Infants and young children with normal CO should have a minimum of 1
mL/kg/hour of urine output. Older children and adults excrete 0.5 mL/kg/hr.
Infants with LCO or shock lose the ability to maintain renal perfusion and
glomerular filtration, which manifests as oliguria or anuria.
Overview of Clinical Signs and Symptoms in Shock
Clinical signs Hypovolemic Distributive Cardiogenic/Obstructive
Airway patency Depends on state – may need intubation with fluid
administration
Respiratory rate Increased
Breath sounds Normal Normal Crackles, grunting
Systolic BP Compensated vs. uncompensated shock
Pulse pressure Narrow Variable Narrow
Heart rate Increased
Peripheral pulses Weak Bounding or
Weak
Weak
Skin Pale, cool Warm or Cool Weak
Capillary refill Delayed Variable Delayed
Urine output Decreased
Level of consciousness Irritable at early stages or lethargic in late stages
Temperature Variable
(Adapted from PALS Provider Manual, 2011.)
Iii. Laboratory Evaluation of Shock and Low Cardiac Output States
It is important to remember that clinical signs and symptoms may be
unreliable or late indicators of poor systemic perfusion. Supplemental laboratory
testing is essential for the prompt recognition of LCO or shock and the
implementation of appropriate management strategies. These include the