Often associated with low SVR (e.g. sepsis), decreased preload (e.g. hypovolemia for any reason), impaired isotropy (ischemic or idiopathy cardiomyopathy), or heart rhythm problems (bradycardia, SVT)
Patients typically quite sick
Meds including metformin in setting ckd
Symptoms
Weak, confused, decreased level of consciousness (impaired perfusion)
Focal symptoms based on cause of hypo perfusion (e.g. fever, sob, sputum if from pneumonia; vomiting blood if from acute anemia related to variceal bleeding, etc)
Physical Exam Findings
Low BP
Often ill appearing
Confused or decreased level of consciousness
Extremities can be warm (low SVR, distributive shock) or cool (hypovolemia, cardiogenic)
Other focal findings based on etiology (e.g. ascites, jaundice, other features portal hypertension if variceal bleeding; etc)