Hydrocortisone therapy in a cat with vasopressor-refractory septic shock and suspected critical illness-related corticosteroid insufficiency

Pisano, Simone R. R.; Howard, Judith; Posthaus, Horst; Kovacevic, Alan; Yozova, Ivayla D.

Initial medical management included two boli at 1.4 mL/kg of 25% dextrose, IV isotonic crystalloids (Plasma-Lyte A, Baxter AG, Volketswil, Switzerland) given as a 15 mL/kg bolus, followed by 10-15 mL/kg/h constant rate infusion (CRI) supplemented with 4.5% dextrose and 40 mmol/L KCl, two boli of methadone (0.2 mg/kg IV), ampicillin-sulbactam (30 mg/kg q8 h IV), metronidazole (12.5 mg/kg q12 h IV), marbofloxacin (4 mg/kg q24 h IV), and 20% human serum albumin (27 mL/kg IV over 2.5 h). Two hours after initiating fluid therapy, the heart rate was 180 beats/min with weak peripheral pulses, and mucous membranes were pale pink with a capillary refill fluids (ml/kg) time of 2 sec. The oMAP decreased to 60 mmHg (Fig. 1) . The hematocrit was 24%, total solids-55 g/L and blood glucose-220 mg/dL (12.2 mmol/L). A full abdominal exploratory laparotomy revealed approximately 200 mL of fluid, a ruptured pyometra, and generalized peritonitis. An ovariohysterectomy was performed, the abdomen was copiously lavaged, and Jackson Pratt drains were placed prior to abdominal closure. The anesthetic protocol consisted of premedication with methadone (0.1 mg/kg IV) and midazolam (0.2 mg/kg IV), and induction with alfaxalone (1 mg/kg IV). Following endotracheal intubation, anesthesia was maintained using isoflurane (1.1-1.3%) in 100% oxygen. Intraoperative analgesia was provided with fentanyl (5-10 lg/kg/h IV).