The condition known as sepsis, along with septic shock, is a major cause of death in people and in animals and a medical emergency when it occurs. Initially caused by an existing infection that progresses to a widespread dysregulated inflammation, sepsis can originate from any infection from the gastrointestinal, respiratory, reproductive or urinary tract, for example. On this show, Dr. Ronald Gonçalves, a clinical assistant professor of emergency medicine and clinical care, will describe how veterinarians manage this critical condition when it occurs in their patients, and why prompt diagnosis and treatment can be the difference between life and death.
Transcript:
DANA HILL: From WUFT-FM, this is Animal Airwaves Live, our weekly hour long show devoted to the discussion of the health and welfare of animals.
DANA HILL: I’m Dana Hill and I am really happy that you could tune in here on this Friday afternoon when I welcome to the program today, Dr. Ronald Goncalves.
DANA HILL: And we’re going to be talking about a topic that I want you all to be concerned about it because it can potentially be very, very dangerous.
DANA HILL: But I don’t want to unduly frighten anybody, but the topic today is sepsis and we’re gonna talk about how you can recognize it and whether it’s an emergency and what you ought to do.
DANA HILL: So let me welcome you to the program, Dr. Gonçalves.
DANA HILL: I’m really glad to have you on the show today.
RON GONÇALVES: Thank you so much, Dana.
RON GONÇALVES: It’s my pleasure.
RON GONÇALVES: Thanks for the invitation.
DANA HILL: I’d ask you kind of right off the bat to talk about what is the definition of sepsis?
RON GONÇALVES: Yeah, absolutely.
RON GONÇALVES: The good way to start.
RON GONÇALVES: So essentially, sepsis is defined when we have a patient that has an infection and this patient in particular cannot deal with this infection properly, which means the infection itself, it’s not going to the resolution area.
RON GONÇALVES: Excuse me.
RON GONÇALVES: And the patient then you progress for significant body changes, significant organs dysfunction induced by that infection in particular, which means if we do not address these and help the patient to deal with that infection, then you go to the area of an emergency or life threatening situation.
DANA HILL: Now, I think about sepsis and some of the outward kind of visible signs, but here again I’m thinking about the human body where for the most part one can see the skin quite easily.
DANA HILL: And I wonder if some of the symptoms that I’m thinking of with sepsis are harder to spot with are pets because they’re generally furry creatures.
RON GONÇALVES: Yeah, you’re absolutely right.
RON GONÇALVES: So when you talk about infection, this is a broad way to say because as we know, our pets may have different, different sites and types of infection.
RON GONÇALVES: Some of them would be easy to identify, such as something on the skin, as you said, or they may have other sites of infection that would be very difficult to identify initially.
RON GONÇALVES: And I’m talking here even about dogs or cats.
RON GONÇALVES: So we may find some like general clinical findings or abnormal findings, such as the patient may be lethargic, maybe not eating properly, not being interacting as much, or more specific signs, or at least specific in a way that something is wrong, not necessary for sepsis.
RON GONÇALVES: But patients, for example, having vomiting or diarrhea and they’re panting more than usual, even when under like resting.
RON GONÇALVES: So these signs may indicate you.
RON GONÇALVES: But one of the challenges.
RON GONÇALVES: Exactly.
RON GONÇALVES: That signs can be pretty random.
RON GONÇALVES: And this is what also you’re going to talk about today for sure to help them to identify better if the patient may have an infection or not.
DANA HILL: Yeah, absolutely.
DANA HILL: So we’ll definitely talk more about the signs and signs, symptoms.
DANA HILL: But I wonder if we’re talking about infections.
DANA HILL: There can be many different kinds of infections that human beings and animals can experience.
DANA HILL: And these could be, I don’t know, they could be viral or fungal and so forth.
DANA HILL: What kinds of infections lead to sepsis?
DANA HILL: Can it be really?
DANA HILL: Any kind.
RON GONÇALVES: Any kind.
RON GONÇALVES: So any sort of microorganism, such as, as you mentioned, the fungal, bacterial, even parasites.
RON GONÇALVES: But we know that bacteria are the most common microorganisms that may induce sepsis.
RON GONÇALVES: So when you compare all those types or different kinds of microorganisms, sepsis is definitely the leading one that will favor or induce this possible like significant organ changes and significant dysfunctions that may favor like the life threatening situation on these patients.
