DEBATE ON DEX / SOLU-DELTA / CORTICO-STEROIDS

[FrostyPaws]

I pilfered my solu-medrol some time ago, because if nothing else, I will be prepared with SOMETHING, and I have lots of somethings!

My wife and I went round and round about this entire subject yesterday. Neither of us can really wrap our heads around the use of GC's for shock aside from maybe an inability to get other significant drugs like some of the colloids, ie Albumin, Volv like Nut mentioned, Heta-Starch, etc. They would go a lot further in helping dogs in most cases, I believe, than the GC therapy. In human use, you only see GC's given for septic shock, and even then, it's not a regular practice.

That's something I'm trying to really determine. What's the reasoning behind using GC.

Here is an interesting link about colloids, advantages, disadvantages, etc.

Colloids

[Officially Retired]

I pilfered my solu-medrol some time ago, because if nothing else, I will be prepared with SOMETHING, and I have lots of somethings!

My wife and I went round and round about this entire subject yesterday. Neither of us can really wrap our heads around the use of GC's for shock aside from maybe an inability to get other significant drugs like some of the colloids, ie Albumin, Volv like Nut mentioned, Heta-Starch, etc.

What is Heta-Starch?

Another anti-shock I saw Scratch-N-Stitch (another great medic) use was Hypertonic Saline. Have no idea what it does, except that it's for shock are removing excess swelling.

They would go a lot further in helping dogs in most cases, I believe, than the GC therapy. In human use, you only see GC's given for septic shock, and even then, it's not a regular practice.
That's something I'm trying to really determine. What's the reasoning behind using GC.

Interesting, why do you think this exactly?

I am not sure comparing human shock to dogs is ideal. Human's don't typically fight till (almost) the death.

I would imagine humans sustain a short, terrible injury.

The anti-inflammatory properties (both internal and external) seem like a good reason to me.

But if you have other ideas, by all means spill the beans.

Have you used these other items on your own dogs? If not, are you going to experiment?

[FrostyPaws]

I have never used hypertonic fluids for aftercare, but there is evidence for it's use though it's not significantly greater than the use of Normal Saline. The thought process behind hypertonic fluids is you don't have to administer as much to achieve the same effect as Normal Saline. That's the only significant upside to using hypertonic fluids over saline or LR.

Heta Starch is a colloid. That link I posted goes into a lot more depth about that subject than I could ever be unless dedicating ample time to the subject.

I can't disagree with the difference of how a human or a dog gets to the point of shock, but once there, shock is still the same in human or dog. Not enough blood flow to organs which can result in shutdown. So the treatment is the same even if how they got there is not. I agree about the anti-inflammatory issues, but that's not ultimately what kills dog or person. The inflammatory response is second on the list of things to worry about when it comes to shock. You need to expand volume so blood and oxygen can start to reach through the body. That has to be corrected first before worrying about inflammatory response.

I've never used any of those products as I simply can't find them anywhere short of a hospital setting. One thing I am going to look into is maybe sodium bicarb if I can find it along the way. It will decrease the acidity of the body after such sustained trauma. We've heard a lot of lactic acid buildup during the dog's work out. While most of that has been disproven to have a negative effect, a very real thing is lactic acid from sustaining trauma due to the body releasing lactic acid, and that will kill you regardless of what you do. Anyway, I don't want to get off track with my rambling about cascading issues from the trauma dog's suffer from shows.

I can't really say if dogs live from the fluids they receive, the GC, or a combination of both. I know I've seen dogs saved with just fluids and a combination of GC/fluids. I know they need the fluids moreso than the GC, but I can't say the GCs didn't help at all. The only thing I can say is I can't find any significant science stating the the administration of GC during hypovolemic shock contributes significantly to the survival rate.

[Officially Retired]

Thanks for the info.

I think perhaps the reason these drugs are needed is because of the TRAUMA, not just the state of being hypovolemic.

Here is a brief study showing Solu-Medrol is effective in reversing traumatic/lethal bloodloss shock, in just about exactly the maximum dose indicated in my original article, and the summit dose in the revised article.

[Officially Retired]

I think if you look up Traumatic Shock, you will find much more research than mere "hypo-volemic" shock

Here's another

And one more

This second article not only supports your own curiosity, but (ultimately) supports our mutual findings right here, directly stating:

"The data presented herein also clearly demonstrate that in order for one to be able to get the maximum benefit from steroid therapy in shock, steroids must be administered early and in very high dosage. Overall, the data reviewed herein provide a solid scientific basis for the therapeutic use of glucocorticoids (and possibly estrogens) in various forms of cilculatory shock and trauma."

I am sure this is why Doc recommended the high-end of the dosages in the original article.

Jack

[FrostyPaws]

The brief study prevented DIC, not fatal shock. I've known about the adrenal insufficiency and addison's crisis aspect of GCs. A lot of what I've read about GC is simply increasing cardiac output and decreasing some vascular resistance.

The first 1/4 or so of this article is interesting as it pertains to dogs specifically.

Shock

[Officially Retired]

In the searching I have done, I agree, for straight blood loss it looks like steroids don't do anything significant.

In tests where they've bled-out puppies, for example, there is no significant benefit to using steroids.

The difference, and relevance, to what we do is the trauma involved with the blood loss ... and there are actually quite a lot of studies that show steroids worked in a variety of ways for trauma shock ... always dosed high.

Jack

[Officially Retired]

The brief study prevented DIC, not fatal shock. I've known about the adrenal insufficiency and addison's crisis aspect of GCs. A lot of what I've read about GC is simply increasing cardiac output and decreasing some vascular resistance.

The first 1/4 or so of this article is interesting as it pertains to dogs specifically.

Shock

That is actually a helluvan article in general.

This says the opposite about steroids:
"Steroids. The proposed benefit of steroids include stabilization of lysosomal membranes, prevention of lipid peroxidation, scavenging and stabilization of free radicals, and maintenance of adrenoreceptor function. Disadvantages are many, and include alterations of GI blood flow (especially in an already compromised GI tract), immunosuppression, vasodilation, and impaired wound healing. Multiple studies have failed to show any benefit of high dose steroid administration in any shock state. Low dose steroid administration (at physiologic doses) may be beneficial in anaphylactic or septic shock."

It also answered some questions about Hypertonic Saline:
"7% NaCl (HTS - hypertonic saline) is used for rapid expansion of the intravascular volume. HTS pulls fluid primarily from the interstitial compartment. The advantage is that only small volumes are required to increase intravascular volume quickly. Its use is primarily for treatment of the head trauma patient and in shock resuscitation. Anti-inflammatory effects have also been documented. The volume expansion provided by HTS is short lived, as the sodium redistributes throughout the extracellular compartment quickly. HTS is available as both 7-7.5% and 23% solutions. The 23% solution MUST be diluted prior to administration. HTS should be administered no faster than 1ml/kg/min as vagally mediated bradycardia or arrest could occur."

[FrostyPaws]

Part of what I posted came from this article last night.

More Shock Stuff

[FrostyPaws]

Yeah! I mean, this whole thing is making me confuzzed. When talking with the wife last night, she says, "How do you know it's not the fluids bringing the dog around instead of the GCs?" And you know? Most of the time she's right. They're always given in conjunction. You have vets around the world advocating the usage of these drugs, but then you have vets, and a lot of science, stating that they don't increase survival rates. I just want to kick my dog at this point.