Specific treatment for localised infection
•
•
•
GIT – e.g. diarrhoea –di-tri-octahedral smectite (Biosponge ®)
Umbilical infection – consider surgical resection
Joint sepsis – arthroscopic and/or needle lavage
Plasma Transfusion
This is advised in cases with failure of passive transfer (IgG < 8 g/L) and has
been supported by a recent paper documenting increased mortality in foals
with IgG < 8g/L.[14] However even if IgG measurement is greater than 8g/L
plasma transfusion may still be beneficial by providing different antibodies
from that provided by the mare. There is also evidence that albumin may help
restore the endothelial glycocalyx which is damaged in sepsis leading to
increased vascular permeability.
In general one litre of plasma is required to raise IgG levels by 2 g/L. Frozen
plasma should be thawed slowly in lukewarm water to prevent denaturing of
plasma proteins. Microwaves should not be used. An in-line blood filter should
be used for administration. Initial infusion rates should be slow and the foal
should be closely monitored for signs of a transfusion reaction (e.g.
tachypnoea, tachycardia, pyrexia, muscle fasciculations, colic signs and/or
collapse). 0.5 ml/kg (20-30 ml for an average foal) should be administered
over 20 minutes. If no adverse signs are seen then infusion rates can be
increased up to 40ml/kg /hr.
Haemodynamic Support
Septic foals can be prone to oedema due to increased capillary permeability
and renal compromise Judicious fluid therapy is therefore required.
N.B. “Too much is bad, too little is bad!”
As a general rule 20 ml/kg crystalloid boluses to achieve survivable perfusion
not normal perfusion are advised. Then reduce to maintenance or less and
rely on endogenous/exogenous inopressor support. Vasoactive drugs should
only be used if infusions pumps and continuous monitoring are available.
See notes on fluid therapy by Dr. Karin Kruger
Respiratory Support
Respiratory support is important to facilitate adequate oxygen delivery to
tissues. Septic shock can result in pulmonary hypertension leading to right-left
shunting and significant V:Q mismatching due to abnormal vascular control.
In addition the work of breathing in cases with respiratory distress can
account for a large proportion of total body oxygen consumption. Intranasal
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
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