RON GONÇALVES: So in other words, when you talk about like pneumonia caused by a bacterial infection or for example, reproductive infections such as an infection in the uterus in old animals, female intact animals or UTI, so urinary tract infections.
RON GONÇALVES: So all those very common bacterial infections may favor this condition.
RON GONÇALVES: I enjoyed the question.
RON GONÇALVES: Also to mention that in dogs and cats, the two most common sites to induce or to have a bacterial infection bar is the gastrointestinal site.
RON GONÇALVES: And this is because, as we know, some pets, they may eat something, some object, some foreign material.
RON GONÇALVES: And then unfortunately, this foreign material may cause significant gastrointestinal changes, including perforations.
RON GONÇALVES: And then once you have a perforation from the GI tract from the gastrointestinal tract, then you may have the sepsis happening because of the bacteria that’s present inside of the gastrointestinal tract going to the abdominal cavity.
RON GONÇALVES: Secondly, the respiratory tract.
RON GONÇALVES: Pneumonia is definitely another very common leading cause of patients inducing having sepsis.
RON GONÇALVES: So these two areas or sites are definitely the most commonly involved.
DANA HILL: Okay.
DANA HILL: And I definitely want us to expand on those two areas as we progress in the program, but I wonder if we could right here, sort of early in the show talk about the body’s natural response to something like a bacterial infection and how the body deals with these infections and eliminates these infections and how that contrasts with a scenario in which sepsis occurs.
RON GONÇALVES: Yeah.
RON GONÇALVES: So and this comes with understanding that when I said have said that it’s a body not responding well to that infection is exactly the Point that you mentioned, which is the immune system.
RON GONÇALVES: So our body, our pet’s body have their own immune system responsible to trying to recognize, isolate and then finish or trying to like cue for example, the bacteria that you talk about it, whatever this bacteria is causing infection.
RON GONÇALVES: So all these process of the immune system deal with that, it’s by causing an inflammation and at the same time some anti inflammation process.
RON GONÇALVES: And these processes over time tends to solve by its own trying to avoid that infection.
RON GONÇALVES: Even the inflammatory process proceed to progress or to spread to the body.
RON GONÇALVES: Unfortunately, some patients may not be able to again isolate, recognize properly isolate and finish that course of infection.
RON GONÇALVES: And then comes the sepsis situation, when unfortunately that inflammatory process will spread and not get isolated together with the detrimental effects of the inflammation plus the infection.
RON GONÇALVES: And then the life threatening situation comes.
DANA HILL: Yeah.
DANA HILL: Okay, so are there commonly other problems that these animals are experiencing that makes it harder for them to fight off these infections?
RON GONÇALVES: Yes, we call those independent factors.
RON GONÇALVES: So which means some patients may develop sepsis.
RON GONÇALVES: Right.
RON GONÇALVES: So what are those independent factors that favors our pets to develop sepsis?
RON GONÇALVES: So we have age, so which means older dogs or cats, or younger dogs and cats, they are more predisposed.
RON GONÇALVES: And this is because for the young ones, they may not have a mature immune system yet to try to fight against that infection.
RON GONÇALVES: Or you have the old ones, which the immune system is not so effective anymore, as when they were middle aged, for example, together with these old animals, or middle aged animals, if they have any comorbidities, any other disease.
RON GONÇALVES: Of course this is also may affect the immune system that will not be so effective.
RON GONÇALVES: Again, that infectious process, if this patient is also taking any medication that affects the immune system, and more specifically I’m talking about immunosuppressive medications, then as the name explains, as a drug causing immunosuppression means that will at some level decrease the effectiveness of the immune system against that infection.
RON GONÇALVES: Another point is if the patient has either disease causing or for example, we talk about a stray animal that has malnutrition, is not well nourished.
RON GONÇALVES: So then you have another condition that favor these patients to develop sepsis.
RON GONÇALVES: And this is because the immune system has a high, it’s a system that has a high demand for substrate for an animal to be well nourished.
RON GONÇALVES: So if it’s not, then this patient also may develop sepsis.
RON GONÇALVES: And lastly, this is all also depend of the site and the extension of the infection.
RON GONÇALVES: In another word, if you have a patient with minor infection, as far as distinction and location, these patients most likely do not develop sepsis.
RON GONÇALVES: But if that infection is very extensive or quite mostly spread, then of course there is a very high chance that that patient, if it’s already not in sepsis, will develop sepsis.
