• Hypovolemia is suspected in patients at risk - most often if there is a history of insufficient fluid intake, excessive fluid loss, use of diuretics, or diseases of the kidneys and adrenal glands.

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

Invasive diagnostic procedures sometimes have to be performed in patients in whom even small additional volume increases may be dangerous.

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

• During hypovolemia, healthy kidneys retain the ability to retain Na.
• When hypovolemia is combined with metabolic alkalosis, the concentration of Na in the urine may increase, since a large amount of HCO3 enters the urine and Na excretion 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 circulating blood and plasma.

Root causes of origin

This position will be able to twist because:

Excessive use of water

Edema

Cool down water in the veins

Largest blood transfusion

Acute hypoxic conditions accompanied by the release of blood from the depot

Sodium retention in the body

Diseases of the cardiovascular system, respiratory system or kidneys

Polycythemia vera, polycythemia vera

Decent bodily overload

Signs of hypervolemia

Typical severe manifestations of hypervolemia: increased body weight, damage to urination and separation of the trace, flabby eunuchoidism, mildly hypertensive eunuchoidism, dry skin, dry mouth, shortness of breath, impotence, headaches, difficulty breathing.

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

Polycythemic hypervolemia is also revealed by an increase in the total volume of blood and an increase in the number of its purest parts. Ht is higher than generally accepted standards.

Diagnostics

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

Variants of the disease

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 consult a hematologist or anesthesiologist.

Treatment of hypervolemia

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

Weights

An increase in hypervolemia threatens pulmonary edema. Hypervolemia is very dangerous in the perspective of complete parenteral administration medical supplies, intravenous or tube feeding. There is evidence that hypervolemia has a toxic effect on function internal organizations and contributes to an increase in the mortality rate of seriously ill patients.

Pharmacoprophylaxis of hypervolemia

Pharmacoprevention of hypervolemia is based on appropriate treatment of diseases of the cardiovascular system. To reduce the risk of developing hypervolemia, avoid excess water intake and limit the use of foods that retain the element (sharp foods, fast food, condiments (including baking soda), hard cheese, etc.).

Hypervolemia

Hypervolemia

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 formed elements and the liquid part of the bcc. Ht remains within normal limits.

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.

Oligocythaemic hypervolemia

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

The main causes of oligocythemic hypervolemia.

• Excessive intake of fluid into the body due to 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 excretory function of the kidneys (for example, in renal failure), overproduction 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 erythrocytes (regardless of the number of leukocytes and platelets).
• Polycythemia vera (polycythemia vera, Vaquez's disease) is a chronic leukemia with damage at the level of the myelopoiesis precursor cell with the unlimited proliferation of this cell characteristic of the tumor, which retains the ability to differentiate along four lineages, mainly red. Erythremia is accompanied by significant erythrocytosis and, as a consequence, increased 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 (normo- and hypobaric) hypoxia.

Symptoms of Hypervolemia:

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

• The increase in cardiac output is the result of compensatory hyperfunction of the heart due to increased blood volume. However, with cardiac decompensation and the development of cardiac failure, cardiac output usually decreases.
• The increase in blood pressure is caused mainly by an increase in cardiac output, as well as volumetric blood volume and the tone of resistive vessels.
• Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood cells, disseminated thrombus formation, and microcirculatory disorders.

Treatment of Hypervolemia:

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.

Causes

An increase in circulating blood volume can occur for various reasons. Hypervolemia develops against the background of excessive fluid consumption, edema, fluid retention in the vascular bed, transfusion of significant volumes of blood, acute hypoxic conditions, damage to 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, edema syndrome, hypertensive syndrome, dry skin, dry mouth, shortness of breath, weakness, headaches, difficulty breathing.

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

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

Diagnostics

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

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

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

Treatment

The result of treatment for this pathological condition largely depends on the patient’s willingness to follow all medical recommendations, as well as follow the diet prescribed by the specialist. It is also recommended for such patients to limit the amount of fluid consumed during treatment.

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 caused by sodium retention in the body, it is necessary to limit sodium intake from food.

As prescribed by your doctor, use diuretics, hormones to improve kidney condition, and drugs to maintain cardiac function.

Prevention

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

Hypovolemia of the thyroid gland - what is it?

Hypovolemia of the thyroid gland (hypovolemia) is a decrease in the organ 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.

Changing sizes leads to weak hormone production. Insufficient levels of microelements cause pathological diseases.

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

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 a person’s body weight. 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 normal amount 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 during pregnancy, there is a decrease in hormone production. The child does not receive enough necessary microelements. Hypoplasia begins to develop.

It is dangerous for the baby with consequences:

• mental retardation;
• deviations from physical standards maturation and growth;
• neurological disorders.

Pathology of a hypovolemic nature is explained by a decrease normal amount fluids in the cells of thyroid tissue formations. The rate of hormone synthesis decreases. Typically, detection of the disease is preceded by heavy blood loss and impaired thyroid function.

