6,7Ĭoagulation testing may reveal abnormalities associated with disseminated intravascular coagulation (DIC) due to: 8 Ionized hypocalcemia is associated with a longer length of hospitalization in both dogs and cats.

Hyperbilirubinemia may be secondary to cholestasis in dogs and, possibly, hemolysis in cats.

Preferential synthesis of acute phase proteins by the liver.

Loss of albumin from the body via the gastrointestinal tract or wounds, effusion into a third body space, or vascular permeability into interstitial space.

Specifically, hypoalbuminemia is likely due to 1 or more of the following: 5 (Wright’s stain original magnification, x100) A toxic band neutrophil containing several distinct Dohle bodies, which indicate presence of systemic toxins (often bacterial) that are interfering with development of neutrophils in the bone marrow or accelerated neutrophil production. Hematologic and biochemical changes in small animals with sepsis typically reflect the underlying disease process and secondary indices of organ dysfunction, as outlined in Table 5.įIGURE 4. Animals with SIRS frequently have concomitant organ injury or dysfunction that must be detected early in order to determine appropriate therapy, monitor for changes, and assist with prognosis. Patients with SIRS and/or sepsis should have a complete blood count, serum biochemical profile, urinalysis, and coagulation testing performed.

The clinician should use the SIRS criteria in the context of the clinical picture and the underlying inflammatory disease process to enhance the specificity of the diagnosis.

However, depending on the criteria and reference values used, sensitivity and specificity range from 77% to 97% in dogs and 64% to 77% in cats.

Sensitivity is increased with the use of stricter inclusion criteria therefore, the presence of more SIRS criteria in a given patient increases the likelihood of a true systemic inflammatory process.

In order for a diagnosis of SIRS to be made, dogs must have at least 2 of the 5 criteria present and cats, 3 of the 5 criteria.

In cats, proposed criteria for SIRS were derived from a retrospective study of clinical findings in cats with severe sepsis confirmed at necropsy.

2,3 In 1 study, bradycardia was identified in 66% of cats, highlighting the difference between dogs and cats with regard to their physiologic responses to sepsis. Cats frequently do not develop a hyperdynamic response (ie, no red mucous membranes nor bounding pulses) and are more likely to have relative bradycardia and hypothermia.

It is important to note that clinical signs of SIRS differ in dogs and cats. Diagnosis Clinical ManifestationsĬlinical manifestations of SIRS and sepsis are often nonspecific and vary depending on the underlying disease process historical findings also differ and may be nonspecific ( Table 3). The distinction between SIRS and sepsis is based upon the presence or absence of underlying infection ( Table 2). However, in patients with SIRS, severe local or regional inflammation leads to an “overflow” of inflammatory mediators into the systemic circulation that results in a variety of global derangements that are characterized by vasodilation and increased vascular permeability. In sites of localized tissue damage or infection, it is well known that the localized inflammatory response is characterized by 5 cardinal signs- heat, pain, redness, swelling, and loss of function-which are caused by local capillary dilation and an increase in permeability, and occur in order to protect the host and eliminate noxious agents and injured cells. The term SIRS was first introduced by the American College of Chest Physicians and Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference in 1991, in an attempt to emphasize the importance of the inflammatory process as a systemic contributor to organ failure in patients with sepsis. Systemic inflammatory response syndrome (SIRS) describes a clinical condition characterized by widespread activation of the inflammatory system, secondary to a sterile inflammatory disease or infectious insult ( Table 1). Read the ACCP/SCCM Consensus Conference Committee’s Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis at /data/journals/chest/21647/1644.pdf.

Sirds in dogs