DANA HILL: Yeah.
DANA HILL: Okay, so you mentioned earlier that sepsis is commonly found in the GI tract, maybe even in sort of the respiratory system, and is associated with something like pneumonia or whatever.
DANA HILL: And we can talk more about these in detail in a minute.
DANA HILL: But maybe what are some other areas that sepsis might occur?
DANA HILL: I’m wondering whether or not, if you mentioned bacteria, if sepsis can be associated with, say, physical injury.
RON GONÇALVES: Yeah.
RON GONÇALVES: So essentially any organ or any tract in the body can have an infection.
RON GONÇALVES: Right.
RON GONÇALVES: So the gastrointestinal tract and the respiratory tract are the most commonly diagnosed in our routine.
RON GONÇALVES: But for example, UTIs causing sepsis, it’s absolutely possible and not that unusual.
RON GONÇALVES: We may have even an infection affecting bones or the brain or the heart.
RON GONÇALVES: So those are also possible and we have in our routine, but are not as common as the perforation of the gastrointestinal tract or a more severe pneumonia, as I was mentioning.
RON GONÇALVES: And then the clinical signs may vary exactly based on where is the site of the infection.
RON GONÇALVES: Because then of course, you have some different clinical signs diagnosed based on, for example, if a patient has a pneumonia or if a patient has a urinary tract infection.
RON GONÇALVES: And then based on the veterinarian expertise and understanding then, and the other clinical signs, plus some other diagnostics needed, then the suspicions will be very high for sepsis or even diagnosed for an appropriate treatment.
DANA HILL: So, and let’s say, for instance, hypothetically, that you’ve got a dog that has been chewing on or eating something, or maybe a dog that, oh my gosh, imagine a dog that’s got an injury in its mouth from that, or maybe a dog that already didn’t have very good oral care, you know, maybe it has an injured tooth or something like that.
DANA HILL: Could sepsis occur from an infection in the mouth or another site of a physical trauma?
RON GONÇALVES: Well, it’s absolutely possible, but not the most common.
RON GONÇALVES: Again, any source of infection from the mouth, skin, Some patients may develop sepsis from there, but then it’s dependent on the different factors together, as we were discussing, such as age, how extensive and deep that infection is if the patient has any comorbidities.
RON GONÇALVES: So if you give an example of middle aged dog that some stick and essentially has some minor trauma in the mouth despite it’s an area that has its own bacteria.
RON GONÇALVES: Right.
RON GONÇALVES: So this patient not necessarily develops sepsis based on that or at least has a lower chances to develop sepsis in comparison with a same for example, old dog, which has some underlying other disease.
RON GONÇALVES: We may, for example, think about diabetes or maybe cancer.
RON GONÇALVES: And this patient also has an abscess formation in the mouth or some specific trauma there.
RON GONÇALVES: This patient definitely has a higher chance to develop sepsis because cannot deal properly with that local infection.
RON GONÇALVES: Doesn’t mean that the first one cannot, but it’s less likely and also doesn’t mean that the first one should not be addressed by the veterinarian since we cannot 100% predict that that patient will not develop sepsis.
RON GONÇALVES: So you need to be addressed anyway as soon as possible to make sure that everything will heal and be treated properly.
DANA HILL: Yeah.
DANA HILL: Okay.
DANA HILL: Well, that makes a lot of sense.
DANA HILL: So this is perhaps a good place to take our first break in the program.
DANA HILL: And here I want to remind listeners that this is Animal Airwaves Live on WUFT-FM.
DANA HILL: I’m Dana Hill.
DANA HILL: My guest today from the University of Florida College of Veterinary medicine is Dr. Ronald Gonçalves.
DANA HILL: We’re talking about sepsis today in our pets.
DANA HILL: And we’ll be back with more right after this.
DANA HILL: Stay tuned.
DANA HILL: Welcome back to Animal Airwaves Live here on WUFT-FM, our weekly hour long show devoted to the discussion of the health and welfare of animals.
DANA HILL: I’m Dana Hill.
DANA HILL: My guest Today from the UF College of Veterinary Medicine is Dr. Ronald Gonçalves.
DANA HILL: And we’re talking today about sepsis and how that can affect our pets.
DANA HILL: And not in a great way, I gotta tell you.
DANA HILL: So Dr. Gonçalves, we mentioned sort of earlier in the program what some of the symptoms are of sepsis.
