Septic Shock in Dogs

There are two categorizations of bacterial blood infection in dogs — bacteremia and sepsis. Bacteremia is a temporary presence of bacteria in the blood stream, while sepsis is when bacteria are in the bloodstream for a longer period of time, causing illness. When sepsis becomes severe, septic shock can occur.

Symptoms are broken down into early and late stages. Early stage symptoms may include increased heart rate, shaking, fever, and rapid breathing. Late stage symptoms may include low body temperature, difficulty breathing and organ failure. Treatment of sepsis typically requires IV fluids, antibiotics, cardiovascular support, insertion of feeding tubes, and others, up to and including surgery. While recovery from sepsis depends on the severity and underlying conditions, most cases in which the pet has gone into septic shock have a grave prognosis.

While there are thousands of different types of bacteria in the world, only a few kinds tend to cause disease to dogs. Bacteria enter the bloodstream on a regular basis though this usually occurs in small quantities. When there are more bacteria than the white blood cells are able to remove, an infection develops. There are varying degrees of infection. For example, bacteremia is a more temporary infection and rarely exhibits any symptoms. It can occur e.g. during a dental cleaning, when bacteria is dislodged from the mouth. Sepsis, on the other hand, is when the bacteria in the blood stream cause illnesses. Sepsis is more severe and will exhibit symptoms. A septic shock is a severe form of sepsis.

Symptoms of sepsis will vary depending on the severity and progression of the condition, as well as the underlying causes of the septic condition. Symptoms are typically broken down into two stages of progression, early and late.

• Early stages:
• Shaking
• Fever
• Weakness
• Confusion
• Rapid heart rate
• Bounding pulses
• Rapid rise in temperature
• Rapid breathing or panting
• Decrease in urinary output
• Glucose deficiency in bloodstream
• Red mucous membranes
• Late stages:
• Pale mucous membranes
• Inconsistencies in pulse
• Cool extremities
• A dazed condition
• Low body temperature
• Organ failure
• Difficulty breathing
• Fluid retention

Types

When there is bacteria within the bloodstream, there are two categorizations used to identify the severity of illness.

• Bacteremia is a term used to describe a presence of bacteria in the bloodstream. Temporary bactermia may occur with dental procedures, because the bacteria in and around the gums are freed into the bloodstream. This can also occur when bacteria from the intestine passes into the bloodstream, but these are removed when the blood then passes through the liver. Cases of bacteremia are usually not serious.
• Sepsis, commonly referred to as septic shock, is when illness results from bacteria and/or their toxins remaining in the bloodstream for a period of time. Sepsis is less common than bacteremia and usually occurs when there’s an infection at some other place in the body, such as the lungs, stomach, or urinary tract. Sepsis can also occur after a surgery. The risk of sepsis can be increased by the presence of a foreign body. Animals with immune system disorders are more vulnerable to sepsis. Septic shock is an extreme condition of sepsis.

Cytokines, which are substances the immune system produces to fight infections, and toxins produced by bacteria, are often the cause of sepsis. These substances cause dilation of the blood vessels, which leads to a drop in blood pressure. The flow of blood is reduced, including blood flow to important organs like the kidneys and brain. The body tries to compensate for this by increasing heart rate so that more blood is pumped. Over time this weakens the heart and blood flow is even further reduced. Sepsis most regularly originates from the GI tract, respiratory tract, severe dental problems, chronic UTIs, and infected wounds.

Conditions that may increase the likelihood of sepsis:

• Surgery, especially if the location of the surgery is infected
• Pre-existing infections
• Immune system disorders
• Pneumonia
• Uterine infection
• Urinary tract infection
• Skin infection
• Being young or old

Diagnosis of septic shock may require a variety of tests.

• Physical exam
• Blood tests that look at levels of white blood cells, oxygen levels, platelet count, lactic acid concentration and levels of metabolic waste products.
• Electrocardiogram, looking for heart irregularities.
• Blood cultures to identify the infectious bacteria.
• Urinalysis
• Urine culture
• X-Rays of the chest and abdomen
• Ultrasound of stomach and heart
• If there is abnormal fluid found in the chest or stomach, a fluid analysis should be completed.
• Catscan or MRI

Because sepsis is an infection of the blood, your vet will look for certain findings in the blood work that is done. This can include the following:

• Increased or decreased count of white blood cells
• Very high or very low blood sugar
• Increased or decreased count of red blood cells, from dehydration or anemia
• An increase in liver enzymes
• An increase in kidney values
• Abnormal clotting times

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Sepsis treatment is focused on removing the source of the infection, with a secondary goal of treating the symptoms and stabilising the unwell patient. Possible treatments that achieve this include:

• IV fluids to increase blood pressure
• Antibiotic therapy
• Colloid and vasopressor administration
• Drugs to increase blood flow to vital organs
• Nutritional management
• Administration of oxygen
• Placement of feeding tubes, due to a decreased appetite and struggle eating
• Surgery, typically used to drain abscesses or remove dead tissue.
• Persistent monitoring for any change in status, particularly in clotting, hydration, and organ functionality.

Close monitoring is an essential part of the recovery process. Your vet may do follow-up tests, such as blood work, and will focus on organ function, hydration, and clotting ability. Treatment and follow-up will likely be completed in the hospital to monitor indicators of relapse. The vet will monitor white blood cell count, blood sugar level, red blood cell count, liver enzymes, kidney values, and clotting. While recovery of sepsis depends largely on the severity of the condition and the underlying issues that led to sepsis, conditions in which the pet goes into septic shock have a guarded prognosis.