The Veterinary clinics of North America. Small animal practice
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Vet. Clin. North Am. Small Anim. Pract. · Mar 1998
ReviewTreatment of endotoxic shock: glucocorticoids, lazaroids, nonsteroidals, others.
Review of the literature would indicate that a therapy inhibiting a single step in the inflammatory mediator cascade, although potentially beneficial, cannot serve as the "magic bullet" in endotoxic shock. Thus, combination therapy using drugs that target multiple steps in the mediator cascade may prove useful in the future. Until controlled clinical studies have been performed in veterinary medicine using the agents discussed in this manuscript (or others), many questions will remain regarding the best possible pharmacologic therapies to use in supplementing traditional supportive care (e.g., fluids, broad-spectrum antimicrobials) measures. ⋯ Therapies that may hold promise for the patient with established endotoxic shock possibly include the lazaroids, certain NSAIDs, pentoxifylline, and selective inhibitors of iNOS activity. Although still controversial, methylprednisolone and other glucocorticoids are probably best reserved for the patient at risk for endotoxic shock, or those identified very early in the course of endotoxemia and endotoxic shock, and should never be used in conjunction with NSAIDs. Since no one therapy is likely to provide the "magic bullet" for the patient in endotoxic shock, treatment may ultimately involve combination therapy using some of these drugs that target different pathways and mediators and may also include antibodies against endotoxin or its mediators.
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Appropriate fluid therapy requires an understanding of fluid dynamics and pathologic alterations during various disease states. In addition, it requires an understanding of the pharmacologic differences of available fluids. ⋯ Blood products are used to replace blood components and coagulation proteins. Frequent monitoring and reassessment are required to prevent volume overload and life-threatening edema.