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

The thyroid gland is essential for the functioning of the body. With her participation, the metabolism takes place, iodine is produced, and bone tissue grows. Under the influence of various factors, diseases of the thyroid gland are becoming more common.

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

Signs

The clinical manifestations of hypovolemia are determined by its type.

The main symptoms of normocythemic hypovolemia:

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

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

Signs of polycythemic hypovolemia:

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

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

Degree of hypovolemia

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

• Lightweight. Blood loss is about 15% of the total. There is a drop in blood pressure, rapid pulse, tachycardia, pallor of the skin, insufficient blood supply to the extremities, dry mouth, weakness.

• Average. Blood loss is approaching 40%, the condition is severe, the 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%, blood pressure is up to 60 mm, the pulse is poorly audible, tachycardia, impaired consciousness, convulsions, and heavy breathing are pronounced. The condition is unsafe for life, it can be fatal.

Diagnostics

Revealing hypervolemia is a rather difficult task that confronts doctors. There are no specific symptoms of the disorder, and it is rather difficult to calculate the total blood volumes in the body. Therefore, the diagnosis of hypervolemia is reduced to the determination of hematocrit indicators. 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 reception of the patient consists of taking anamnesis, examination, prescribing laboratory tests of blood, urine, which will help determine the number of erythrocytes in the blood plasma and urine. The research results will make it possible to draw up a complete picture of the disease, determine the stage, cause, and prescribe the necessary treatment.

An important stage in treatment is the identification and elimination of the etiological factor that provoked the development of hypervolemia. Basically, the treatment is symptomatic and is prescribed individually for each patient. Adherence to a diet, a correct and healthy lifestyle is considered no less important in treatment. A person should take as little liquid as possible, eliminate any physical and psychological stress, completely stop smoking and drinking alcohol. In case of hypervolemia, it is recommended to consult other specialists: cardiologist, infectious disease specialist, gastroenterologist, urologist.

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

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

• Determination of electrolytes, nitrogen and serum creatinine levels:

1. adipsia often leads to abnormalities in serum electrolytes;
2. hypernatremia is a hallmark of clinically significant water deficit that may be associated with adipsia;
3. Water deficiency associated with adipsia also causes high creatinine levels and an increase in the creatinine to AMA ratio.

• Water deficiency often results in markedly increased whey osmolality;
• Urine electrolyte levels and osmotic pressure:

1. Simultaneous measurements of urine electrolytes and osmolality are critical in determining the central, rather than renal, causes of impaired water homeostasis;
2. In adipsia, fractional sodium excretion is less than 1% if the defect coexists with impaired vasopressin functionality;
3. Osmolality of urine is very high if there are no defects due to vasopressin deficiency;
4. In diabetes insipidus, urine concentration is submaximal, even under 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 can arise when adipsia and diabetes insipidus coexist. In these patients, initial test results may indicate suggestive diabetes insipidus. However, the administration of vasopressin increases urine osmolarity and decreases the tendency for hypernatremia. The patient's history of no thirst indicates the coexistence of adipsia.

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

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

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

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

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

The basis of the diagnosis assumes:

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

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

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

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

Causes

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

Symptoms

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

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

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

Diagnostics

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

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

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

Treatment

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

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, dietary sodium intake should be limited.

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

Prophylaxis

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

Prevention of hypovolemia includes:

• prevention of injuries;
• timely treatment of acute intestinal infections;
• sufficient intake of water into 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 rendered help in case of profuse blood loss is of great importance. It must be borne in mind that incorrect actions can lead to the death of the patient.

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

Therapy problems

In the course of treatment, patients are forced to face such problems as the consequences of drug therapy, and the 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 the instability of the hormonal background, his mood does not allow him to fully relax in order to enjoy life.

Effects

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

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

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

Pathophysiological basis of adipsia

In humans, the center of thirst is located in front of the hypothalamus. The main physiological stimuli for the manifestation of signs of the need for replenishment of water are hypertonicity, based on the osmotic pressure of the blood and hypovolemia. Adipsia is often a congenital pathology, additional social stimuli arising in the course of life, as a rule, are primary in relation to disruptions in the regulation of water in the body.

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

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

Thirst anomalies can result from specific functional lesions of the hypothalamus, which prevent the activation of regulation of osmotic or hypovolemic processes. Often these two phenomena occur in combination, interfering with the cognitive processes necessary for the perception of thirst.

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

Highlights of adipsia treatment:

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

Treatment options:

• Pharmacological therapy is not currently indicated for the treatment of this disease.
• The main direction in therapy is the consumption of water regularly and regardless of the requirements of the body.
• Electroconvulsive therapy has been used with mixed results among patients in whom psychogenic factors are the underlying cause.
• When behavioral therapy fails, there is only the option of prolonged administration of fluids through a nasogastric tube in especially advanced cases.
• Prescribing desmopressin acetate is useful if it is necessary to limit urine output. The method is especially useful in patients with coexisting central diabetes insipidus.
• In adipsia in the case of diabetes insipidus, the restoration of thirst function, after excluding the underlying cause, can be assessed using a visual analogue scale after hypertonic solution infusion.