Causes of hypovolemia:

• dehydration of the body;
• large blood loss;
• loss of plasma due to extensive burns;
• osmotic diuresis;
• diabetes insipidus;
• bleeding;
• vomit;
• diarrhea.

Hypovolemia has three types:

• normocythemic;
• oligocythemic;
• polycythemic.

The first type is a reaction to blood loss, improper use of medications, severe infectious intoxications, shock lesions, and excess histamine intake.

The oligocythemic type is diagnosed when blood is lost at the stage of untreated hypovolemia during the period of blood release, but before it enters new cells. This type is the result of plasmorrhagia, erythropoiesis.

The polycythemic form is a consequence of dehydration. It can occur after repeated vomiting (toxicosis), prolonged diarrhea and polyuria, and increased sweating. This 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 a person’s health:

Disorders of the nervous system and mental processes.

Sharp and frequent deterioration of bowel movements: constipation or flatulence.

Decreased temperature and blood pressure.

Swelling of the face and body (especially limbs).

Deterioration of general tone: drowsiness, lethargy and apathy.

Voice change.

Decreased hemoglobin levels.

Lack of skin moisture.

Deterioration (slowdown) of the metabolic process.

Formation of compactions in the thyroid gland.

For children, pathology is dangerous due to the appearance of an incorrect reaction to stimuli and a developmental lag compared to their peers.

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

Mild degree. Reduces blood pressure, dizziness, and dry mouth. The patient's reaction to external stimuli is inhibited, frequent fainting occurs, and loss of physical strength occurs.

Average degree. The pressure drops, the pulse becomes arrhythmic, and 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, and blurred awareness.

Severe degree. The pressure reaches critical low level. The person practically loses consciousness, there are convulsions and periodic loss of breathing.

Treatment of hypovolemia

The main task of the therapeutic complex is to increase hormones. Doctors strive to normalize the production of hormones necessary for the body to function properly. The specialist will conduct diagnostics and laboratory tests. A nutritionist will select the right nutrition.

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

Medical advances cannot find a design or technology that can bring back lost thyroid cells. Neither the pharmaceutical industry nor medical professionals have any means of restoring gland tissue. It is only possible to block the development of pathology.

Endocrinologists strive to stop the development of gland diseases that lead to a decrease in its size.

Hypervolemia: types, causes, symptoms and treatment

Hypervolemia - 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
• Urinary dysfunction

Hypervolemia is a violation of the circulating blood volume in the blood vessels in the direction of increase. In medicine, this condition is divided into simple, oligocythaemic and polycythaemic. 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.

U simple type 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 three other cases, because blood enters the vessels from the “reserves” of the body itself.

Oligocythemic appearance has the following etiology development:

• The period of bearing a baby is the norm, since the increased blood volume 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 tissues into blood vessels. In other words, when a water imbalance occurs in the body.
• Violation of the fluid removal process. Occurs with renal failure, sodium retention in the body.

Polycythemic appearance occurs for the following reasons:

• Chronic lack of oxygen in the body. Occurs when chronic diseases upper respiratory tract, heart defects. This can also happen during a long stay in mountainous areas.
• Blood diseases - neoplasms of various types, congenital pathologies, in which many cells are formed in the blood.

This or that 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 respiratory tract - occurs during improper ventilation of the lungs and with a strong cough;
• poor left ventricular performance during arrhythmia and heart attack;
• chronic poisoning of the body with drugs;
• apnea that occurs at night.

What is apnea

In some cases, it is not possible to determine the cause 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 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 when the cellular component of the blood and hematocrit level increase.

Since the etiology of each species is different, the diagnostic method 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 a decreasing direction: 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 cases where hypervolemia was caused by chronic or acute illness, treatment is selected to eliminate it.

In general, this pathology is manifested by various nonspecific signs, namely:

• increased blood pressure;
• increased heart rate;
• obesity;
• swelling;
• dyspnea;
• dryness of the oral mucosa and skin;
• urinary disorders;
• hard breath;
• weakness;
• pain in the head and lumbar region;
• decreased performance.

Separately, it should be noted the signs of this condition of the respiratory system. On initial stage development and clinical picture are absent, which leads to delayed 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 area;
• disruption of the heart.

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

Diagnostics

Today it is difficult to diagnose this condition because there are no methods for determining circulating blood volume. The hematocrit level must be established. It is he who can indicate the type of developing pathology and its cause.

Held initial examination at a doctor's appointment, which includes:

• visual examination of the patient;
• collection of anamnesis of the disease.

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 performed using 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 manner. A thorough examination makes it possible to accurately diagnose and, based on this, prescribe effective treatment.