DANA HILL: And the sepsis of course, being sort of an infection that just the body is not able to overcome and can cause changes to the body and can cause problems with the organs.
DANA HILL: Well, you mentioned some of the symptoms, but let’s revisit those.
DANA HILL: Some of these symptoms might potentially be confused with other causes, it sounds like.
RON GONÇALVES: Yes, you’re absolutely right.
RON GONÇALVES: And I think this is a very important point to people think about it and know more about it because I just said that the gastrointestinal tract is the most common source of patients developing sepsis.
RON GONÇALVES: One, for example, they have the gastrointestinal perforation after ingesting some foreign object.
RON GONÇALVES: And then the patient may be, for example, having nausea, vomiting and not eating.
RON GONÇALVES: So these clinical signs of nausea, not eating and vomiting, they are very specific.
RON GONÇALVES: So many other conditions may cause that.
RON GONÇALVES: So on this understanding, I think the important information that people should remember is that unfortunately for many septic patients, the clinical signs would be pretty in specific and we cannot just based on those tell 100% of the patient unfortunately is having sepsis on this end.
RON GONÇALVES: The second and important information is remember that one at the moment that you see those clinical signs despite any specific, some of them caused by not life threatening condition, but possibly by a life threatening condition such as sepsis, then it’s very important to be proactive to go to a veterinarian, to your primary veterinarian or facility as soon as possible to make sure that we are not dealing with this condition that we’re discussing here.
RON GONÇALVES: And lastly, the clinical signs would be again related to the site of the infection.
RON GONÇALVES: So let me give you some examples.
RON GONÇALVES: For the GI tract, as you said, we will have gastrointestinal signs such as vomiting.
RON GONÇALVES: The patient will not be eating, which we call anorexia or eating less hyporexia and may have nausea if the patient has a urinary tract infection.
RON GONÇALVES: So the most common clinical sign will be the patient having a hard time to pee, which we call stranguria.
RON GONÇALVES: Sometimes the urine color can change to be more reddish urine.
RON GONÇALVES: And this patient also can be uncomfortable having some discomfort and showing some like abnormal behaviors.
RON GONÇALVES: Pneumonia as another common source of sepsis.
RON GONÇALVES: Once you have an infection in lungs, then these patients tends to have some respiratory clinical signs such as increased respiratory rate despite the patient not having any major exercise and efforts.
RON GONÇALVES: The patient more serious condition may not eat as well because doesn’t feel comfortable to eat when it’s having respiratory efforts.
RON GONÇALVES: Cough.
RON GONÇALVES: And if you go to other areas not that much common such as heart, the patient may have for example syncope episodes when they lost that conscience consciousness for some period of time or for example not as much common but possible if the brain it’s where we have the infection, then the patient may have significant behavioral changes or even having seizures caused by that infection.
RON GONÇALVES: So those are some examples.
RON GONÇALVES: But again, many other diseases can cause these clinical signs.
RON GONÇALVES: And this is why it’s important to be proactive to go to a veterinarian earlier to make sure that we are not dealing with an infection inducing sepsis.
DANA HILL: Right.
DANA HILL: I wonder though, does the veterinarian have any tools available that can definitively identify sepsis?
DANA HILL: Is there any kind of test that will say, oh well, this animal is experiencing sepsis or is it a number of different factors that go together to make a diagnosis?
RON GONÇALVES: Yeah, the second option mostly.
RON GONÇALVES: So this is another very important understanding why it’s important to come earlier to the veterinarian because unfortunately, most of times you don’t have necessarily one specific test to confirm that patient has sepsis.
RON GONÇALVES: And because of that, once we need not just our fiscal exam findings, but other some diagnostics results that we need to altogether confirm or even if we’re highly suspicious of sepsis happening when many times we cannot have the diagnosis right away because sepsis is a medical emergency.
RON GONÇALVES: So, after having those diagnostics perform according to the area that’s affected, we believe it’s affected or is the source of infection, plus our fiscal exam findings at the end, we are highly suspicious of infection.
RON GONÇALVES: We’re going to treat this patient accordingly.
RON GONÇALVES: So, this is why the veterinary assessment plus the diagnostics are so important as soon as possible.
DANA HILL: And when you are looking at an animal that you suspect of having sepsis and you see some of these signs and it may be several of them together, as you say, this is an emergency situation, are you immediately compelled to act?