• surgical removal of tumors, hematomas, or cysts that suppress the activity of the thirst center;
• dietary restrictions are not provided;
• frequent and regular water intake should be maintained;
• activity restrictions are not required.

Symptoms and causes of the development of the disease

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

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

Physical signs that indicate an underlying disorder are often obvious. Examples of such physical signs include:

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

Objective reasons for the development of adipsia are often:

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

CHANGES IN BLOOD VOLUME AND HEMATOCRITIS

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

Changes in blood volume

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

RATE VOLUME

Normovolemias are conditions characterized by a normal total blood volume, combined with a decreased or increased Ht.

Distinguish between oligocythemic and polycythemic normovolemia. Oligocythemic normovolemia - a condition with a normal total blood volume with a decrease in the number of its formed elements (mainly erythrocytes); accompanied by a decrease in the hematocrit value below normal.

The main reasons: massive hemolysis of erythrocytes, 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 blood corpuscles fractions (erythrocyte, leukocyte or platelet mass) to patients, chronic hypoxia, erythremia.

Manifestations: an increase in blood viscosity, the 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.

Distinguish between normocythemic, oligocythemic and polycythemic hypervolemia.

Manifestations of hypervolemia. Hypervolemia is characterized by an increase in cardiac output, an increase in blood pressure; a significant increase in blood viscosity, aggregation and agglutination of blood corpuscles, 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. At the same time, Ht remains within the normal range. The main reasons: transfusion of a large volume of blood, acute hypoxic conditions, prolonged significant physical activity, leading to hypoxia.

Oligocythemic hypervolemia

Oligocythemic hypervolemia (hydremia, hemodilution) is a condition characterized by an increase in the total blood volume due to an increase in its liquid part. At the same time, the Ht indicator is below the norm. The main reasons: excessive intake of fluid in the body with pathological thirst or the introduction into the vascular bed of a large number of plasma substitutes or blood plasma; a decrease in the excretion of fluid from the body as a result of insufficiency of the excretory function of the kidneys, hyperproduction 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 uniform elements. In this regard, Ht exceeds the upper limit of the norm. Main reasons:

♦ Secondary polycythemia (eg, erythrocytosis with overproduction of erythropoietins).

♦ Primary (true) polycythemia (erythremia, Vakes 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, by a violation of the ratio of its formed elements and plasma.

Distinguish between normocythemic, oligocythemic and polycythemic hypovolemia.

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

The most common causes: acute blood loss, shock conditions, 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 BCC 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 the total blood volume with a predominant decrease in the number of its formed elements. At the same time, Ht is below the norm.

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

Manifestations: a decrease in the 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 blood volume in the body is mainly due to a decrease in plasma volume. The Ht index in this condition is above the normal range.

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

Manifestations: disorders of organ-tissue and micro-hemocirculation, increased blood viscosity, aggregation of blood corpuscles and disseminated microthrombosis.

Blood loss

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

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

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

Bleeding must be distinguished from hemorrhage and hematoma.

Hemorrhage is focal or diffuse tissue penetration (eg, subcutaneous tissue, muscles) with blood.

Hematoma is a local accumulation of blood in tissue.

With 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 incision or rupture), purulent fusion or destruction by a growing tumor, rupture of the walls of the ventricles or atria in the zone of myocardial infarction or aneurysm.

♦ Significant increase in the permeability of the walls of blood vessels, especially the microvasculature. It is observed with 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 outcomes of blood loss

Features of blood loss.

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

♦ Rate of blood loss.

A decrease in the activity or content of clotting factors or an increase in the anticoagulant and fibrinolytic systems can lead to an increase in the rate and volume of blood loss.

The reactivity of the body. 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), the current state of the body (with overheating or cooling, the consequences of blood loss are more severe than at normal temperature).

PATHOGENESIS At the initial stage of blood loss, the BCC decreases while maintaining normal Ht, i.e. normocythemic hypovolemia develops. In this regard, the flow of venous blood to the heart, its shock and minute output, decrease. 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 decreases, and from the latter - carbon dioxide and metabolic products. Capillary-trophic insufficiency, intoxication of the body with products of disturbed metabolism, hypoxia develops. This, in turn, causes disorders in the energy supply of cells and plastic processes in them. The function of organs and tissues is impaired, which is often accompanied by a more or less pronounced failure of them. The vital activity of the organism as a whole is significantly upset. The extreme degree of these disorders is referred to as posthemorrhagic shock. Violation of systemic hemodynamics and a decrease in the intensity of 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 measures the volume of red blood cells in relation to the total blood volume.

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

• Oligocythemic.

  Polycythemic.

The approach to diagnosing and treating each type of hypervolemia will differ.

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

Simple hypervolemia is not often diagnosed. Its development can be caused by such reasons as:

Blood transfusion in large volumes.

Excessive physical activity.

Finding a person in high temperatures.

Oxygen starvation.

If a person receives a lot of blood transfusion, then this naturally provokes an increase in its volume in the body. With increased physical exertion, while in the heat, with 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:

Alveolar hypoxia to which oxygen will not reach. The reason for this violation is chronic bronchitis, chronic lung obstruction, silicosis, anthracosis, bronchiectasis, etc.

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

High pressure in the airways, which leads to a strong cough, a jump in barometric pressure, violations of technology when performing mechanical ventilation.

