Infectious Dx: Sepsis and Septic Shock

Question 1

Untreated, what can result as a result of sepsis and septic shock?

Answer 1

Hypotension, vascular leakage, and micro vascular dysfunction

Question 2

What are the more feasible parameters to use for monitoring systemic inflammatory responses?

Answer 2

TPR, leukogram

Question 3

What are the criteria for determining SIRS in dogs?

Answer 3

Hypothermia/ hyperthermia
Tachycardia
Tachypnea
Leukocytosis/ leukopenia

Question 4

What are the criteria for determining SIRS in cats?

Answer 4

Hypothermia/ hyperthermia
Bradycardia/ tachycardia (bradycardia #1)
Tachypnea
Leukocytosis/ leukopenia

Question 5

Inflammatory cytokines include:

Answer 5

TNF-alpha, IL-1, IL-6, IL-8, and IFN-gamma

Question 6

Counter-inflammatory cytokines include:

Answer 6

IL-4, IL-10, IL-13, TGF beta, Glucocorticoids

Question 7

The overproduction of what chemical leads to a loss of vasomotor tone in patients with severe sepsis or septic shock?

Answer 7

Nitrous oxide (NO)

Question 8

In septic patients, what occurs to natural anticoagulant and fibrinolytic processes?

Answer 8

They are inhibited via down regulation of antithrombin, tissue factor pathway inhibitor, and tissue plasminogen activator, and increased plasminogen activator inhibitor (favoring procoagulant and antifibrinolytic states)

Question 9

What effect does increased vascular permeability have on oxygen transport and delivery?

Answer 9

Increased fluid and solute transfer into the interstitial space causes decreased oxygen delivery and transport to the mitochondria (cytopathic hypoxia). This contributes further to hypoxia.

Question 10

What are some common causes for sepsis?

Answer 10

Septic peritonitis (GI perforations, ulcers, dehiscence, severe colitis), Pyelonephritis, Pneumonia, Pyothorax, Septic arthritis, Deep pyoderma, Bacterial endocarditis, Tick borne Dx, Vasculitis, Septic meningitis, Osteomyelitis, Immune suppression

Question 11

Higher levels of _________ are associated with poorer outcomes, particularly if it is accompanied by __________.

Answer 11

Lactate, hypotension

Question 12

True or False: Bacteriostatic antimicrobials are preferred for treatment of septic patients.

Answer 12

False, bactericidal antimicrobials are preferred for treatment of septic patients

Question 13

IV administration of what types of antimicrobials are commonly preferred for treatment of septic patients?

Answer 13

Bactericidal antimicrobial combinations that are effective against gram-positive and gram-negative aerobes and anaerobes

Question 14

Common bactericidal drug combinations used for treatment of septic patients includes -?

Answer 14

Ampicillin (22mg/kg q8hrs) with Enrofloxacin (10-20 mg/kg q24hrs in dogs; 5mg/kg q24hrs in cats) OR Amikacin (15mg/kg q24hrs in dogs, 10mg/kg q24hrs in cats)

Cefazolin (22mg/kg q8hrs) with Amikacin (15mg/kg q24hrs in dogs, 10mg/kg q24hrs in cats)

Question 15

Patients that are septic are also very often ______________. Requiring IV administration of ________ ___________ ______ for correction of coagulopathies and factor deficiencies.

Answer 15

Hypoalbuminemic; Fresh frozen plasma

Question 16

Why might vasopressors be required in patients in septic shock?

Answer 16

They are hypotensive, despite fluid resuscitation

Question 17

What effect could vasopressors have in patients in septic shock?

Answer 17

Renal and GI ischemia, particularly an increased loss of gut barrier function and bacterial translocation to the bloodstream