What Causes Shock?

There are multiple causes of shock and symptoms depending on which type of shock you are dealing
with.

Causes of Physiological Shock
Physiological (circulatory) shock can be caused by any condition that reduces the blood flow.
There are various types of physiological shock and symptoms include:
Cardiogenic shock occurs when the heart is severely damaged by heart attack or heart failure.
Hypovolemic shock occurs when the total volume of blood in the body drops below normal such as
severe external or internal bleeding, dehydration, diabetes insipidus, kidney failure, extensive burns,
or inflammation of the pancreas.
Hemorrhagic shock occurs as a result of hemorrhage due to physical trauma e.g. motor vehicle
collisions or penetrating injuries such as gunshots or knife wounds.
Neurogenic shock occurs specifically from trauma that leads to spinal cord injuries.
Septic shock occurs when bacterial infection causes toxic shock syndrome and blood pressure
drops. Damage to the lungs causing acute respiratory distress syndrome can occur as can liver failure,
kidney failure and coma.
Anaphylactic shock is caused by severe allergic reactions to things such as bee and wasp stings,
nuts, shellfish, eggs, latex and certain medications, including penicillin.

Causes of Psychological Shock
Receiving disturbing news such as the death of loved one
Being involved in a traumatic event such as a car accident, or being the victim of crime
Psychological shock can disrupt your life, leaving you engrossed and preoccupied with the event or news that
caused the shock. The individual may also have difficulty coping with day to day functioning such as
personal relationships and work.
In some cases, an individual starts to experience psychological shock symptoms after the event actually
occurred. This is known as delayed shock. Delayed shock symptoms can occur within hours or in some
cases years of a traumatic event.
If symptoms do not improve and continue to persist, leaving the individual unable to return to normal life,
post-traumatic stress disorder (PTSD) may have developed.
The individual with psychological shock symptoms may be affected in the following ways:
Intrusion - the individual fixates on the event and news by playing it over and over again in his or
her mind
Avoidance the individual withdraws from normal activities and may resort to alcohol and drugs to
numb the pain
Increased arousal the individual feels ill-tempered and angry

(Hyperglycemia) High Blood Sugar Causes
Diabetes mellitus is one of several persistent conditions causing high blood sugar levels. For someone with
diabetes, hyperglycemia has many possible causes:
Carbohydrates: Eating food containing too many carbohydrates, a form of sugar. The body of a person with
diabetes cannot process high levels of carbohydrates fast enough to convert it into energy. Blood sugar levels
in patients with diabetes can rise within hours after eating.
Insulin control: Not producing enough insulin action (either by injection of insulin or taking medicine which
stimulates the pancreas to make more insulin). People with diabetes must control blood sugar by a
combination of dietary discretion, taking medication, and physical activity. When food, exercise, and insulin are
not balanced, blood sugar levels rise.
Stress: Emotions can play a role in causing hyperglycemia, but should not be used as an excuse for poor
control of diabetes.
Low levels of exercise: Daily exercise is a critical contributor to regulating blood sugar levels.
Infection, illness, or surgery: With illness, blood sugar levels tend to rise quickly over several hours.