Malfunctions of the left ventricle of the heart, which is observed with myocardial infarction, against the background of arrhythmias and with myocarditis.

Thickening of the blood.

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

Tumors, aneurysms, adhesions and other disorders that get in the way of the blood vessels that carry blood from the lungs.

Chronic poisoning of the body with narcotic substances.

Genetic disorders leading to enzymatic disruptions.

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

AIDS virus.

Short-term breathing stops during night rest.

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

When the disorder is just beginning to develop, the person will not experience any symptoms.

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

A person quickly gets tired, he has mood swings, the weight goes away, he will suffer from insomnia.

The patient often has dizziness.

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

In severe cases, fainting is possible.

The person begins to suffer from a paroxysmal cough, accompanied by the separation of sputum with blood.

Periodically, attacks of heart pain occur.

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

Development of ascites is possible.

In the area of ​​the liver, painful sensations begin to disturb.

The heart works intermittently.

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

An electrocardiogram can detect abnormalities in the work of the heart.

Chest X-ray provides information about the condition of the lungs, with hypervolemia, their vascular pattern increases. The heart grows in size.

CT scan.

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

The level of pressure in the pulmonary system can be determined using the method of pulmonary catheterization. This is an invasive procedure in which special sensors are inserted into the lumen of the blood vessels of the lungs. 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 the hypervolemia of the pulmonary circulation, it will be necessary to direct efforts to the cause that provoked such a violation. It makes no sense to treat hypervolemia without establishing an etiological factor.

Most often, drugs are used in therapy that are effective for correcting high blood pressure. A drug such as Euphyllin has proven itself well. You also need to carry out activities aimed at eliminating tissue hypoxia (oxygen therapy).

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, she completed her residency in the specialty "Oncology". In 2016, 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. Distinguish between 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. By definition, hypovolemia is a discrepancy between the volume of blood required by the body, a decrease in the level of fluid in the thyroid tissue and the amount of hormones it synthesizes.

Blood problems have serious consequences. Among the many diseases of the blood, its pathologies associated with the volume of plasma are also common.

The essence of hypovolemia

The thyroid gland is essential for the functioning of the body. With her participation, the metabolism takes place, iodine is produced, and bone tissue grows. Under the influence of various factors, diseases of the thyroid gland are becoming more common.

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

Causes of hypovolemia

The thyroid gland does not necessarily shrink for age-related reasons.

Causes of hypovolemia:

• diseases of the pituitary gland;
• underdevelopment of the thyroid gland (hypoplasia);
• organ atrophy;
• vasodilation collapse (vasodilation, inappropriate to the mass of circulating blood);
• high vascular permeability;
• increased hydrostatic pressure in arterioles;
• increased venous pressure;
• insufficient intake of fluid into the body;
• prolonged significant blood loss;
• blood loss with burns;
• states of shock.

The most common cause of hypovolemia is hypoplasia: iron synthesizes fewer hormones, which leads to 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, menstrual irregularities in women. In the absence of treatment, there is a threat of infertility.

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

Autoimmune thyroiditis is a disease on the basis of which hypovolemia is possible; this manifests itself as a cessation of the production of thyroid hormones and is used as the main indicator in diagnosing the degree 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, unfavorable ecology, genetic characteristics.

Symptoms

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

Symptoms of hypovolemia are:

• swelling of the face and body;
• low temperature and pressure;
• tachycardia;
• decreased urine output;
• instability of the nervous system;
• apathy, lethargy, fainting;
• disorder of the digestive system;
• metabolic disease;
• dry skin;
• low hemoglobin;
• change of voice;
• induration in the thyroid gland;
• weakening of immunity and frequent illnesses;
• decreased sex drive, infertility;
• slowing down of child development.

Additional signs of hypovolemia may be: cyanosis of the mucous membranes and skin, cramps in the limbs, 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, vasodilation collapse. This condition is typical for the first time after blood loss.
2. Oligocythemic: the percentage of formed elements drops significantly. Reasons: a state of weakening due to blood loss, erythropenia with burns. The condition leads to the cessation of oxygen access to the body. An urgent blood transfusion is indispensable.
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, disturbance of the water regime, the blood becomes viscous.

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

Degree of hypovolemia

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

• Lightweight. Blood loss is about 15% of the total. There is a drop in blood pressure, rapid pulse, tachycardia, pallor of the skin, insufficient blood supply to the extremities, dry mouth, weakness.

• Average. Blood loss is approaching 40%, the condition is severe, the 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%, blood pressure is up to 60 mm, the pulse is poorly audible, tachycardia, impaired consciousness, convulsions, and heavy breathing are pronounced. The condition is unsafe for life, it can be fatal.

Diagnosis

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

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 blood volume due to an increase in its liquid part. At the same time, the Ht indicator is below the norm.

The main causes of oligocythemic hypervolemia.

• Excessive intake of fluid into the body during 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 insufficient renal excretory function (for example, in renal failure), hyperproduction 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 uniform elements. In this regard, Ht exceeds the upper limit of the norm.

The main causes of polycythemic hypervolemia.

