Editing Shock (circulatory) (section)

===Progressive/decompensated===
The Progressive stage (stage 3) results if the underlying cause of the shock is not successfully treated. During this stage, compensatory mechanisms begin to fail. Due to the decreased perfusion of the cells in the body, [[sodium]] ions build up within the intracellular space while [[potassium]] ions leak out. Due to lack of oxygen, [[cellular respiration]] diminishes and [[Anaerobic respiration|anaerobic metabolism]] predominates. As anaerobic metabolism continues, the arteriolar smooth muscle and precapillary [[sphincters]] relax such that blood remains in the [[capillaries]].<ref name="Robbins">{{Cite book |last1=Kumar |first1=Vinay |url=https://www.worldcat.org/oclc/69672074 |title=Robbins Basic Pathology |last2=Abbas |first2=Abul K. |last3=Fausto |first3=Nelson |last4=Mitchell |first4=Richard N. |date=2007 |publisher=Saunders/Elsevier |isbn=978-1-4160-2973-1 |edition=8th |location=Philadelphia, PA |pages=102–103 |oclc=69672074 |archive-date=2020-06-05 |access-date=2022-09-02 |archive-url=https://web.archive.org/web/20200605131552/https://www.worldcat.org/title/robbins-basic-pathology/oclc/69672074 |url-status=live }}</ref> Due to this, the [[Hydrostatics#Medicine|hydrostatic pressure]] will increase and, combined with [[histamine]] release, will lead to [[Extravasation|leakage of fluid]] and [[protein]] into the surrounding tissues.  As this fluid is lost, the blood concentration and [[viscosity]] increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause the vital organs to be compromised due to [[ischemia|reduced perfusion]].<ref name=Robbins/> If the bowel becomes sufficiently [[ischemic]], bacteria may enter the blood stream, resulting in the increased complication of [[septic shock|endotoxic shock]].<ref name=Guyton/><ref name=Robbins/>