This chapter discusses the diagnosis, evaluation and management of shock. It presents special circumstances which make diagnosis and management of shock difficult in pediatric and pregnant patients. Shock should be suspected when patients present with a constellation of signs including ill-appearance, tachycardia, tachypnea, hypotension, and oliguria. The principles of shock management include specific therapy for treating the underlying cause, and general therapy to manage the shock syndrome. Recognition of shock is difficult due to variations in age-dependent vital signs, difficulty in assessing mental status, and the non-specificity of early manifestations of shock such as irritability and poor feeding. Elderly patients experience significantly more morbidity and mortality from all causes of shock due to their limited ability to augment cardiac output and maintain vascular tone. Elderly patients often have multiple comorbidities or use multiple medications that distort the diagnosis and management of shock.

Acute renal failure (ARF) is a common condition which is a major contributor to morbidity and mortality amongst critical care patients. As renal function is highly dependent upon adequate renal blood flow and glomerular filtration pressure, oliguria is an early marker of an inadequate haemodynamic status. This chapter lists out prerenal causes, intrinsic causes and postrenal causes of renal failure. Early identification of reversible causes of renal impairment with expedient intervention may prevent progression to established ARF. Prerenal uraemia should be treated by urgent restoration of circulating volume and renal perfusion pressure and by correction of electrolyte deficits. Renal replacement therapy (RRT) is the mainstay of treatment for established acute renal failure. Survival following an episode of ARF is variable and, within the critical care environment, is largely dependent upon the accompanying pathological conditions, e.g. severe sepsis.