Page 2779 - Cote clinical veterinary advisor dogs and cats 4th

1448 Sepsis and Septic Shock

Sepsis and Septic Shock
VetBooks.ir

Suspect sepsis and/or septic shock:
• Fever or hypothermia
• Tachycardia or bradycardia (cats)
• Tachypnea
• Leukocytosis or leukopenia
• Hyperglycemia or hypoglycemia

Initiate broad-spectrum parenteral
Identify source of infection and bactericidal antimicrobials (choice
obtain culture samples influenced by sight of infection,
(e.g., urine, blood, pleural Gram stain, and other factors, but
exudate) if possible combinations such as ampicillin
and enrofloxacin often appropriate)

Intravenous crystalloid fluid resuscitation
and closely monitor heart rate, blood
pressure, mentation, and (if available) lactate
If safe • Initial bolus 10–20 mL/kg crystalloid (e.g.,
LRS, Plasmalyte)
• Assess and repeat if needed up to 80 (dog)
or 50 (cat) mL/kg/h
• Consider need for blood or plasma
transfusion
Consider vasopressors until MAP ≥ 65 mm Hg:
• Dopamine 5–15 mcg/kg/min IV or
Institute source control • Norepinephrine 0.05–2.0 mcg/kg/min IV or
(e.g., thoracic drainage for yes Normalization of monitoring no • Vasopressin 0.5–5 mU/kg/min IV
pyothorax or surgical parameters? Consider + inotrope if ↓ myocardial contractility
treatment of pyometra) on echo:
if possible • Dobutamine 5–15 (dog) or 3–6 (cat; seizure risk)
mcg/kg/min
Consider atropine 0.04 mg/kg IV for bradycardia
Monitor and support organ function:
• Oxygenation (supplement, ± ventilate)
• Electrolyte disturbances (K, Na, iCa, Mg)
• Electrocardiogram (arrhythmias)
• Gastroprotectans/antiemetics If unimproved:
• Coagulation status (± plasma, heparin) • Hydrocortisone 0.5 mg/kg IV q 6h, or
• Urine production/renal function • Dexamethasone 0.05–0.1 mg/kg IV once
• Analgesia (avoid NSAIDs) • Epinephrine 0.05 –0.5 mcg/kg/min
• Nutritional support • Reassess need for blood/plasma transfusion

www.ExpertConsult.com