Normotensive and hypertensive (cryptic) shocks

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  2. Why this site ?
  3. References for this site
  4. Stage 1: Pre-shock Anticipation
  5. Stage 2: Pre-shock Slide
  6. Stage 3: Compensated shock
  7. Stage 4: Decompensated shock, but reversible
  8. Stage 5: Decompensated shock, but irreversible
  9. Vicious cycles
  10. S.I.R.S.
  11. Shock Combo
  12. Microvascular Complications
  13. Geneva Handshake
  14. Normotensive and Hypertensive shocks (cryptic shocks)
  15. EGDT
  16. contact

The term "cryptic shock" is often used for patients with deceptively normal hemodynamic parameters, yet presenting high risk for morbidity and mortality because of global ischemia with increased lactate blood level. If blood pressure is normal, but lactate blood level is high secondary to global tissue ischemia, some call this condition NORMOTENSIVE shock instead of "cryptic shock".

Actually, some patients can even be in HYPERTENSIVE shock! ....For example:
(a) in cardiogenic or hypovolemic shock with marked sympathetic system activation,
(b) during a hypertensive crisis due to pheochromocytoma, or
(c) during eclampsia

In those cases, shock is easily diagnosed by finding out that organs are dysfunctional or failing while lactate blood level is high!... And this, despite normotension or even hypertension!

It is important to note that many physicians do not believe that patients with normal blood pressure can be in shock. For those non-believers, they should at least admit that a previously chronically hypertensive patient with blood pressures running chronically in the 180/100 mmHg range, and presenting to the emergency room department with a blood pressure of 100/70 ("normal BP"), can be in full blown shock!
In these cases, compensatory mechanisms are at play (vasoconstrictive autonomic system) and maintain blood pressure through severe increase in systemic vascular resistance. This severe vasoconstriction induces tissue ischemia/hypoxia and, as a consequence, lactic acidosis.

Note that, without betablockade, these patients tell you that they are sick: they are tachycardic!... and in severe cases, sweating profusely!