L24: Sepsis, Failure Of Passive Transfer, And Fluid Therapy In Calves (Reuss) Flashcards
(45 cards)
1
Q
Infection in sepsis can be:
A
- bacteremia, viremia, fungemia, etc.
- endotoxemia: circulating LPS
- generalized or focal
- identified or suspected
2
Q
Portals of entry for sepsis
A
- in utero
- ingestion (via non-selective pinocytosis, translocation of enteritis; most common)
- inhalation
- umbilical (uncommon)
3
Q
Risk factors for developing sepsis
A
- failure of passive transfer
- lack of normal adult intestinal flora
- environmental
4
Q
Etiology of sepsis
A
- E. Coli (>50%)
- Salmonella
- Campylobacter
- Klebsiella
- Listeria
- Staph/Strep
- Lepto
- Actinobacillus
5
Q
Steps of sepsis
A
- Infection (invasion of normally sterile host tissue)
- Systemic inflammatory response
- Septic shock
- Multiple organ dysfx syndrome
6
Q
CS of generalized sepsis
A
- altered mental status
- weakness
- lack of suckle
- abnormal TPR (fever or hypothermia)
- Diarrhea
- Acute death
- scleral injection
- petechiation, ecchy, hyperemia
- cold extremities, slow CRT, weak pulses
7
Q
Local infections assoc. with sepsis
A
(Often sequelae to generalized infection)
-usually in older calves
Septic arthritis
Meningitis
Hypopyon
Pneumonia
8
Q
Umbilical disorders
A
- urachus most commonly affected structure
- can cause systemic sepsis, or walled off internal abscesses in older calves
- abscesses can lead to fever, poor condition, dysuria, stranguria, colic +/- septic peritonitis if they rupture
9
Q
Dx of sepsis
A
Blood culture Hematology: -leukopenia due to neutropenia -toxic neutrophils, degenerative L shift -leukocytosis with persistent infection -decreased (?) fibrinogen
Chemistry (hypoglycemia +/- hypoproteinemia)
Blood Gas
Misc: Thoracic rads, US, arthrocentesis, CSF aspirate
10
Q
Explain chemistry changes in septic calf
A
Hypoglycemia (esp. In younger calves) since bacteria consuming glucose. Hypoproteinemia if failure of passive transfer.
11
Q
Blood gas changes in septic calf
A
- Metabolic acidosis due to L and/or D lactate
- Hypoxemia
- Hypoventilation
12
Q
Metabolic acidosis: young vs. old calves
A
- L lactate comes from calves and more common in younger calves, and D lactate comes from bacteria and more prevalent in older calves with greater bacterial flora in GIT.
- older calves will usually have worse acidemia and may need to be treated with bicarb, whereas younger calves can be treated with crystalloid fluids
13
Q
Tx of sepsis
A
Abx:
- Ceftiofur = drug of choice (off label) because reaches MIC for E. Coli
- Ampicillin
- Florfenicol
- anti-inflammatory (flunixin)
- address failure of passive transfer
- fluid support
- nutritional support
- supportive care
14
Q
Duration of abx tx for sepsis
A
7-10 days if sepsis suspected but undocumented
2 wks if + blood culture but not localized
3-4 wks if localized infection
Or until have normal WBC, fibrinogen, rads
15
Q
Supportive care of septic calf
A
- warmth, good bedding
- oxygen, ventilation
- address decubital sores, urine scald, fecal scald
- postural changes, physical therapy
- ocular monitoring/tx
16
Q
passive transfer
A
- epitheliochorial placentation doesn’t transfer Abs, WBCs
- calves are immunocompetent at birth and have protective Ab lvls at 30 days with maximal lvls at 2-3 mos.
