Evaluation of Hypotension

Last updated: April 9, 2026, Pacific Time (PDT)

Symptom-first framework for low blood pressure. Confirm the measurement and perfusion state, stabilize while assessing, then sort hypotension into distributive, hypovolemic/hemorrhagic, cardiogenic, obstructive, medication, or endocrine physiology.

All Immediate stabilization Distributive Volume / bleeding Cardiac / obstructive Back to Main Page

Interactive diagnostic assistant

Activate the assistant to re-rank likely hypotension causes from bedside clues.
Vitals / perfusion
Distributive clues
Volume / bleeding clues
Cardiac / obstructive clues
Meds / endocrine

Likely causes from entered data

Recommended next labs, imaging, and diagnostics

Flowchart

First pass
Low BP is a number; shock is a perfusion problem
Confirm cuff / arterial-line accuracy, compare with baseline, and assess mentation, skin, urine output, lactate, creatinine, and symptoms.
Immediate stabilization
Stabilize while classifying physiology
Bedside assessment, repeat BP/MAP, IV access, labs, ECG, POCUS, cautious fluids when appropriate, vasopressors / ICU if shocky.
Distributive
Sepsis common
Sepsis / vasodilatory shock
Fever, source, lactate rise, warm extremities early, organ dysfunction.
Exposure-driven
Anaphylaxis / inflammatory vasodilation
Hypotension plus urticaria, wheeze, angioedema, GI symptoms, or medication/food exposure.
Volume / bleeding
Fluid loss
Hypovolemia / overdiuresis / GI losses
Low intake, vomiting, diarrhea, diuresis, dialysis/UF, orthostasis.
Blood loss
Hemorrhage / occult bleeding
Hgb drop, melena, hematemesis, hematuria, postop bleeding, expanding hematoma.
Cardiac / obstructive
Pump / rhythm
Cardiogenic shock / unstable rhythm
Chest pain, ECG change, pulmonary edema, cool extremities, new severe brady/RVR/VT.
Blocked flow
PE, tamponade, tension physiology
Hypoxia/RV strain, pericardial effusion/JVP, unilateral absent breath sounds, shock out of proportion.

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