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

At the same time, polycythemia 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 with chronic circulatory failure, alveolar hypoventilation, decreased oxygen capacity of the blood and the effectiveness of biological oxidation, with 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 an increase in blood volume. However, with decompensation of the heart and the development of heart failure, cardiac output, as a rule, decreases.
• The increase in blood pressure is mainly due to an increase in cardiac output, as well as BCC and the tone of resistive vessels.
• Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood corpuscles, disseminated thrombus formation, and microcirculation 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 terms of hematocrit.

Isolated hypervolemia of the pulmonary circulation is called pulmonary hypertension.

The experience accumulated over the entire period of development of medicine has established a certain framework for various laboratory parameters, going beyond which is regarded as a disease. The same framework also determines the amount of blood that is simultaneously inside our vessels.

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

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

Clinical manifestations, diagnosis and treatment of hypervolemia

Therapy of hypervolemia should be aimed at the cause that provoked this violation:

Treatment of kidney pathology.

Treatment of heart defects.

Therapy of disorders in the work of the endocrine glands.

Surgical and drug treatment of tumor neoplasms.

Treatment of blood diseases.

Respiratory system diseases therapy.

Performing blood transfusion in accordance with the available 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 can be recommended:

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

Reducing the load on the heart muscle.

Control over the ambient temperature, ensuring a sufficient supply of oxygen 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 quality composition.

Taking herbal diuretics. Bearberry, horsetail, viburnum, dill, fennel have such properties.

A doctor should be involved in the treatment of hypervolemia. Self-therapy can lead to serious health problems and even pose a threat to life.

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

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

If the hypervolemia is caused by any chronic or acute disease, the therapeutic tactics are aimed primarily at the disease itself causing an increase in the amount of intravascular blood, as well as, if necessary, at the relief of the immediate symptoms of hypervolemia, which manifests itself in a varied and nonspecific manner:

• Increased blood pressure;
• An increase in the load on the heart can lead to manifestations of heart failure, angina pectoris;
• unexplained weight gain;
• Swelling;
• Dyspnea;
• Feeling of dry skin and dry mouth;
• Violation of urination;
• Increased breathing rate and a feeling of heaviness when breathing;
• General weakness;
• Headache;
• Lower back pain;
• Increased fatigue.

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

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

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

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

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

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

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

Treatment and especially diagnosis of hypervolemia requires an attentive 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 of which can preserve human health and even life.

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

Diagnostics and treatment of hypervolemia

An important stage in treatment is the identification and elimination of the etiological factor that provoked the development of hypervolemia. Basically, the treatment is symptomatic and is prescribed individually for each patient. Adherence to a diet, a correct and healthy lifestyle is considered no less important in treatment. A person should take as little liquid as possible, eliminate any physical and psychological stress, completely stop smoking and drinking alcohol. In case of hypervolemia, it is recommended to consult other specialists: cardiologist, infectious disease specialist, gastroenterologist, urologist.

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

Patent ductus arteriosus (PDA) is the presence of communication between the aorta and the pulmonary artery, considered an abnormality 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.

With ductus-dependent heart defects (TMA, extreme form of Fallot's tetrad, critical stenosis of the aorta and pulmonary artery, break of the aortic arch, left ventricular hypoplasia syndrome), this cardiac anomaly is vital.

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

Hemodynamics.

In the prenatal period, the patent ductus arteriosus and the open oval window 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, shortly after birth, smooth muscle fibers spasm 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 neonatal period as a syndrome of respiratory disorders, congenital pneumonia, asphyxia during childbirth prevent the closure of the PDA. Physiological closure of the duct is delayed in premature babies, and the younger the gestational age of the child, the longer it takes to close the PDA. So, with a body weight of less than 1000 g in 80% of children, the ductus arteriosus functions for several months.

For the development of hemodynamic disorders, the size of the duct, the angle of its departure from the aorta, the difference in pressure in the large and small circles of blood circulation are important. With a thin, long and tortuous duct extending from the aorta at an acute angle, resistance to blood flow is created and pronounced hemodynamic disturbances do not occur; over time, the duct may obliterate.

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 heart, especially the left atrium, hypervolemia in the lungs with the formation of pulmonary hypertension.

Clinical picture will depend on the size of the duct.

In the neonatal period, the child listens to a systolic murmur from the river. swing - in the II intercostal space to the left of the sternum. The diastolic component of the murmur is absent due to the neonatal pulmonary hypertension characteristic of this period of life. For the same reason, in the neonatal period, a cross-discharge of blood can occur through the PDA, which will clinically be expressed in the appearance of a cyanotic color of the skin during a cry, sucking, or straining a child. As the pressure in the pulmonary circulation decreases, the left-right discharge of blood is carried out both in systole and in diastole, which leads to the phenomenon of systolic-diastolic murmur with a "machine" component. At an older age, as pulmonary hypertension progresses, the diastolic component of the noise weakens again until it disappears completely. The auscultatory features of the PDA can also include the strengthening and splitting of the II tone over the pulmonary artery. In the final stage of the natural course of the defect, the appearance of a diastolic murmur of pulmonary artery insufficiency - Graham-Still murmur - can be noted.

