Veterinary Clinical Medicine-I (General and Systemic)

TREATMENT 

• The aim of treatment in septic shock is care, improve and maximize oxygen delivery to the tissues to address their demands. Two or three largest possible catheter should be placed for fluid administration and if possible, a jugular catheter for asses central venous pressure.
• The adequate fluid and administration rate choice for fluid therapy remains as a very controversial issue. Initially you can start with a crystalloid fluid at 70-90 ml/kg in dogs, 45-60 ml/kg in cats, looking forward a hemodynamic stability (Blood pressure, Capillary refill time, Central Venous Pressure, Good quality and rate Femoral Pulse, Mucous Membrane Color, Peripheral temperature).
• If there is not adequate response to therapy, the remainder volume can be given as a colloid such as Haemacell, Dextran or Hetastarch (10-20 ml/kg/day). Therefore, colloids should also be considered if the total protein is less than 3.5 gm/dl. In cats, the best response is achieved with colloid bolus 5-10 ml per cat. If there is a glucose level less than 60 mg/dl, a bolus of 50% dextrose should be given at a volume of 0.5-1 ml/kg, diluted with and equal volume of saline, IV.
• If the microorganism source can be identified, samples should be aseptically obtained and submitted for culture and sensitivity. While wait for the culture results, antibiotic therapy should be instituted. Broad-spectrum antibiotics should be selected based on the suspected pathogen organism.
• Intravenous empirical antimicrobial therapy directed to all potential infections sources should be given as early as possible. Coverage should always include Staphylococcus, Streptococcus and E. Coli.
• Infectious process requiring surgical drainage or debridement should be treated promptly. Cardiopulmonary unstable function is not an acceptable reason to delay surgical treatment if sepsis is the cause of instability.
• Frequent complications associated to the Septic Shock patients are sepsis and GI ulceration. Use of Famotidine, Ranitidine may help to reduce the risk of ulceration. If there is evidence of GI hemorrhage, Sucralfate is indicated by oral tube if needed.
• Nutrition is the key to maximize the likelihood of healing in septic patients, and enteral nutrition is the best choice to feed both to the patient and to the enterocytes. If the patient do not eat despite adequate GI protective and antiemetic drugs, a pharyngei-esophageal tube can be placed for short-term enteral nutrition. Otherwise, total parenteral nutrition (TPN) is very expensive and does not provide nutritional support of the enterocytes.
• Finally, good hospital care is very important for the patient's well being, like prevention of decubital ulcers keeping patients on soft padded surfaces covered with absorbent material to prevent scalding by urine and feces. Catheters must to be checked daily and the entrance point must be routinely disinfected