SIRS, Sepsis, MODs, DIC and Fluid therapy Flashcards
What is SIRS and what can it result in?
Self-amplifying dysregulated systemic inflammatory response
Triggered by bacterial toxins, lipopolysaccharide from cell walls of Gram -ve bacteria, Staphylococcus aureus, burns, neoplasia and pancreatitis (non-equine)
Causes cell death and apoptosis due to inflammation
Can result in coagulopathies
What is the difference between Sepsis and SIRS?
Sepsis is SIRS with a culture proven infection
True or False?
Severe Sepsis is Sepsis (SIRS and culture proven infection) plus systemic hypoperfusion
False
Severe Sepsis is Sepsis (SIRS and culture proven infection) plus organ hypoperfusion or dysfunction
Describe the term ‘Septic Shock’
Severe Sepsis plus systemic hypotension
Common in foals and rare in adults; also occurs in small animals
Severe Sepsis:
- SIRS
- Culture proven infection
- Organ hypoperfusion or dysfunction
What are the 2 categories of Multi-Organ Dysfunction Syndrome?
Primary:
- Well-defined insult
- Organ dysfunction occurs early as a direct consequence of the insult
- E.g. burns and neoplasia
Secondary:
- Organ failure not in direct result to the insult
- Consequence of host response (SIRS)
What are the 2 categories of Multi-Organ Dysfunction Syndrome?
Primary:
- Well-defined insult
- Organ dysfunction occurs early as a direct consequence of the insult
- E.g. burns and neoplasia
Secondary:
- Organ failure not in direct result to the insult
- Consequence of host response (SIRS)
Define the term ‘Multi-Organ Dysfunction Syndrome’ (MODS)
Altered organ function in an acutely ill animal
Haemostasis can’t be maintained without intervention
What is the name of the condition which causes a consumptive coagulopathy involving microvascular clotting, haemorrhagic diathesis and consumption of procoagulants?
Disseminated Intravascular Coagulation
What is haemorrhagic diathesis?
Abnormal tendency to have spontaneous, often severe bleeding
What conditions is DIC associated with?
SIRS
Sepsis
Septic Shock
Multiple Organ Dysfunction (MODS) - systemic neoplasia, enteritis and colitis
What are the clinical signs seen in large animals with DIC?
Thrombosis more common than spontaneous haemorrhage in large animals
Petechial haemorrhage
Bleeding following trauma (venipuncture, surgery, NG intubation)
How is Disseminated Intravascular Coagulation diagnosed?
3 out of the following must be present:
- Thrombocytopaenia (lack of platelets)
- Prolonged Prothrombin Time
- Prolonged Activated Partial Thromboplastin Time
- Increased antithrombin 3
Also low fibrinogen - not used very often as reference range <4g/L
Give 4 conditions which are common complications of GI disease in horses
SIRS or sepsis
Hypovolaemia (acute pre-renal disease)
Dysregulation of perfusion
Hypoproteinaemia
Ileus
Nutritional challenges
Gut flora changes
Thrombophlebitis
Coagulation abnormalities
Pain
Which of the following isn’t an unusual complication of GI disease in horses?
1. Electrolyte abnormalities
2. Anaemia
3. Coagulation abnormalities
4. Laminitis
Coagulation abnormalities - common GI disease complication
Unusual GI disease complications also include ventricular dysrhythmias, e.g. due to large colon volvulus or GDV
What is the most important prognostic indicator when treating the critically ill patient?
Time until treatment - abnormalities treated within 24 hours are more likely to survive
True or False?
Hypoproteinaemia, electrolyte disturbances and appropriate antimicrobial use are all prognostic indicators when treating the critically ill horse
True
Also correction of sepsis/SIRS and correction of decreased cardiac output/hypotension
How can you assess volume status in horses during your clinical exam?
Heart rate
Capillary refill time
Jugular filling time
Temperature of extremities
Demeanour
What clinical pathology tests can be used to assess volume status in horses?
Lactate
PCV/TP
Creatinine
You have diagnosed a critically ill 8 year old cob gelding with hypovolaemia. How will you treat him? Include all steps.
Calculate percentage fluid deficit (hypovolaemia isn’t dehydration)
Calculate maintenance fluid rates (2-3ml/kg/hr)
Replace 50% of fluid deficit as a bolus in the first 2-4 hours
Replace remaining 50% and maintenance requirements over the next 6-8 hours
Include estimate of fluid loss in vomit/reflux, diarrhoea, etc.
A horse presents with a skin tent lasting 3 seconds, tacky mucous membranes, CRT 2 seconds, heart rate of 44bpm, and a decreased arterial pulse quality. Blood lactate is 5mmol/L. What is the fluid deficit of this horse?
About 8%
Skin tent 3-5 seconds
Tacky mucous membranes
CRT 2-3 seconds
HR normal to 60bpm
Lactate 3-6mmol/L
Decreased arterial pulse quality
What clinical signs would you see in a horse with a 5% fluid deficit?
Skin tent lasting 1-3 seconds
Moist to slightly tacky mucous membranes
CRT <2
HR 28-44bpm
Lactate <3mmol/L
Decreased urine output
A horse presents with a skin tent lasting 7 seconds, dry mucous membranes, HR 65bpm, decreased jugular fill, poor pulse quality and sunken eyes. Blood lactate is 7mmol/L. What level of fluid deficit does this horse have?
10-12%
True or False?
Dehydration is rare in horses
True - start with hypovolaemia and true dehydration is quite rare
You have a horse with ileus. Will you give him oral or IV fluids?
IV fluids, though more expensive
Oral fluids are cheaper, but generally won’t be absorbed and will cause discomfort and pain
Oral fluids often ok if fluid deficit is <5%
Which type of IV fluids should you give to a horse with hypovolaemia?
Hartmann’s or Lactated Ringers
Except in horses in intrinsic renal failure, as the kidneys may not be able to deal with the electrolytes
Kidney will be able to sort out the acid-based and electrolyte issues as long as it is adequately perfused
Which 2 minerals are likely to be lacking in horses which have had food withheld whilst being given resuscitation fluids?
Potassium and magnesium
Both obtained from the diet, so giving food again normally fixes it