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 (flattening of the waist, immersion of the apex of the heart in the diaphragm, bulging of the ascending part of the aorta). An enlargement of the left heart is well detected 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 the PDA. signs of left atrial overload and left ventricular hypertrophy are recorded. In the future, signs of overload and hypertrophy of the right sections join them.

Echocardiography 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 the natural course, the life expectancy of patients is 20-25 years. Spontaneous closure of the ductus arteriosus rarely occurs after 12 months of age. The main complications of PDA are heart failure, pulmonary hypertension, infective endocarditis, aortic aneurysm and / or pulmonary artery.

Operative treatment implies ligation or transection with suturing of the aortic and pulmonary ends of the duct, but recently, catheter endovascular occlusion of the duct has also been used. The therapeutic method of treatment involves the use of prostaglandin inhibitors during 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 the rate of 0.1-0.2 mg / kg body weight in 1-2 doses for 1-3 days. Heading dose should not exceed 0.6 mg / kg. This method is not widespread, since it has significant limitations and contraindications. Indomethacin has antiaggregatory properties, which can lead to intracranial hemorrhage, gastrointestinal bleeding, and transient renal dysfunction.

Ventricular septal defect

Ventricular septal defect (VSD) - occurs most often, both in isolation and as part of many other heart defects. Among CHD, the frequency of this defect varies from 27.7 to 42%. Equally common in both boys and girls.

In the interventricular septum, 3 sections are distinguished:

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

the middle part is muscular,

and the lower one is trabecular.

Accordingly to these departments, the defects of the interventricular septum are also called, however, most of them have perimembranous localization (up to 80%). For a share muscle VSD accounts for 20%. According to their size, defects are divided into large, medium and small. For a correct assessment of the size of the defect, its size must be compared with the diameter of the aorta. Small defects 1-2 mm in size located in the muscle 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 for their characterization. Separately, there are multiple large IVS defects, like "Swiss cheese", which have an unfavorable prognostic value.

Intracardiac hemodynamic disturbances in VSD begin to form some time after birth, usually on the 3-5th day of life. In the early neonatal period, a heart murmur may be absent due to the same 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, as a result of which a left-to-right discharge of blood appears (from the high-pressure region to the low-pressure region). 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 accession of infection, the development of pneumonia, manifesting in the early stages of life, having a severe course and difficult to treat. If it is not possible to cope with hypervolemia with conservative methods, in such cases a palliative operation is performed - narrowing of the pulmonary artery according to Mueller. 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, the increased load that falls on the right ventricle in the future (after 3-6 months) dictates the need for a radical operation.

With 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, begins to gain weight. The patient's stable condition during 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 mm Hg. The auscultatory picture is characterized by a decrease in the intensity of the noise when an accent of the II tone appears above the pulmonary artery.

In the future, if the surgical correction of the CHD is not performed, the processes of hardening of the lung vessels begin to form ( high pulmonary hypertension - Eisenmenger syndrome). This pathological process does not reverse development and leads to a significant increase in pressure in the pulmonary artery (sometimes up to 100-120 mm Hg). Auscultation can be used to hear a pronounced accent of the II tone over the pulmonary artery ("metallic" shade). The systolic murmur becomes weakly intense, and in some cases it 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 artery valves (Graham-Still murmur). In the clinical picture of the disease, there are many pathological signs: cardiac "hump", expansion of the boundaries of relative cardiac dullness, more to the right. Above the lungs, areas of weakened and hard breathing are heard, wheezing rales may occur. The most characteristic sign of Eisenmenger's syndrome is a gradual increase in cyanosis, at first peripheral, and later on diffuse. This is due to the cross-discharge of blood in the area of ​​the defect of the interventricular septum, which, when the pressure in the right ventricle is exceeded, becomes right-left, i.e. changes its direction. The presence of a third stage of pulmonary hypertension in a patient may become the main motive for refusal of cardiac surgeons to perform an operation.

Clinical picture with VSD, it consists of a symptom complex of heart failure, which usually develops in 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 the child, tachycardia and shortness of breath, expansion of the boundaries of relative cardiac dullness, displacement of the apical impulse down and to the left can be detected. In some cases, the symptom of "cat's purr" is determined. Systolic murmur, as a rule, is intense, dried over the entire region of the heart, well conducted on the right side of the chest and on the back with punctum maximum in the IV intercostal space to the left of the sternum. On palpation of the abdomen, an increase in the liver and spleen is determined. Changes in peripheral pulsation are not typical. In children with VSD and NC, as a rule, malnutrition rapidly develops.

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

At radiological examination of the chest cavity organs describe the shape of the heart and the state of the pulmonary pattern, determine the size of the cardio-thoracic index (CTI). All these indicators have their own characteristics at different degrees of pulmonary hypertension. In the first (hypervolemic) stage, there is a flattening of the waist and immersion of the apex in the diaphragm, an increase in CTI. On the part of the pulmonary pattern, its strengthening, indistinctness, and blurring are noted. The extreme degree of pulmonary hypervolemia is pulmonary edema. In the transitional stage of pulmonary hypertension, there is a normalization of the pulmonary pattern, some stabilization of the size of the CTE. The sclerotic stage of pulmonary hypertension is characterized by a significant increase in the size of the heart, and mainly due to the right sections, an increase in the right atrium (formation of a right atriovasal angle), bulging of the pulmonary artery (Moore's index more than 50%), elevation of the apex of the heart, which forms with the diaphragm is an acute angle. From the side of the pulmonary pattern, the symptom of a "chopped off tree" is often described: bright, clear, enlarged roots, against which the pulmonary pattern can be traced only up to a certain level. On the periphery, there are signs of emphysema. The rib cage 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 CHD 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 - join, which indicates high pulmonary hypertension. The electrical axis of the heart is always deflected to the right. Conduction disorders can occur - from signs of incomplete blockade of the right bundle branch block to complete atrioventricular blockade.