DANA HILL: This is something that you probably don’t want to lose much time in dealing with.
RON GONÇALVES: Yeah.
RON GONÇALVES: So it’s well defined, at least in human medicine, that for when the patient is declared with sepsis and must be treated as long you like, delay the treatment of that patient, higher chances that that patient will not survive.
RON GONÇALVES: And we believe that this is not different for our pet animals.
RON GONÇALVES: So in another words, once we have the highly suspicious that the patient SAP score is even, we diagnose sepsis, then it’s our protocol to start the treatment immediately because we know that this will increase the chance that the patient will survive and be discharged from the hospital earlier.
DANA HILL: Well, let me ask you this, and I probably should have asked this earlier.
DANA HILL: In cases in which an animal is experiencing sepsis, how long from the initial onset of infection before the infection becomes septic, before it becomes a dangerous situation?
DANA HILL: I mean, because an animal might, you know, get exposed to some sort of bacteria or a virus or, you know, as we said, a fungus or maybe even a parasite, but I don’t imagine that it becomes dangerous and septic immediately.
RON GONÇALVES: Yeah, and I can enjoy your question, your great question with the previous one as far as if you have a specific way to diagnose sepsis with one exam.
RON GONÇALVES: Unfortunately, we don’t, because the answer for your last question is because we cannot say exactly how long take for a patient who once has infection, how long if this patient develops sepsis, how long this will be, because it’s absolutely individual.
RON GONÇALVES: So as you know, each animal or even person has their own, its own immune system more or less effective.
RON GONÇALVES: So again, if the infection is Pretty extended in a specific organ or if that patient has a specific comorbidity or other problems, issues, critical conditions that favor the sepsis development.
RON GONÇALVES: We know that most likely that patient will develop sepsis and this will be fast versus other patients that they are previously healthy, they don’t have any other conditions and they do not take any medication.
RON GONÇALVES: So that patient may even not develop sepsis.
RON GONÇALVES: So there is nonexistent specific timeline for that patients, once they have the infection and assuming that they will develop sepsis, how long that will be.
RON GONÇALVES: But what I can tell is that based on those factors that we discussed, tends to be faster than in comparison with patients, that they don’t have those factors unfortunately contributing to a patient to develop sepsis and in a faster pace.
DANA HILL: Yeah.
DANA HILL: And an animal that becomes septic, that has sepsis, how long can it have this condition before its life is genuinely in danger?
RON GONÇALVES: Well, I have to say that as a doctor that for example, if I have a septic patient that developed this sepsis very recently, I’m talking about few hours ago, this is making me feel much more comfortable to treat this patient as soon as possible and right now, because again, anytime that I’m late on the treatment of this patient, I know as a doctor that this will increase the chance that I’ll not be able to treat and save this patient.
RON GONÇALVES: So this is why it’s important.
RON GONÇALVES: Again, not just the honor part of like being proactive on treating, on bringing this patient to the veterinarian, but also the doctor being proactive and looking for if those in a specific clinical findings, physical exam findings will be related to sepsis or not to then start treating these patients as soon as possible.
DANA HILL: Now.
DANA HILL: And it does sound like you’ve got some animal friends nearby.
RON GONÇALVES: Yes, I’m sorry, veterinarian, of course I have it.
DANA HILL: Of course, of course.
DANA HILL: Now you’re looking for these symptoms and you’re trying to find them as early as you can because the mitigation strategies and the treatments available to you are much more likely to be effective if you can treat it early.
DANA HILL: Certainly.
DANA HILL: Is there, and this is maybe a complicated question, is there sort of a progression of symptoms that if you see some particular symptom, you know that it’s further along than maybe some of the other ones.
DANA HILL: Do some symptoms come first?
RON GONÇALVES: I would say there is no specific clinical signs necessary for sepsis because you the patient has a spread inflammatory process or inflammation, which many other diseases can also cause widespread inflammation.
RON GONÇALVES: And then the clinical signs would be the same or similar, but the patient unnecessarily septic.
RON GONÇALVES: So what I would say then is if you assume that the gastrointestinal tract is the most common source of infection, and this happens when they have again a Sporima 2 severely affecting the tract, even causing perforation.
RON GONÇALVES: So owners should be aware of a dog’s having persistent vomiting home.