- passive immunity impacts long-term production
17
Q
Properties of colostrum
A
- secreted last 4-6 wks of pregnancy
- IgG > IgM, IgA
- offers local protection
- contains fat, protein, vitamins, minerals, lactoferrin, growth factors, mis. Immune factors
18
Q
Absorption of colostrum
A
Nonselective pinocytosis by intestinal ep. –> lymphatics –> blood
- closure stimulated by ingestion of any material
- capacity 50% at 6 hrs, 33% at 8 hrs, 0 at 24 hrs
19
Q
Delivery of colostrum
A
- 3-4 L of good quality should be delivered
- concentration should be >1.050
- delivered via natural sucking (60% have FPT!), bottle feeding (19% FPT), or esophageal feeder in one large volume (most successful with only 10% FPT)
20
Q
Factors that effect transfer of IgG
A
- timing of colostral feeding
- colostral IgG
- dam parity
- volume fed
- method of administration
21
Q
When to test for passive transfer
A
At 12-24 hrs, at least one in 1st few days
- detectable within 2 hrs of ingestion, and peaks at 32 hrs
- FPT does NOT guarantee disease, but DOES predispose to sepsis
22
Q
Tests for FPT
A
1) Radial immunodiffusion (gold standard)
2) ELISA
3) Sodium Sulfite Turbidity Test
4) Zinc Sulfate Turbidity Test
5) Serum TP
6) Serum GGT
7) Glutaraldehyde coagulation test
23
Q
Radial immunodiffusion test for FPT
A
Gold standard
- requires 24 hrs to perform
- IgG >1000 = success
24
Q
Sodium Sulfite Turbidity Test for FPT
A
- rapid, cost-effective, stall side
- use 14/16/18% solutions and look for precipitation
- precipitation at lower % solutions indicates higher Ab
-has fewer false positives that zinc sulfate turbidity test
25
Serum total protein test for FPT
>5.2 g/dl = adequate transfer if healthy
>5.5 = adequate transfer if ill
*falsely increased by dehydration
26
Serum GGT test for FPT
GGT should be >200 U/L at 24 hrs
27
Glutaraldehyde coag. test for FPT
10% reagent coagulates with serum IgG >600
*Poor Sp/Se
28
ELISA test for FPT
- stall side, blood or plasma
| - should be >10 mg/ml IgG
29
Treatment of FPT
In first 12 hrs, give colostrum or colostrum replacer:
-2L replacer at 2 hrs + dose of supplement at 2-12 hrs --> successful PT
After 12 hrs, give plasma or whole blood transfusion
- don't transfuse from dam (won't have good Ab)
- not imperative to crossmatch
-Fluids, Nutritional support
30
Colostrum supplement properties
- comes from bovine colostrum, milk products, or serum
- 40-60 g IgG/dose
- can't raise IgG above 1000 mg/dl
- utilized when only low medium quality colostrum available
31
Colostrum REPLACER properties
- made from bovine serum or colostrum based products
- contain at least 100g IgG per liter + fat, protein, vitamins, minerals
- better than poor quality colostrum
- less risk of Johnes transmission
*high quality maternal colostrum still gold standard!
32
Goals of fluid therapy for FPT
Correct:
- hypovolemia
- hypoglycemia
- metabolic acidosis
- electrolyte abnormalities
33
1-5% dehydration CS
Eyes not or slightly sunken
Skin tent 1-4 s
Membranes moist
34
6-8% dehydration CS
Eyes slightly sunken
Skin tent 5-10s
Membranes tacky but calf still suckling
35
9-10% dehydration CS
Eyes sunken
Skin tent 11-15s
Membranes tacky to dry
Calf depressed
36
11-12% dehydration CS
Eyes very sunken
Skin tent 16-45s
Membranes dry
Calf can't stand and is severely depressed
37
Fluid calculation
Replacement + Maintenance + Ongoing losses
```
Replacement = % dehydration x BW
Maintenance = 75-100 mls/kg/day
```
38
IV fluids indications
```
More than 8% BW decrease
Severe CNS depression
Inability to stand
Not suckling >24h
Body temp
```
39
Fluid choices for septic calf
- Balanced crystalloids best (LRS, Normosol, Plasmalyte)
- Physiologic saline will acidify them
- Colloids: plasma, whole blood, hetastarch
- Hypertonic saline not good for neonates b/c will throw off Na
40
Fluid supplementations
1) Dextrose: 2.5-5% for hypoglycemia
2) Bicarb for D-lactic acidosis in older calves >8 days**
- should monitor pH, HCO3, TCO2
41
Calculation for how much bicarb to give
BW x 0.5 x (24 - measured HCO3)
42
Indications for oral fluids (vs. IV)
- ambulatory
- functional GIT
*is cost effective and can be done on the farm. Can give following IV fluids/bicarb, and in place of milk for short durations
43
Types of oral electrolyte solution
- depend on degree of acidosis and electrolyte abnormalities what type you give
- most contain Na, Cl, K, glucose, glycine
- if osmolarity is too low, won't have enough glucose for energy
- if osmolarity to high, will slow abomasal emptying rate
- avoid >145 mmol Na/L (has no alkalinizing agent)
44
Oral alkalinizing agents
1) Bicarb (curdles milk)
2) Acetate (best)
- doesn't interfere w/ milk clotting, produces energy when metabolized, facilitates Na and water absorption in SI, and doesn't alkalinize the abomasum
3) Proprionate
- also doesn't interfere w/ milk clotting
45
Nutritional support for septic calf
- if unwilling to suckle, start tubing with 10-15% BW/24 hrs over 3-5 feedings
- if bloated, provide parenteral nutrition
- use cows milk/replacers
