Suspected norepinephrine-associated skin slough in a dog with sepsis

Authors: Cumming S, Martinez-Taboada F, McDonald B, Martinez N
Publication: Australian Veterinary Practitioner, Volume 49, Issue 4, pp 99-104, Dec 2019
Publisher: Australian Veterinary Association

Animal type: Dog
Subject Terms: Anaesthesia/analgesia/sedation, Animal remedies/veterinary medicines, Clinical examination, Sepsis/infection
Article class: Clinical Report

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Abstract:

An 11-year-old male neutered Staffordshire Bull Terrier presented for acute vomiting and lethargy. An abdominal mass and effusion were detected by ultrasound examination. Cytology of the fluid revealed septic peritonitis. A ventral midline exploratory laparotomy revealed a caecal mass with rupture of the bowel wall. During the surgery the dog became severely hypotensive, likely the result of septic shock. Hypotension was principally managed with an intravenous infusion of norepinephrine. The dog recovered from surgery and was discharged from hospital, but represented 11 days later with an eschar-like lesion on the dorsum. It is speculated that a combination of factors including marked hypotension under anaesthesia due to sepsis, mechanical loading of the region, and peripheral vasoconstriction caused by the norepinephrine may have resulted in hypoperfusion and ischaemia of the area. The dog was treated symptomatically and the lesions resolved.

KEYWORDS: norepinephrine, eschar, skin, hypotension, sepsis, anaesthesia

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