Hypovolemic Shock in the Setting of Third Spacing with Concentric Left Ventricular Hypertrophy: A Physiology-Guided Management of Fluid Resuscitation—Case Report and Literature Review

Authors

• Akram M. Eraky, Kansas City University
• Yasser Mokhtar, Freeman Health System
• Guy Grabau, Freeman Health SystemFollow
• Adnan Khan, Freeman Health System
• Mark Jarosz, Kansas City UniversityFollow
• Alisha Wright, Freeman Health SystemFollow
• Matthew Grounds, Freeman Health SystemFollow
• Kyle Kennedy, Freeman Health System

Document Type

Article

Publication Title

Pathophysiology

Abstract

Patients with preload-dependent conditions are at high risk of hemodynamic instability from both hypovolemia and hypervolemia. In hypovolemic states, the presence of third spacing may be misleading and obscure true intravascular volume status. Therefore, management of critically ill patients should be guided by a thorough understanding of physiology and pathophysiology to appropriately address hemodynamic derangements. Overreliance on rigid protocols and protocol-driven care without adequate clinical judgment may, in some cases, adversely affect patient outcomes. Herein, we present a case of hypovolemia-induced hypotension in the setting of third spacing and concentric left ventricular hypertrophy.

DOI

10.3390/pathophysiology33020027

Publication Date

4-17-2026

Keywords

hypovolemic shock, hypervolemia, hypovolemia, hypertrophic cardiomyopathy, left ventricular hypertrophy, third spacing, preload-dependent conditions, albumin, fluid resuscitation

ISSN

1873-149X

Recommended Citation

Eraky AM, Mokhtar Y, Grabau G, Khan A, Jarosz M, Wright A, Grounds M, Kennedy K. Hypovolemic Shock in the Setting of Third Spacing with Concentric Left Ventricular Hypertrophy: A Physiology-Guided Management of Fluid Resuscitation—Case Report and Literature Review. Pathophysiology. 2026; 33(2). doi: 10.3390/pathophysiology33020027.