Physiological Mechanisms of Circulatory Failure in Emergency Medicine: Integrating Diabetic Ketoacidosis, Massive Hemorrhage, and Cardiogenic Shock — A Narrative Review
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Review Paper | 2026 | Volume 3 | Issue 3 | Page 72-76
Dr Shahan Layek¹, Dr Vanshita Mishra²,
Dr Shiv Narayan Tripathi³, Dr Akshaymani Tripathi⁴
¹ Independent Researcher, West Bengal, India
² Emergency Medical Officer, District Women Hospital, Sitapur, Uttar Pradesh, India
³ Emergency Medical Officer, District Hospital Sitapur, Uttar Pradesh, India
⁴ Junior Resident, Department of General Surgery, Autonomous State Medical College, Lakhimpur Kheri, Uttar Pradesh, India
Abstract
Circulatory failure is a challenge in emergency medicine and critical care. It occurs when the cardiovascular system cannot deliver adequate circulation to the tissues in order to meet the metabolic demand of oxygen. Diabetic ketoacidosis, massive hemorrhage and cardiogenic shock are conditions that although etiologically diverse, eventually have the same common final pathways: cell hypoxia and multi organ failure. In DKA circulatory failure is due to dehydration, electrolyte derangement and metabolic acidosis; while in massive hemorrhage it is due to the loss of blood volume, and in cardiogenic shock it is due to intrinsic cardiac pump failure. Despite these, the compensatory mechanisms are largely the same. There is sympathetic activation, neurohormonal responses, and microcirculatory dysfunction. In recent years there are newer theories about the importance of endothelial integrity and cellular energy pathways in the outcome of shock. A clear understanding of this whole pathway is crucial for effective treatment in the emergency settings. In this review article, we focus on the normal physiology of circulation and the pathophysiological events that lead to circulatory failure due to these three different situations: diabetic ketoacidosis, massive haemorrhage, and cardiogenic shock in emergency and critical care.
Keywords:- Circulatory failure, diabetic ketoacidosis, hemorrhagic shock, cardiogenic shock, tissue perfusion, emergency medicine.