RON GONÇALVES: So if the dog even despite initial therapy with like drugs that may reduce or treat the nausea or vomiting, but the patient’s still persistently vomiting, not to having bowel movements for example, or young puppies, like puppies having persistent vomiting and diarrhea and then not eating properly, then this is like a red flag that this patient should be seen as soon as possible.
RON GONÇALVES: For the respiratory tract, if a patient is despite, even despite initial therapy, if it’s the case, still having persistent respiratory signs, most commonly cough, respiratory stress or effort, increased respiratory rate, even under rest, like when the patient’s quiet and comfort seems comfortable, this is another red flag.
RON GONÇALVES: And in general, the septic patient, if not treat properly, these patients tend to have a persistent of clinical signs which over time will get worse and lethargy and the maintenance, maintenance for example would be definitely worse over time.
RON GONÇALVES: These are like red flags that the owner should be very proactive to bring earlier dispatch to the veterinarian for a new assessment to make sure that the treatment should be changed or a new approach or even new diagnostics to make sure we are not here dealing with aseptic patients.
DANA HILL: Well, I think this is a good place, Dr. Goncalves, to maybe take our next break.
DANA HILL: I want to remind listeners that this is Animal Airwaves Live here on WUFT-FM.
DANA HILL: I’m Dana Hill.
DANA HILL: My guest from the UF College of Veterinary Medicine is Dr. Ronald Goncalves.
DANA HILL: And we’re gonna be back with more on sepsis right after this.
RON GONÇALVES: Stay tuned.
DANA HILL: Welcome back to Animal Airwaves Live here on WUFT-FM, our weekly hour long show devoted to the discussion of the health and welfare of animals.
DANA HILL: I’m Dana Hill, my guest from the UF College of Veterinary Medicine is Dr. Ronald Gonsalves.
DANA HILL: And we’re talking about sepsis today.
DANA HILL: And we have already learned a lot about the symptoms of sepsis and we’ve learned a bit about how it can happen to our pets and how it is an emergency.
DANA HILL: But let’s talk now, Dr. Gonçalves, if we can, about some of the treatment strategies because this has got to be the most important part because as you say in emergency situation, our animals lives can really be in danger if they Experience sepsis, There’s got to be strategies for treating this.
DANA HILL: What are they?
RON GONÇALVES: Yeah, the most important treatment protocols are related to one, of course, trying to diagnose as early as possible.
RON GONÇALVES: Secondly, give antibiotics to this patient as soon as possible.
RON GONÇALVES: And on this particular matter, it’s when we have to try to be a little bit aggressive with antibiotics in a sense that if we know the source of infection, this helps us as doctors to decide what’s the best antibiotic for that patient.
RON GONÇALVES: But sometimes or many times in sepsis, we are initially not 100% sure what it’s the bacteria causing that infection.
RON GONÇALVES: We assuming that what’s the organ, we know what’s the organ affected.
RON GONÇALVES: But to know specifically what the bacteria causing it, we need time sending some samples to the lab and then later we have the results.
RON GONÇALVES: During this timeline, we also have to start treating it because we need to be very proactive starting treating the infection.
RON GONÇALVES: We cannot wait, right?
RON GONÇALVES: Since time is against us in this sense, once the patient’s already septic.
RON GONÇALVES: So because of that, we start antibiotic as soon as possible to help that patient to treat that infection or to finish that infection.
RON GONÇALVES: In addition to that, patients with sepsis, they tend to develop some organ dysfunction, as we defined sepsis at the beginning, that was related with some specific organ dysfunction induced by that infection and spread inflammation.
RON GONÇALVES: So what I’m saying here is that one of the most common organ affected when the patient has sepsis is a cardiovascular system.
RON GONÇALVES: And this is clinically showed through a patient which is very lethargic and with a low blood pressure.
RON GONÇALVES: So patients with sepsis, very commonly they develop hypotension when the blood pressure is low.
RON GONÇALVES: So then we also have to address that in the hospital, because if we don’t, of course, patient may die because of the low blood pressure.
RON GONÇALVES: And we do this by giving them fluid therapy into their veins.
RON GONÇALVES: So these are the two most common and necessary initial treatment to these patients.
RON GONÇALVES: IV fluids and start there these patients on antimicrobials.
RON GONÇALVES: From there, of course, some other drugs and care may be needed based on the patient’s clinical signs.
RON GONÇALVES: For example, if the patient is vomiting, then we give drugs to avoid more vomiting or nausea.
