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It is essential that initial treatment of systemic hypotension always be aimed at correction of the underlying physiologic problem: decreased preload, cardiac dysfunction, or peripheral vasodilation. Differentiation of cardiac and noncardiac causes of systemic hypotension is a critical first step. If the animal is hypovolemic, intravenous fluids and/or blood products should be administered until euvolemia has been attained. If hypovolemia is severe enough to cause hypotension, a shock bolus should be given, up to 60 to 90 mL/kg for dogs and 45 to 60 mL/kg for cats (given incrementally as you know!).
If the animal remains hypotensive once euvolaemia has been achieved, the use of pressors should be considered. Commonly used pressors for treating vasodilation include dopamine (5-15 mcg/kg/min), epinephrine (0.05-1 mcg/kg/min), norepinephrine (0.1-1 mcg/kg/min), or phenylephrine (0.5-5 mcg/kg/min), administered for their alpha-agonist effects, as constant-rate IV infusions. Only phenylephrine is a pure alpha-agonist; the others have varying degrees of beta effects in addition to their alpha effects. Vasopressin (0.5-5 mU/kg/min) also can be used in cases with vasodilatory shock and may be especially useful in cases of sepsis/SIRS as the vessels can become refractory to catecholamines. These drugs need to be titrated to effect, requiring frequent blood pressure monitoring. They should never be used in place of adequate volume expansion, because most patients with hypovolemic shock already have compensatory vasoconstriction.
My first choice drug wise would probably be norepinephrine.
Hope that helps.
Scott x
It is essential that initial treatment of systemic hypotension always be aimed at correction of the underlying physiologic problem: decreased preload, cardiac dysfunction, or peripheral vasodilation. Differentiation of cardiac and noncardiac causes of systemic hypotension is a critical first step. If the animal is hypovolemic, intravenous fluids and/or blood products should be administered until euvolemia has been attained. If hypovolemia is severe enough to cause hypotension, a shock bolus should be given, up to 60 to 90 mL/kg for dogs and 45 to 60 mL/kg for cats (given incrementally as you know!).
If the animal remains hypotensive once euvolaemia has been achieved, the use of pressors should be considered. Commonly used pressors for treating vasodilation include dopamine (5-15 mcg/kg/min), epinephrine (0.05-1 mcg/kg/min), norepinephrine (0.1-1 mcg/kg/min), or phenylephrine (0.5-5 mcg/kg/min), administered for their alpha-agonist effects, as constant-rate IV infusions. Only phenylephrine is a pure alpha-agonist; the others have varying degrees of beta effects in addition to their alpha effects. Vasopressin (0.5-5 mU/kg/min) also can be used in cases with vasodilatory shock and may be especially useful in cases of sepsis/SIRS as the vessels can become refractory to catecholamines. These drugs need to be titrated to effect, requiring frequent blood pressure monitoring. They should never be used in place of adequate volume expansion, because most patients with hypovolemic shock already have compensatory vasoconstriction.
My first choice drug wise would probably be norepinephrine.
Hope that helps.
Scott x
This is an excellent point.
I think that is such a good discussion point… there might be more than one factor contributing to the acidaemia!
Scott 🙂
Thanks so much for this Simon!
This is brilliant… you are spot on! Thanks so much for the contribution. Really valuable!
Scott 🙂
Thank you so much for this excellent question Gail!
Scott 🙂
Sounds very sensible to me!
Did you use the cheat sheet Annette? Scott 🙂
Hey.
I think we would consider the average lifespan of the cells to be around 4 days. So not long, but will be lifesaving in the moment!
Scott x
Good point!
They are an amazing resource! We did actually order blood from them. We got this next day delivery but the cat had an acute deterioration. I think this is a great example of how immediately life saving the xenotransfusion can be!
I love getting the delivery of cat blood from Portugal! The little bags of blood are so cute!
Scott 🙂
Good point!
They are an amazing resource! We did actually order blood from them. We got this next day delivery but the cat had an acute deterioration. I think this is a great example of how immediately life saving the xenotransfusion can be!
I love getting the delivery of cat blood from Portugal! The little bags of blood are so cute!
Scott 🙂
It is definitely not as high risk as we maybe thought.
There is no specific recommendation for any measures above and beyond what we would do for a ‘normal’ transfusion. Careful monitoring and slow rate to begin with.
Scott 🙂
How long after the xenotransfusion did you give the feline transfusion?
Scott 🙂
Thank you for the question.
I have no direct experience using it but have had a look at the information available. Cartrophen Vet is not approved for use in cats but vets are using it off-label (cascade system) in cats for the treatment of arthritis following owner consent. There seems to be very limited research overall:
https://www.ncbi.nlm.nih.gov/pubmed/2481039
https://www.ncbi.nlm.nih.gov/pubmed/12779171I could only find the two publications above looking directly at the veterinary literature. The following paper is the only one listed on the Cartrophen website:
What is your experience?
Scott 🙂
This is so interesting.
I have looked at this again and spoken to neurology and surgical collegues. I do not think there is good literature to support a bladder size guide in dogs. We will assess patients on a very individual basis. I also think it is interesting to consider the method of supporting urination. Indwelling atheter vs expression vs intermittent catheterisation. I have popped an interesting papaer below.
I also saw a paraplegic dog this week with a sacral implant so that the owner could control exactly when the dog voided urine! How cool. I have posted a paper below.
https://www.ncbi.nlm.nih.gov/pubmed/19121176
https://www.ncbi.nlm.nih.gov/pubmed/23194073Thank you again for starting this great discussion!
Scott 🙂
My heart was in my mouth! It reminded me of the contrast studies we were trying to achieve when we were doing the intrahepatic shunt. You do it better when you are not even trying! x
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