Hypoglycemia Low Blood Sugar Causes
Common causes of low blood sugar include the following:
Overmedication with insulin or antidiabetic pills (for example, sulfonylurea drugs)
Use of medications such as beta blockers, pentamidine, and sulfamethoxazole and trimethoprim (Bactrim,
Septra)
Use of alcohol
Missed meals
Reactive hypoglycemia is the result of the delayed insulin release after a meal has been absorbed and occurs
4-6 hours after eating.
Severe infection
Cancer causing poor oral intake or cancer involving the liver
Adrenal insufficiency
Kidney failure
Liver failure
Congenital, genetic defects in the regulation of insulin release (congenital hyperinsulinism)
Congenital conditions associated with increased insulin release (infant born to a diabetic mother, birth trauma,
reduced oxygen delivery during birth, major birth stress, Beckwith-Wiedemann syndrome, and rarer genetic
conditions)
Insulinoma or insulin-producing tumor
Other tumors like hepatoma, mesothelioma, and fibrosarcoma, which may produce insulin-like factors
What follows are expansions on the points noted above and should be incorporated within those points (such as
cancer, diabetes drugs, organ failures).
Most cases of hypoglycemia in adults happen in people with diabetes mellitus. Diabetes has two forms, type 1
(loss of all insulin production) and type 2 (inadequate insulin production due to resistance to the actions of
insulin). People with type 1 diabetes must take insulin to control their glucose level; if they skip meals or have a
decreased appetite without changing their insulin dose, they may develop hypoglycemia. Insulin is also used to
treat some people with type 2 diabetes.
If a person with type 1 diabetes accidentally takes too much insulin, or a person with type 2 diabetes
accidentally takes too much of their oral medications or insulin, he or she may develop hypoglycemia. Even
when a diabetic patient takes medications correctly, improper meals, odd mealtimes, or excessive exercise
may result in hypoglycemia.
Often a person who has more than one medical problem may become confused about how much of a certain
medication they should take, or their medications may interact to cause hypoglycemia.
Hypoglycemia also may occur in people with cancer, which often causes loss of appetite. Many such people
skip meals because they are not hungry or because chemotherapy causes foods to taste differently. To
prevent this, people on chemotherapy should be encouraged by their doctors and loved ones to try to stay on
special diets and take medications to keep them from feeling sick. If this does not work, special medications to
help with appetite are available.
Adrenal insufficiency results from diseases that impair the adrenal glands, which are located above the
kidneys. These small structures make certain hormones and substances, mainly cortisol and epinephrine,
which also help elevate glucose in addition to their other functions. If these substances are not made, low
blood pressure, hypoglycemia, or both can result.
The pituitary gland makes growth hormone, which also helps to maintain the balance of glucose. Deficiency of
growth hormone causes hypoglycemia, especially in young infants and children.
Kidney failure causes hypoglycemia in three separate ways. The kidneys help to generate new glucose from
amino acids (called gluconeogenesis). Gluconeogenesis is impaired in kidney failure. Also, insulin circulates
for a longer period of time and is cleared slowly when kidney function is poor. The third important reason is that
kidney failure reduces the appetite and consequently, oral intake of food.
The liver stores glucose in a form called glycogen. In the presence of liver failure, the abilities of the liver to
generate new glucose and to release glucose are impaired.
Insulin-producing tumors of the pancreas (called insulinomas) cause hypoglycemia by releasing
inappropriately high amounts of insulin. Certain tumors of the liver called hepatomas or other tumors such as
fibrosarcomas and mesotheliomas can also cause hypoglycemia by producing insulin-like factors.








ASTHMA (Causes)

Asthma is caused by a combination of complex and incompletely understood environmental and genetic
interactions. These factors influence both its severity and its responsiveness to treatment. It is believed
that the recent increased rates of asthma are due to changing epigenetics (heritable factors other than
those related to the DNA sequence) and a changing living environment.

Environmental
Many environmental factors have been associated with asthma's development and exacerbation
including: allergens, air pollution, and other environmental chemicals. Smoking during pregnancy and
after delivery is associated with a greater risk of asthma-like symptoms. Low air quality, from traffic
pollution or high ozone levels, has been associated with both asthma development and increased asthma
severity. Exposure to indoor volatile organic compounds may be a trigger for asthma; formaldehyde
exposure, for example, has a positive association. Also, phthalates in PVC are associated with asthma in
children and adults as are high levels of endotoxin exposure.
Asthma is associated with exposure to indoor allergens. Common indoor allergens include: dust mites,
cockroaches, animal dander, and mold. Efforts to decrease dust mites have been found to be ineffective.
Certain viral respiratory infections may increase the risk of developing asthma when acquired as young
children such as: respiratory syncytial virus and rhinovirus. Certain other infections however may
decrease the risk.
Hygiene hypothesis
The hygiene hypothesis is a theory which attempts to explain the increased rates of asthma worldwide as
a direct and unintended result of reduced exposure, during childhood, to nonpathogenic bacteria and
viruses. It has been proposed that the reduced exposure to bacteria and viruses is due, in part, to
increased cleanliness and decreased family size in modern societies. Evidence supporting the hygiene
hypothesis includes lower rates of asthma on farms and in households with pets.