RON GONÇALVES: If the patient’s having respiratory signs because of pneumonia, we may start them on some auction therapy to make them more comfortable.
RON GONÇALVES: If the patient associated with the infection has significant pain on the source of the infection, which brings another example that I didn’t mention yet, which is very common in pet animals, which is like bite wounds.
RON GONÇALVES: So bite wounds may favor an abscess formation, which then based on the extinction may favor sepsis.
RON GONÇALVES: And this can be painful, this abscess.
RON GONÇALVES: Then we also give them pain medication.
RON GONÇALVES: So some other therapies may be needed based on where the source of the infection is and what the clinical signs the patient’s presenting to us.
RON GONÇALVES: And in addition to the necessary, again, antibiotics and most likely also fluid therapy, IV fluid therapy.
DANA HILL: Okay, so it does sound like that you have options.
DANA HILL: Now the option that you, that you choose may vary from patient to patient.
DANA HILL: I wonder if you have fewer or different options if you’re dealing with a patient that may have other comorbidities or maybe is older, that is compromised in some other ways.
RON GONÇALVES: Yeah, so this is a good information.
RON GONÇALVES: For example, an example, excuse me, for the IV fluid therapy.
RON GONÇALVES: So some patients, especially old patients, they may have some other comorbidities, such as cardiac comorbidity, which is very common in dogs and cats when they are old, that may affect their capacity to receive IV fluid therapy.
RON GONÇALVES: Because in the septic patient, the patient may be hypotensive, common finding.
RON GONÇALVES: And then you have to treat that accordingly, giving IV fluids as initial therapy.
RON GONÇALVES: But the heart from that patch in particular may not be able to receive that volume in such a like short period of time to treat a hypotension.
RON GONÇALVES: And then you have to be very diligent on that.
RON GONÇALVES: So yeah, based on other comorbidities, these also may change our initial treatment plan.
RON GONÇALVES: The antibiotic itself, it’s more related, not necessarily with comorbidities, but with another very important point to us, which is if that patient is receiving an antibiotic for any other reason or for that same infection, if the patient received antibiotic over the last three months at least, this is another important information to the veterinarian because will help us to decide among the different antibiotics that we have available, what to be the best and hopefully initially most effective antibiotic against that bacteria or that infection that we assume that we should treat initially.
RON GONÇALVES: And to have a more definitive information,.
DANA HILL: The options that are available at a large veterinary hospital like the one where you are, must be considerable.
DANA HILL: And here’s where.
DANA HILL: I certainly don’t want to disparage any neighborhood veterinarian anywhere in the country.
DANA HILL: But are the options more limited depending on where you may be geographically?
DANA HILL: Will everybody, will every veterinary clinic have the same sort of ability to treat sepsis?
RON GONÇALVES: Yeah.
RON GONÇALVES: So sepsis, it’s an intensive care needs an intensive care treatment.
RON GONÇALVES: So essentially these patients, you need to be an ICU under like a well-trained professional.
RON GONÇALVES: And also based on the source of the infection.
RON GONÇALVES: This patch may need like a multitask team.
RON GONÇALVES: For example, if you’re saying about a patient that has a gastrointestinal perforation because of a foreign material that the patient chewed and swallowed.
RON GONÇALVES: So then this patient will need surgery, which means part of the treatment of this patient is not just what I do working in intensive care unit, but I also, I need the initial treatment and stabilization with the surgery service together with what we discussed about the fluids and antibiotics.
RON GONÇALVES: But we need to, when possible, treat the stress of that infection.
RON GONÇALVES: If it’s the treatment for it, it’s surgical treat is a surgical treatment, then a surgery team will be involved, which also then will come with the anesthesia team to be involved to anesthetize this patient.
RON GONÇALVES: And from there the patient will go to the ICU to be treated by the intensive care team, which is where I work.
RON GONÇALVES: So it’s.
RON GONÇALVES: Yes, it’s a very intensive treatment which most of time may be associated with different specializations.
RON GONÇALVES: Get involved to treat this patient.
RON GONÇALVES: And for the same reason, we try explaining to the pet owners to be as much as proactive to like diagnose and bring the pets as soon as possible to help them.
DANA HILL: How mortal is sepsis?
DANA HILL: Do you see a lot of patients succumb to if they’ve, if they’ve had these infections that can’t get under control?