At Doppler echocardiography the location of the defect, its size is specified, 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 mm Hg, in the second stage - from 30 to 70 mm Hg, in the third - more than 70 mm Hg.

Treatment this defect implies conservative therapy of heart failure and surgical correction of the heart defect. Conservative treatment consists of inotropic support drugs (sympathomimetics, cardiac glycosides), diuretics, cardiotrophics. In cases of high pulmonary hypertension, angiotensin-converting enzyme inhibitors such as capoten or captopril are prescribed. Surgical interventions are subdivided into palliative operations (in the case of VSD - the operation of narrowing the pulmonary artery according to Müller) and radical correction of the defect - plasty of the interventricular 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, by a violation of the ratio of its formed elements and plasma. Distinguish between 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 dramatically. This condition is called hypovolemia.

note

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

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

Causes (etiology) of hypovolemia

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

The most common causes of normocythemic hypovolemia: acute blood loss, shock conditions, 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 BCC 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.

Oligocythemic hypovolemia

Oligocythemic hypovolemia is a condition characterized by a decrease in the total blood volume with a predominant decrease in the number of its formed elements. At the same time, Ht is below the norm.

The most common causes of oligocythemic hypovolemia.

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

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

Polycythemic hypovolemia

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

The most common causes of polycythemic hypovolemia.

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

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

Pathogenesis

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

Severe hypovolemia reduces cardiac output and thus decreases systemic blood pressure. At the same time, the blood supply to tissues and organs decreases.

Blood pressure is normalized due to an increase in venous return, heart contractility and heart rate, as well as an increase in vascular resistance due to an increase in renin secretion of renin and a sympathetic effect.

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

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

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

Symptoms (clinical picture) of hypovolemia

Manifestations of oligocythemic hypovolemia.

Decrease in the oxygen capacity of the blood (as a result of erythropenia).
Signs of hypoxia (for example, a decrease in the oxygen content in the blood, acidosis, a decrease in venous blood pO2, etc.).

Disorders of organ-tissue blood circulation and micro-hemocirculation of varying degrees, caused, among other factors, by a decrease in the BCC.

Manifestations of polycythemic hypovolemia.

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

Signs of an underlying pathology that causes 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 an average degree of blood loss (from 11 to 20% of the BCC).

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

The skin becomes pale, the limbs become cold, dizziness, a feeling of weakness, dry mouth and nausea are noted. Inhibited reaction, fainting and a sharp breakdown are possible.

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

note

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

There may be a darkening of consciousness, lethargy, increased thirst, vomiting is possible, the appearance of a bluish color of the skin and a decrease in the amount of urine.

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

There is a sharp tachycardia, complete apathy, confusion or lack of consciousness, delirium and deathly pallor, anuria. Features sharpen, eyes become dull and sunken, and seizures are possible.

Breathing becomes periodic (Cheyne-Stokes type).

Hypovolemia of newborns

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

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

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

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

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

In the future, the type and amount of transfused fluids depend on the course of the disease, data from clinical and laboratory studies. Repeated pouring of the above liquids is acceptable.

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

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

When treating dehydration in children with transfusions of various saline solutions, complications may arise, the main ones of which are hypokalemia, alkalosis, acidosis, hypocalcemia, hypoxemia, and water intoxication.

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

Diagnosis of hypovolemia

Used for diagnostics:

• The clinical picture.
• In rare cases - determination of plasma osmolality and biochemical analysis of urine.
• Hypovolemia is suspected in high-risk patients - most often if there is a history of insufficient fluid intake, excessive fluid loss, diuretic use, or kidney and adrenal disease.

The diagnosis is based on symptoms. If the cause is clear and can be corrected, laboratory tests are unnecessary; in other cases, serum electrolytes, urea nitrogen and creatinine are measured. When metabolic alkalosis is detected, the C1 content in the urine is also determined.

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

There are a few things to keep in mind when interpreting urine electrolyte levels and urine osmolality.

• In 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 the excretion of Na is necessary to maintain its electrical neutrality. In such cases, a more reliable indicator of volume reduction is the concentration of C1 in the urine.

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

Hypervolemia

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

Root causes of origin

This position will be able to twist because:

Excessive use of water

Edema

Cool down the water in the vein

Blood transfusion of the largest blood size

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

Hitching sodium in the body

Diseases of the cardiovascular system, respiratory organizations or kidneys

Polycythemia, sure polycythemia

Decent bodily overload

Signs of hypervolemia

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

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

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

Diagnostics

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

Disease variants

The following variants of hypervolemia are distinguished:

normocythemic (uncomplicated)

oligocythemic (liquefaction, hemodilution)

polycythemic

The patient's efforts

When signs specific to hypervolemia come out, you need to go to a doctor, a hematologist or an anesthesiologist.

