Nutritional support is extremely important in septic patients. The systemic inflammatory response in septic cats results in
a catabolic state that can rapidly result in severe nutritional deficiency. Nutritional needs should be addressed early in
the course of hospitalization. This support can be provided enterally by a nasoesophageal, esophagostomy, or percutaneous
endoscopic gastrostomy tube if the patient is not vomiting and is normothermic. In cats that cannot tolerate enteral feeding,
total parenteral nutrition may be necessary.
Recent studies in people have shown that maintaining normoglycemia significantly improves the outcome in some critically ill
patients.27 Many septic cats are hypoglycemic on presentation, and higher mortality may be associated with hypoglycemia than with hyperglycemia.
However, during hospitalization, particularly in patients receiving total parenteral nutrition, you must carefully monitor
for hyperglycemia and treat with low doses of insulin when appropriate.
Pain management is also important in patients with sepsis. Pain can be difficult to recognize in veterinary patients, particularly
in critically ill cats. The severity of illness in these cases often results in a reluctance to treat with analgesic agents.
Untreated pain in these cats leads to depression, inappetence or anorexia, decreased mobility, and an increase in stress hormones.
Appropriately administering analgesics is an essential part of appropriately managing septic cats.
Depending on the case, analgesia can be maintained with either local (nerve blocks, epidural analgesia) or parenteral analgesics.
In septic cats, nonsteroidal anti-inflammatory drugs carry a high risk of renal damage and should be avoided. Constant-rate
infusions of analgesics may be helpful to maintain adequate pain control. Common analgesics that can be used in critically
ill cats include buprenorphine (1 to 3 µg/kg/hr or 0.005 to 0.02 mg/kg intravenously or intramuscularly every four to eight
hours), butorphanol (0.1 to 0.4 mg/kg intramuscularly or subcutaneously every one-and-a-half to four hours), fentanyl (2 to
4 µg/kg/hr), and morphine or methadone (0.1 to 0.5 mg/kg intramuscularly or subcutaneously every two to six hours).28-30
Corticosteroid use in the treatment of sepsis and septic shock has been an area of controversy since the 1950s. Although placebo-controlled
trials failed to document beneficial effects of high-dose corticosteroids for the treatment of septic shock in people, recent
studies have suggested that some septic human patients may benefit from physiologic doses of corticosteroids.31 A study evaluating adrenal function in critically ill cats with a variety of disease processes failed to document adrenal
insufficiency in any of the patients.32 It is important to note that the low number of septic cats in this study (n=3) limits the conclusions that may be drawn
and warrants further investigation.
In people, the recommendation is to administer replacement doses of glucocorticoids in patients with refractory septic shock.
Without further investigation, this recommendation cannot be made in cats.
Cats with sepsis can be challenging to identify. Unlike dogs and people, cats often present with bradycardia and hypothermia.
Although the prognosis in sepsis for any species is guarded, early recognition, early institution of appropriate antibiotics,
and supportive care to maintain perfusion and function of key organs have been recognized as critical components of therapy.
To continue to make progress in the treatment of cats with sepsis, ongoing research is necessary to identify 1) additional
predisposing factors, 2) the types of infections and their evolving antibiotic sensitivity, and 3) the unique features of
cats' response to sepsis that can be used in the diagnosis and prognosis. Prospective clinical trials are also needed to optimize
organ support and survival in cats with sepsis.
Cynthia M. Otto, DVM, PhD, DACVECC
Department of Clinical Studies
School of Veterinary Medicine
University of Pennsylvania
Philadelphia, PA 19104
Merilee Costello, DVM, DACVECC
Allegheny Veterinary Emergency Trauma & Specialty
4224 Northern Pike
Monroeville, PA 15146