2 Shock - Early Late

Q. An alert 6 month old child is brought with vomiting & diarrhea. RR-45/min, HR-180/min, SBP-85 mm of Hg. Extremities are cold & mottled. Capillary refilling time is 4 secs. Diagnosis is

a) Early (compensated) shock due to hypovolemia
b) Early (compensated) shock due to SVT
c) Late (decompensated) shock due to hypovolemia
d) Late (decompensated) shock due to SVT

Ans : A
Please see - Some books give an option " Late Compensated "
There is nothing like Late Compensated , if its Late then it is Decompensated.

Must Read : Early and Late Shock :
Early (Compensated) Hypovolemic shock : Compensatory Mechanisms -Tachycardia & Peripheral Vasoconstriction

  • Decreased pulse strength
  • Pallor or mottling
  • Delayed Capillary refill time
  • Dry and cool skin temperature
  • SBP - Normal

Late (Decompensated) Hypovolemic shock ( Compensatory Mechanisms fail to maintain sufficient blood flow to core organs )
  • Organ failure
  • Hypotension
  • Tachypnoea 
  • Tachycardia (if shock not reversed , then later Bradycardia)


  1. In this question the infant is having

    NORMAL SBP (70-100 is normal for infants)
    Tachycardia (100-140 is normal for infants)
    Vasoconstriction features (Cold and mottled ,Delayed Capillary Refill time)


    Typical features of SVT in infants :
    -Lethargy, feeding difficulties , irritability.
    -In newborns and infants with SVT, the heart rate is typically >220 beats per minute

    Also remember - SVT can cause CARDIOGENIC shock.

    This question is classically giving history of hypovolemic condition.

    1. Very nicely explained. It has been a big controversy. Thank u so much for the proper explanation.


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