In human medicine, relative dysfunction of the adrenal glands does occur during severe sepsis. Corticosteroids have been shown
to decrease the need for vasopressors during septic shock in patients with relative adrenal insufficiency. Reports of the
effects of corticosteroids on mortality in this situation have been mixed, but lower doses appear to be associated with better
outcome. At this time, there is little information about the incidence of relative adrenal insufficiency in dogs with sepsis.
Therefore, it is unknown if corticosteroids may be an appropriate adjunctive therapy in dogs. Care should be taken to avoid
corticosteroids except in rare cases where adrenal insufficiency is highly suspected and/or documented.
Insulin: Alterations in glucose metabolism during sepsis are well documented. The administration of regular insulin to maintain tight
glycemic control has decreased mortality by approximately 40 percent in humans with post-surgical sepsis. Additionally, in
experimental models, administration of insulin decreases inflammation and mortality from sepsis. Although this management
strategy has not been evaluated in dogs, it warrants further attention and good glycemic control should be a consideration.
Anesthetic/analgesic drugs: Most anesthetic/analgesic drugs possess anti-inflammatory properties during sepsis. Drugs like the opiate sufentanil and
the NMDA-receptor antagonist (e.g., ketamine) have been shown to decrease the production of TNF during experimental endotoxemia
in dogs. The clinical impact of these findings is unknown and further study is indicated to determine the role of anesthetic/analgesic
drugs for the management of sepsis.
Note: Owners do not want their beloved sick dog to be in pain.
Canine parvoviral enteritis or bacterial infection History and physical examination
- Acute gastrointestinal problems in puppies younger than 6 months
- Gastrointestinal signs such as vomiting, diarrhea, anorexia, depression
- Fecal parvovirus antigen test
- Serum chemistry profile and electrolytes
- Intestinal parasites are likely to be present such as hookworms, roundworms, giardia.
Medical and/or surgical procedures
Aseptically place an intravenous or intraosseous in-dwelling catheter.
Provide adequate fluids for reperfusion of vital organs, using lactated Ringer's solution or Normosol-R at a volume and rate
adequate to restore perfusion to the vital organ at a supranormal level.
If perfusion is poor, rapidly infuse an intravenous bolus of hetastarch or dextran 70 at a rate of 20 ml per kg for initial
resuscitation and provide supplemental oxygen by nasal catheter.
Do not use hypertonic saline solution in this resuscitative process, because the animal is usually severely dehydrated.
Rehydrate with lactated Ringer's solution or Normosol-R at a rate of 3 ml to 10 ml per kg per hour initially until hydration
is restored over four hours; maintenance rate is 2 ml to 3 ml per kg per hour.
Note: Using hetastarch or dextran 70, less fluid is lost into the gastro-intestinal tract, and the total volume of fluid required
for rehydration is approximately 50 percent of what is used when lactated Ringer's solution or Normosol-R is used alone.
Administer intravenous antimicrobial agents such as first-generation cephalosporins.
If the animal appears to be septic, consider cephalosporins, an aminoglycoside and metronidazole once perfusion has improved.
Palpate the animal's abdomen at least every four hours to detect intussusception.
Give nothing orally until vomiting is controlled.
Flush indwelling catheter with heparinized saline solution every six hours.
Warm or cool the animal as deemed necessary once perfusion has been restored.
Listen for bowel sounds; if decreased or no bowel sounds are detected, put the animal on metoclopramide via the intravenous
Control significant vomiting with administration of metoclopramide or chlorpromazine.
If vomiting is persistent, place a nasogastric tube and suction the gastric contents every one to two hours initially; back
off the frequency of suctioning as directed by withdrawal of gastric fluid.