You’ll occasionally see a news story where someone has sadly been affected by sepsis and died. It can strike so quickly, especially as the signs can creep up without warning and go unrecognised before it’s too late. The same problem can affect animals, and in the same way, so all cases need to be carefully evaluated and quickly treated.
Posted: 11 February 2019
Animals suffering from septic shock can develop severe cardiovascular abnormalities, multiple organ failure, and eventually death in no time at all. Aggressive fluid therapy on its own may not be enough, and additional treatments to support the failing circulatory system may be required. You’ll also need to direct your treatment at controlling the infection and protecting vital organs. Unfortunately, despite aggressive treatments, mortality rates can be very high, with anything between 20 and 60% of animals dying.
It cannot be stressed enough how important it is to be on your toes and identify these cases as early as possible. You’ve probably got less that 6 hours to start treatment. This is achieved from a combination of a detailed history and clinical examination. Look for any signs involving all the organ systems, especially those frequently affected with infections.
In early septic shock, common clinical signs are often as a result of peripheral vasodilation. These may present with two or more of the following;
It’s really important to repeatedly examine the patient if you have any suspicion of sepsis, as changes can occur rapidly. Left untreated, the animal will soon decompensate, and will then start to show some of the following;
The common systems which are frequently involved include;
Collect all the necessary samples required to allow you to culture and perform sensitivity tests. You might, for example, collect;
A significant number of bacterial organisms are resistant to some of the more commonly used veterinary antibiotics. For example, E. coli is frequently resistant to fluoroquinolones. For this reason, always take samples prior to starting treatment and perform culture with identification and sensitivity testing.
Septic shock will almost always compromise the circulatory system, resulting in persistent arterial hypotension. Regaining a normal blood pressure by giving intravenous fluids is essential and should be done aggressively. Options include;
Fluid and administration rates for hypovolemic and hypotensive patients can vary. A common approach is to give ¼ to 1/3 of the calculated volume, and then reassess the patient. The aim of treatment is to gain control of the circulatory system and achieve stability.
Animals in shock will, as a result of the circulatory collapse, become hypothermic quite quickly. There are numerous ways to help keep their temperature raised, such as;
For every hour that antibiotics are delayed, survival rates decrease. Some studies have shown increased mortality rates of between 7% and 20% if effective antibiotics are withheld in the first 24 hours. Gram-negative enteric organisms, such as Escherichia coli, are most commonly found in small animal patients with sepsis. Some of the more common antibiotics used include;
Most of the problems from sepsis occur as a consequence of hypotension from circulatory collapse and subsequent organ failure. Fluids are an essential part of the support required, as are;
If a focus of infection is suspected, it’s critical to find the site and deal with the problem. A pyometra, abscess, bladder or kidney infection needs to be located and treated.
MRSA is prevalent these days, and none of us should be complacent. Avoid spreading resistant infections by maintaining ultimate hygiene.
Throughout the whole treatment plan, don’t become complacent. Keep on top of all the vitals by measuring and recording everything. This way all clinicians involved will be aware of even slight changes in overall health.
With septic shock, blood is moved away from vital organs, including the gastro-intestinal system. This can result in ileus, ulceration and poor perfusion. To minimise the damage, you need to consider using some of the following;
This is indicated for any patient with evidence of hypoxemia.