Use of antibiotics in early life has been linked to the development of asthma. Also, delivery via
caesarean section is associated with an increased risk (estimated at 2080%) of asthmathis increased
risk is attributed to the lack of healthy bacterial colonization that the newborn would have acquired from
passage through the birth canal. There is a link between asthma and the degree of affluence.
Genetic
CD14-endotoxin interaction based on CD14 SNP C-159T
[49]

Endotoxin levels CC genotype TT genotype
High exposure Low risk High risk
Low exposure High risk Low risk
Family history is a risk factor for asthma with many different genes being implicated. If one identical
twin is affected, the probability of the other having the disease is approximately 25%. By the end of
2005, 25 genes had been associated with asthma in six or more separate populations including:GSTM1,
IL10, CTLA-4, SPINK5,LTC4S, IL4R and ADAM33 among others. Many of these genes are related to the
immune system or modulating inflammation. Even among this list of genes supported by highly
replicated studies, results have not been consistent among all populations tested. In 2006 over 100 genes
were associated with asthma in one genetic association study alone; more continue to be found.

Some genetic variants may only cause asthma when they are combined with specific environmental
exposures. An example is a specific single nucleotide polymorphism in the CD14 region and exposure to
endotoxin (a bacterial product). Endotoxin exposure can come from several environmental sources
including tobacco smoke, dogs, and farms. Risk for asthma, then, is determined by both a person's
genetics and the level of endotoxin exposure.
Medical conditions
A triad of atopic eczema, allergic rhinitis and asthma is called atopy. The strongest risk factor for
developing asthma is a history of atopic disease; with asthma occurring at a much greater rate in those
who have either eczema or hay fever. Asthma has been associated with ChurgStrauss syndrome, an
autoimmune disease and vasculitis. Individuals with certain types of urticaria may also experience
symptoms of asthma.
There is a correlation between obesity and the risk of asthma with both having increased in recent years.
Several factors may be at play including decreased respiratory function due to a buildup of fat and the
fact that adipose tissue leads to a pro-inflammatory state.
Beta blocker medications such as propranolol can trigger asthma in those who are susceptible. Cardio
selective beta-blockers, however, appear safe in those with mild or moderate disease. Other medications
that can cause problems are ASA, NSAIDs, and angiotensin-converting enzyme inhibitors.
Exacerbation
Some individuals will have stable asthma for weeks or months and then suddenly develop an episode of
acute asthma. Different individuals react differently to various factors. Most individuals can develop
severe exacerbation from a number of triggering agents.
Home factors that can lead to exacerbation of asthma include dust, animal dander (especially cat and
dog hair), cockroach allergens and mold. Perfumes are a common cause of acute attacks in women and
children. Both viral and bacterial infections of the upper respiratory tract can worsen the disease.
Psychological stress may worsen symptomsit is thought that stress alters the immune system and thus
increases the airway inflammatory response to allergens and irritants.
Pathophysiology
- Obstruction of the lumen of a bronchiole by mucoid exudate, goblet cell metaplasia and epithelial
basement membrane thickening in a person with asthma.

Asthma is the result of chronic inflammation of the airways which subsequently results in increased
contractability of the surrounding smooth muscles. This among other factors leads to bouts of narrowing
of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or
without treatment. Occasionally the airways themselves change. Typical changes in the airways include
an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways' smooth
muscle may increase in size along with an increase in the numbers of mucous glands. Other cell types
involved include: T lymphocytes, macrophages, and neutrophils. There may also be involvement of
other components of the immune system including: cytokines, chemokines, histamine, and leukotrienes
among others.