Treatment of hypervolemia

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

Weights

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

Pharmacoprophylaxis of hypervolemia

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

Hypervolemia

Hypervolemia

The main reasons for the downtime hypervolemia

Polycythemia

For hypervolemia

Symptomatic treatment

Hypervolemia

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

What provokes Hypervolemia:

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

Oligocythemic hypervolemia

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

The main causes of oligocythemic hypervolemia.

• Excessive intake of fluid into the body during 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 insufficient renal excretory function (for example, in renal failure), hyperproduction of ADH, hyperosmolality of blood plasma.

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

The main causes of polycythemic hypervolemia.

• Polycythemia (erythrocytosis) is a group of pathological conditions characterized by an increase in the number of red blood cells (regardless of the number of leukocytes, platelets).
• Polycythemia vera (polycythemia vera, Vakez's disease) is a chronic leukemia with lesions at the level of the myelopoiesis progenitor cell with the characteristic of a tumor unlimited proliferation of this cell, which retains the ability to differentiate along four germs, mainly in 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 with chronic circulatory failure, alveolar hypoventilation, decreased oxygen capacity of the blood and the effectiveness of biological oxidation, with 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 an increase in blood volume. However, with decompensation of the heart and the development of heart failure, cardiac output, as a rule, decreases.
• The increase in blood pressure is mainly due to an increase in cardiac output, as well as BCC and the tone of resistive vessels.
• Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood corpuscles, disseminated thrombus formation, and microcirculation disorders.

Hypervolemia Treatment:

Treatment is symptomatic

Which doctors should you contact if you have Hypervolemia:

Anesthesiologist

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

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

Causes

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

Symptoms

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

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

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

Diagnostics

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

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

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

Treatment

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

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, dietary sodium intake should be limited.

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

Prophylaxis

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

Hypovolemia of the thyroid gland - what is it

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

Resizing leads to poor hormone production. An insufficient level of trace elements becomes the cause of pathological diseases.

The thyroid gland has fixed dimensions. Data on the normal volume of the thyroid gland can be found in medical sources, 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 are related to the weight of the human body. In some periods, there is a change in volumes that is not associated with diseases.

These are the following periods:

Pregnancy.

Puberty.

At the end of these processes, the thyroid gland returns to normal.

Medical data suggest several reasons for the development of pathology:

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

The most common cause is hypoplasia. The reduced thyroid gland cannot produce the rate of hormonal elements. Lack of them provokes disease.

Underdevelopment of the thyroid gland in a child often occurs due to disorders in the mother's body. In women with iodine deficiency and untreated pathologies that have entered the period of gestation, the production of hormones decreases. The child does not receive the necessary micronutrients. Hypoplasia begins to develop.

It is dangerous for the baby with the consequences:

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

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

Causes of hypovolemia:

• dehydration of the body;
• great blood loss;
• loss of plasma against the background of 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, misuse of medical devices, severe infectious intoxication, shock lesions, excess histamine intake.

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

The polycythemic form is a consequence of dehydration. It can occur after repeated emetic processes (toxicosis), prolonged diarrhea and polyuria, 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 the state of human health:

Disorders of the nervous system and mental processes.

A sharp and frequent worsening of bowel movements: constipation or flatulence.

Decrease in temperature and blood pressure.

Swelling of the face and body (especially the limbs).

Deterioration of the general tone: drowsiness, lethargy and lethargy.

Voice change.

Decreased hemoglobin rate.

Lack of moisture in the skin.

Deterioration (slowing down) of the metabolic process.

The formation of seals in the thyroid gland.

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

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

Light degree. Reduced pressure, dizziness, dry mouth. The patient's reaction to external stimuli is inhibited, frequent fainting, loss of physical strength occur.

Average degree. The pressure drops, the pulse becomes irregular, and clammy sweat appears. The person feels a lack of oxygen (yawning, drowsiness and pallor). Sometimes the disease is accompanied by an increase in thirst, a decrease in urine output, and clouding of awareness.

Severe degree. The pressure reaches a critically low level. The person practically loses consciousness, there are convulsions, 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 carry out diagnostics, laboratory tests. The nutritionist will select the right food.

The endocrinologist will choose medication, determine the dose and prescribe a course of treatment. The course assumes the duration of the drug intake. It will often continue throughout life.

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

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

Hypervolemia: types, causes, symptoms and treatment

Hypervolemia - the main symptoms:

• Headache
• Mood swings
• 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 abdomen
• Violation of urination

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

Etiology

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

In a simple view, they are as follows:

• Transfusing 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 is supplied to the body from the outside. In three other cases, it is because blood is supplied to the vessels from the "reserves" of the organism itself.

The oligocythemic form has the following developmental etiology:

• 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 there is an imbalance in the body's water balance.
• Violation of the process of liquid withdrawal. Occurs with renal failure, sodium retention in the body.

