Introduction:

Shock occurs when your blood pressure falls to a very low level. As your blood pressure falls, your brain and other organs don't get enough blood or oxygen to function, and they begin to fail. Shock can arise from any of a number of causes. It is a life-threatening medical emergency and must be treated early to avoid serious complications and even death.

Signs and Symptoms:

Common signs and symptoms of shock include:

• Low blood pressure
• Altered mental state, including reduced alertness and awareness, confusion, and sleepiness
• Cold, moist skin. Hands and feet may be blue or pale
• Weak or rapid pulse
• Rapid breathing and hyperventilation
• Decreased urine output
• In septic shock (from overwhelming blood infection) -- shaking chills, rapid temperature increase, warm, flushed skin, and rapid pulse
• In shock related to heart problems -- lung congestion, rapid pulse, heart murmur, enlarged neck veins

What Causes It?:

Shock can have several causes. Doctors classify shock according to four categories:

Loss of fluid in the bloodstream (hypovolemic shock) -- occurs after heavy bleeding from an injury or a condition such as bleeding ulcers. Hypovolemic shock can also occur if your body loses too much of fluids other than blood (such as losing water after severe diarrhea or vomiting, or losing plasma after serious burns).

Blood vessels become too dilated (distributive shock) -- If the blood vessels expand too much, they are not able to keep blood circulating to all organs. Septic shock, which occurs when bacteria invade the bloodstream, and anaphylactic shock, which is a severe allergic reaction, are examples.

Heart problems (cardiogenic shock) -- In this case, the heart doesn't pump enough blood through the body. It can be caused by a heart attack, abnormal heart rhythm, or damage to the heart from heart disease.

Who's Most At Risk?:

The following conditions and characteristics increase the risk for shock:

• Serious injury and trauma
• Heart conditions such as heart disease or heart attack
• Surgery
• Bacterial infection that has spread to the blood
• Bleeding
• Losing large volume of fluids from severe diarrhea or vomiting
• Excessive alcohol use
• Severe anemia
• Weakened immune system
• Allergic reaction to a drug, food, or environmental exposure
• Drug overdose
• Pregnancy

What to Expect at Your Provider's Office:

Shock is an emergency and requires immediate conventional treatment. Your health care provider will diagnose shock based on your symptoms and any information about underlying disease or recent injury. Your health care provider will check blood pressure, assess mental status (memory, orientation, and alertness), measure urine output, and order blood tests to check heart, lung, and kidney function and search for evidence of sepsis (blood infection). Imaging and other procedures -- such as x-ray, electrocardiography (ECG), echocardiography -- may be performed to check the heart.

Treatment Options:

Prevention

If you have heart disease or another condition that makes you susceptible to shock, you should seek treatment for that condition. If you have severe allergies, avoid substances that may trigger anaphylactic shock and carry self-injectable epinephrine to treat anaphylaxis.

Treatment Plan

The main goals of treatment are to maintain blood pressure and to make sure the person's vital organs get enough blood and oxygen. First aid for shock includes having the person lie on their back, raising their legs to help blood return to the heart, stopping any bleeding, covering them with a coat or blanket to ensure warmth, and performing cardiopulmonary resuscitation (CPR), if needed. Emergency medical staff will administer oxygen and, in the case of hypovolemic and septic shock, intravenous fluids.

Drug Therapies

The following medications may be used to treat shock:

• Drugs that increase pressure in the arteries and help the heart pump more blood, such as dopamine, dobutamine, and norepinephrine
• Medications to either dilate or constrict blood vessels (depending on the cause of shock)
• Antibiotics for septic shock, to combat wide-ranging infection
• Thrombolytic therapy (drugs that dissolve clots as they form) may be considered in the case of heart attack or pulmonary embolism

Complementary and Alternative Therapies

Shock is always life threatening and requires emergency conventional medical care. Some complementary and alternative therapies, however, may be used along with conventional treatment after a person's condition stabilizes, to help prevent shock. For instance, certain nutrients may help protect against the harmful effects of shock and improve the outcome of conventional treatment.

Nutrition and Supplements

Oxidative stress (damage to cells caused by the body's normal use of oxygen) may play a role in shock. Several studies have suggested treatment with antioxidants that help rid the body of free radicals (harmful byproducts of the oxidative process) may protect against some types of shock. However, most of these have been animal studies. It is not known whether or not these supplements will also benefit humans.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
• Omega-3 fatty acids, such as fish oil (1 - 2 capsules or 1 - 2 tablespoonfuls daily), for inflammation.
• Vitamin C, 1 - 6 gm daily, as an antioxidant. You may use higher doses. If diarrhea develops, lower dosage.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• L-carnitine, 500 - 2000 mg daily for support of a healthy cardiovascular system. A study of 115 patients with septic, cardiac, or traumatic shock showed that acetyl-L-carnitine helped return heart rate and blood pressure to normal and boosted oxygen delivery throughout the body.
• Coenzyme Q10, 50 - 200 mg daily, as an antioxidant and for support of cardiovascular function.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects.

Herbs

Since shock always requires emergency conventional medical treatment, it should never be treated with herbs alone. Some herbs that support the immune system may be beneficial in treating septic shock, along with conventional medications. Talk to your doctor before taking any herbs to treat or prevent shock.

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

• Bilberry (Vaccinium myrtillus) standardized extract, 80 mg two to three times daily, for antioxidant support.
• Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for antioxidant and vascular support.
• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Rhodiola (Rhodiola rosea) standardized extract, 150 - 300 mg one to three times daily, for stress and immune support. Rhodiola is an "adaptogen" and helps the body adapt to stress.

Homeopathy

No scientific studies have evaluated homeopathic remedies for the treatment of shock. The remedy aconite, however, is often used by homeopathic doctors for emergency conditions. In homeopathic remedies, aconite is highly diluted, and only a trace amount of the herb is present, so it is not toxic in a homeopathic formulation.

Prognosis/Possible Complications:

If someone suffering from shock receives immediate treatment, the prognosis is good. Immediate treatment for anaphylactic shock, for example, usually results in complete recovery. But any case of shock is life threatening, regardless of its cause, particularly in the elderly. Shock often causes organ damage (including the kidneys, brain, and liver), cardiac arrest, and respiratory failure.

Following Up:

If you are suffering from shock, you will likely be admitted to intensive care. Following treatment, your health care provider will carefully monitor your condition, including temperature, blood pressure, heart function, urine flow, and blood chemistry.