Endotoxemia

Question 1

Proinflammatory mediators

Answer 1

TNF alpha
Tissue factor

Question 2

TNF alpha

Answer 2

Initiates: hypertension, hemoconcentration, metabolic acidosis, DIC
Stims synthesis of: interleukins, acute phase proteins, tissue factor

Question 3

What effect do endotoxins have on the vasculature?

Answer 3

Leukocyte margination (leukopenia and neutropenia)
Fluid leakage (hypovolemia, hypoproteinemia)
Pooling of blood in the microvasculature (injected blood vessels, hypotension)

Question 4

What are the clinical signs of endotoxemia?

Answer 4

Increased HR and RR
Ileus
Mild/moderate colic
Congested mm
Injected vessels
Increased CRT
Decreased peripheral pulses
DIC, thrombosis, petechiation, ecchymosis
Laminitis

Question 5

What are the treatment targets for endotoxemia?

Answer 5

1. Prevent uptake
2. Neutralize
3. Prevents release
4. Prevent activation

Question 6

How do we prevent endotoxin uptake?

Answer 6

Remove source of endotoxin (umbilicus, colic sx, effusions)
Bind endotoxin within GI lumen (activated charcoal, bio-sponge)

Question 7

How do we neutralize endotoxin in circulation?

Answer 7

Antiendotoxin antiserum (enhance opsonization)
Polymyxin B (abx, forms complexes)

Question 8

How do we prevent endotoxin inflammatory mediator release?

Answer 8

NSAIDs (prostaglandins, thromboxane, flunixin meglumine)
Glucocorticoids (contraindicated, increased risk of laminitis)

Question 9

How do we prevent endotoxin activation?

Answer 9

Toxic oxygen metabolite scavengers (allopurinol)
Prevent receptor interaction (Anti-CD14 Ab)