The polycythemic form manifests itself for the following reasons:

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

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

Small circle hypervolemia has its own etiology of development:

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

What is apnea

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

Classification

As mentioned earlier, there are three types of hypervolemia:

• Simple. This type of pathology is extremely rare. It differs in that the volume of circulating blood increases proportionally. That is, the number of cells and liquid part remains within the permissible 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. It occurs with an increase in the cellular component of the blood and the level of hematocrit.

Since the etiology of each species is different, the method of diagnosis and treatment methods are also selected individually.

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

Symptoms

note

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

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

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

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

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

• mood swings;
• a sharp decrease in body weight;
• insomnia;
• dizziness;
• fainting on 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 when they appear.

Diagnostics

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

An initial examination is carried out 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 carried out with the help of contrast, then the result can say more than an x-ray;
• ultrasound examination of the heart - will show congenital pathologies, the speed and volume of blood flow in the vessels.

How is ECG performed

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

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

• Etiotropic, that is, they eliminate the cause of the development of the pathological process. The treatment of kidney diseases, heart disease surgery, therapy of thyroid diseases, and the fight against blood neoplasms are carried out. They also treat chronic and acute lung diseases and strictly control the volume of intravenous infusions.
• Symptomatic - will help to cope with the signs of the disease. For example, high blood pressure is lowered with antihypertensive drugs. 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 surgical intervention, followed by a period of rehabilitation, is not excluded.

In addition, 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 shaped elements will decrease. Thus, the hematocrit level is normalized.
• Herbal diuretics. These are dill, fennel, viburnum, horsetail and many others.

But it must be borne in mind that diuretics will not help with severe kidney disease. In this situation, it is necessary to carry out hemodialysis and hemofiltration.

Possible complications

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

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

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

Prophylaxis

Preventive measures for this pathology are as follows:

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

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

What is hypovolemia? 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.

By definition, hypovolemia is a discrepancy between the volume of blood required by the body, a decrease in the level of fluid in the thyroid tissue and the amount of hormones it synthesizes.

Blood problems have serious consequences.

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

The essence of hypovolemia

The thyroid gland is essential for the functioning of the body. With her participation, the metabolism takes place, iodine is produced, and bone tissue grows. Under the influence of various factors, diseases of the thyroid gland are becoming more common.

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

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

Causes of hypovolemia

The thyroid gland does not necessarily shrink for age-related reasons.

Causes of hypovolemia:

• diseases of the pituitary gland;
• underdevelopment of the thyroid gland (hypoplasia);
• organ atrophy;
• vasodilation collapse (vasodilation, inappropriate to the mass of circulating blood);
• high vascular permeability;
• increased hydrostatic pressure in arterioles;
• increased venous pressure;
• insufficient intake of fluid into the body;
• prolonged significant blood loss;
• blood loss with burns;
• states of shock.

The most common cause of hypovolemia is hypoplasia: iron synthesizes fewer hormones, which leads to 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, menstrual irregularities in women. In the absence of treatment, there is a threat of infertility.

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

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

Deficiency of hormones 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 on the basis of which hypovolemia is possible; this manifests itself as a cessation of the production of thyroid hormones and is used as the main indicator in diagnosing the degree 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, unfavorable ecology, genetic characteristics.

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Symptoms

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

Symptoms of hypovolemia are:

• swelling of the face and body;
• low temperature and pressure;
• tachycardia;
• decreased urine output;
• instability of the nervous system;
• apathy, lethargy, fainting;
• disorder of the digestive system;
• metabolic disease;
• dry skin;
• low hemoglobin;
• change of voice;
• induration in the thyroid gland;
• weakening of immunity and frequent illnesses;
• decreased sex drive, infertility;
• slowing down of child development.

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

Views

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, vasodilation collapse. This condition is typical for the first time after blood loss.

Oligocythemic: the percentage of formed elements drops significantly. Reasons: a state of weakening due to blood loss, erythropenia with burns. The condition leads to the cessation of oxygen access to the body. An urgent blood transfusion is indispensable.

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, disturbance of the water regime, the blood becomes viscous.

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

Degree of hypovolemia

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

• Lightweight. Blood loss is about 15% of the total. There is a drop in blood pressure, rapid pulse, tachycardia, pallor of the skin, insufficient blood supply to the extremities, dry mouth, weakness.

• Average. Blood loss is approaching 40%, the condition is severe, the 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%, blood pressure is up to 60 mm, the pulse is poorly audible, tachycardia, impaired consciousness, convulsions, and heavy breathing are pronounced. The condition is unsafe for life, it can be fatal.

Diagnosis

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

The basis of the diagnosis assumes:

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

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

Treatment

When hypovolemia is diagnosed, hormone therapy is required in combination with diet and iodine intake to stabilize the condition. Patients have to undergo long-term treatment, and if it is impossible to improve the functions of the thyroid gland, it persists throughout life.

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

With an uncritical loss of fluid, oral medication is prescribed, and with severe hypovolemia, intravenous medication. Typically, the patient is administered isotonic saline, 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 shock state, anti-shock therapy is performed. In case of respiratory failure, the patient is provided with artificial ventilation of the lungs.

Therapy problems

In the course of treatment, patients are forced to face such problems as the consequences of drug therapy, and the 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 the instability of the hormonal background, his mood does not allow him to fully relax in order to enjoy life.

Effects

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

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

Prophylaxis

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

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