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

• Etiotropic, that is, they eliminate the cause of the development of the pathological process. Treatment of kidney diseases, operations of heart defects, therapy of thyroid diseases, and the fight against blood tumors are carried out. Also treats chronic and acute diseases lungs and strictly control the volume of intravenous infusions.
• Symptomatic – will help cope with the signs of the disease. For example, high blood pressure is reduced with antihypertensive drugs medicines. Diuretics are also prescribed. Angina pectoris, which was caused by this particular pathology, is treated with antianginal drugs, but only after reducing the cardiac load.

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

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

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 is necessary to take into account that diuretics will not help with serious illnesses kidney In this situation, hemodialysis and hemofiltration should be performed.

Possible complications

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

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

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

Prevention

Preventive measures for this pathology are as follows:

• diagnosis and timely treatment of cardiovascular pathologies;
• reducing 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;
• avoiding excessive alcohol consumption.

It is also worth giving up bad habits and excessive physical activity.

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

Hypovolemia of the thyroid gland 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 discrepancy 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 it synthesizes.

Problems related to blood have serious consequences.

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

The essence of hypovolemia

The thyroid gland is important in the functioning of the body. With its participation, metabolism occurs, iodine is produced, and bone tissue grows. Under the influence of various factors, thyroid diseases are becoming increasingly common.

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

Its dimensions correspond to the parameters 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 shrink due to age-related reasons.

Causes of hypovolemia:

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

The most common cause of hypovolemia is hypoplasia: the gland synthesizes fewer 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 condition, dry skin, and menstrual irregularities in women. If left untreated, there is a risk of infertility.

A fetus that does not receive enough thyroid hormones and iodine during development will suffer from hypovolemia of the thyroid gland, and a congenital disease is possible.

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

Hormone deficiency will affect the development of the fetus, both mental and physical. Therefore, observation and timely treatment of the disease is necessary.

Autoimmune thyroiditis is a disease that can cause hypovolemia; this manifests itself as a cessation of thyroid hormone production and is used as a main indicator in diagnosing the extent of the disease.

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

Video on the topic

Symptoms

Signs of hypovolemia are not identified with the disease in everyone; patients explain it by 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;
• decreased diuresis;
• instability of the nervous system;
• apathy, lethargy, fainting;
• digestive system disorder;
• metabolic disease;
• dry skin;
• low hemoglobin;
• voice change;
• compaction in the thyroid gland;
• weakened immunity and frequent illnesses;
• decreased libido, infertility;
• slowdown in child development.

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

Kinds

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

Normocythemic hypovolemia. This is a general decrease in blood volume with a stable level of elements per plasma volume. Causes: acute blood loss, shock, vasodilatory collapse. This condition is typical for the first time after blood loss.

Oligocythemic: the percentage of formed elements drops significantly. Causes: state of weakness due to blood loss, erythropenia due to burns. The condition leads to the cessation of oxygen access to the body. You cannot 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 can be acute, which occurs during blood loss, and chronic, which develops after providing medical assistance to the victim.

Degrees of hypovolemia

The highest degree 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, and weakness.

• Average. Blood loss is approaching 40%, the condition is serious, blood pressure is up to 90 mm, the pulse is rapid, breathing is arrhythmic, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are expressed. Sometimes – vomiting, fainting, decreased amount of urine.
• Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is hard to hear, tachycardia, impaired consciousness, convulsions, and heavy breathing are pronounced. The condition is life-threatening and can lead to death.

Diagnosis

Diagnosis is carried out based on the clinical picture. The list of studies is prescribed depending on the characteristics of the pathology that has caused a drop in the volume of blood circulating in the body.

The basis of diagnosis involves:

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

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

Treatment

If hypovolemia is diagnosed, hormonal therapy is required in combination with diet and iodine intake to stabilize the condition. Patients undergo long-term treatment, and if it is impossible to improve thyroid function, it continues throughout life.

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

For non-critical fluid loss, prescribe oral administration medications, and in case of severe hypovolemia - intravenous. Typically, the patient is given an isotonic saline solution, which is appropriate in shock and hypotension.

Further measures to restore blood volume are carried out independently, 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 the cause of insufficient blood volume is a state of shock, anti-shock therapy is carried out. At respiratory failure the patient is provided artificial ventilation lungs.

Therapy problems

During 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 disrupts the microflora of the gastrointestinal mucosa.

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

Consequences

Severe hypovolemia, in the absence of medical intervention, develops into hypovolemic shock, which is life-threatening.

A decrease in blood volume leads to disruption of the functioning of internal organs, which, in the presence of diseases, complicates the patient’s condition and treatment.

Prevention

To prevent hypovolemia, it is necessary to monitor the condition of the heart, blood vessels, and kidneys. Correctly provided assistance in case of heavy 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 specify the prevention of injuries, timely detection of intestinal diseases, compliance with the water regime and control of water intake when changing the environment, and the use of diuretics only on the recommendation of a doctor.