RON GONÇALVES: Yeah.
RON GONÇALVES: So in veterinary medicine, we don’t have as much as.
RON GONÇALVES: So, so much information as a human medicine they have, but we know that the mortality rate for sepsis can reach.
RON GONÇALVES: Can reach even 80%.
RON GONÇALVES: And this depends on how critical the patient is.
RON GONÇALVES: If we talk about sepsis per se, the mortality rate can range between like 20% to even 70%.
RON GONÇALVES: Sepsis may progress for what we call septic shock.
RON GONÇALVES: Septic shock, again, is a subset of sepsis when the patient has the hypotension that I mentioned and tends to be refractory to the initial treatment that we give them with IV fluids.
RON GONÇALVES: So what I’m giving here is example of that patch that unfortunately, the sepsis happening for hours to days and got you in a very critical situation on this particular case, then the mortality in general is like between 70 and 80%.
RON GONÇALVES: If we don’t do the treatment as soon as possible.
RON GONÇALVES: For the most cases that we receive in the hostel, we have as an average a mortality about 50% that we discussed with them.
RON GONÇALVES: But again, this is pretty case by case based on those many factors that we discussed.
DANA HILL: Yeah, yeah.
DANA HILL: So in the time left that we have on this program, maybe we can talk about animals that might have already had sepsis have recovered.
DANA HILL: And let’s be grateful for these instances in which the animals do recover.
DANA HILL: What are their long term sort of prognoses for you know, getting along afterwards?
DANA HILL: Do they, can they recover well and live happy healthy lives?
RON GONÇALVES: Absolutely, yes.
RON GONÇALVES: We have many cases that despite initial life threatening condition once you’re able to properly treat them and diagnose and offer them the intensive care they need, yes they absolutely can have a normal life after that.
RON GONÇALVES: It’s that you also that some patients based on the severity in what the organ was affected initially or also other organs that were affected caused by the spread inflammatory process.
RON GONÇALVES: So some patients may develop a chronic condition.
RON GONÇALVES: For example, patients with a severe infection on the urinary tract affecting kidneys for example.
RON GONÇALVES: Sometimes some of those patients despite they are discharged and then they have their life and then it can be moving on natural normally.
RON GONÇALVES: Sometimes they unfortunately develop some chronic conditions.
RON GONÇALVES: Some chronic kidney condition which then you need extra care such as specific diet or some rechecks with the veterinarian but not necessarily aseptic patient treating the hostel will develop chronic conditions.
RON GONÇALVES: It’s based on the factors such as age, what were the source of infection, how severe was.
RON GONÇALVES: So may happen, may not happen.
DANA HILL: Well, I think that perhaps the best advice that we can leave listeners with is that if you suspect that there’s any potential for your pet having an infection that is not being resolved by this animal’s own body, speak to a veterinarian right away because early, early diagnosis is key here to successful treatment.
DANA HILL: Is that the case, doctor?
RON GONÇALVES: Absolutely.
RON GONÇALVES: Some, some countries trying to reduce the mortality rate on both human side on small animal side.
RON GONÇALVES: They have been working very hard on exactly explaining the people about what sepsis is and how happens how we should be watching for these patients to like once they having these clinical signs or persistent clinical signs then to go to a veterinarian at least contact one veterinarian to discuss to see if something more intensive should be like performed or not.
RON GONÇALVES: So once the population is more aware of about it and then more diligent sending their patients to be evaluated definitely we have much higher chances to even avoid prevent the sepsis to occur or to treat earlier that will increase substantially the survival rate and then to send them home to enjoy the rest of their lives.
DANA HILL: Well, let’s all hope for the best.
DANA HILL: And Dr. Gonçalves, thank you so much for being my guest today.
DANA HILL: I really enjoyed talking to you and I think that I learned a lot.
RON GONÇALVES: Absolutely.
RON GONÇALVES: I very much enjoy also thank you for the invitation again, and I hope these help our wonderful pets everywhere.
DANA HILL: Ronald Goncalves is a veterinarian at the University of Florida College of Veterinary Medicine, where I also want to thank Sarah Carey and Amanda Buckley for their help with the program.
DANA HILL: And I want to thank you all for listening.
DANA HILL: I’m Dana Hill.
DANA HILL: I hope you’ll join me next time for another episode of Animal Airwaves Live.
RON GONÇALVES: Bye.