Laboratory Data

1. Hemoglobin and hematocrit. Severe anemia (Hgb < 8 g/dL) has been associated with poor outcomes in patients with shock. During fluid resuscitation, hemoglobin is likely to be diluted. If hemoglobin is < 8 g/dL and patient does not respond to aggressive fluid resuscitation, consider transfusion.

2. Electrolytes. Hypotensive patients may present with a variety of electrolyte disturbances (too many to list here). Electrolytes should be checked initially, and then rechecked frequently during resuscitation. Frequent electrolyte assessment will allow appropriate intervention.

3. Coagulation studies. If sepsis is suspected, coagulation abnormalities may exist; these may require treatment with fresh frozen plasma, platelets, or cryoprecipitate.

4. ABGs. This evaluation is essential in determining acid-base balance. Metabolic acidosis reflects inadequate perfusion and cardiac output until proven otherwise. Compensatory respiratory alkalosis may also be seen. Evaluation of serum lactate level may be helpful; level is elevated if perfusion and cardiac output are inadequate.

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