Changes

===Medical Management===

===Medical Management===

====Fluid Therapy====

====Fluid Therapy====

Aggressive fluid therapy with [[Crystalloids|crystalloid]] and [[Colloids|colloid]] should be given on initial presentation to improve haemodynamic parameters and this should be mainatined into the peri- and post-operative periods where appropriate and until the patient is normotensive.  If the patient remaines hypotensive, the use of a vasopressor such as [[Dobutamine|dobutamine]], [[Dopamine|dopamine]] or even [[Vasopressin|vasopressin]] should be considered as animals in septic shock are likely to have systemic peripheral vasodilation.

Aggressive fluid therapy with [[Crystalloids|crystalloid]] and [[Colloids|colloid]] should be given on initial presentation to improve haemodynamic parameters and this should be mainatined into the peri- and post-operative periods where appropriate and until the patient is normotensive.  If the patient remaines hypotensive, the use of a vasopressor such as [[Interventional_Agents#Dobutamine|dobutamine]], [[Interventional_Agents#Dopamine|dopamine]] or even [[Interventional_Agents#Vasopressin|vasopressin]] should be considered as animals in septic shock are likely to have systemic peripheral vasodilation.

Glucose and potassium should be supplemented where these parameters are found to be abnormal and, in cases of severe metabolic acidosis, the use of sodium bicarbonate may be considered.  This product should be used with care as overdoses may result in overshoot metabolic alkalosis, tissue anoxia due to a left-shift of the haemoglobin-oxygen dissociation curve and paradoxical cerebral acidosis as carbon dioxide (not bicarbonate) crosses the blood brain barrier.

Glucose and potassium should be supplemented where these parameters are found to be abnormal and, in cases of severe metabolic acidosis, the use of sodium bicarbonate may be considered.  This product should be used with care as overdoses may result in overshoot metabolic alkalosis, tissue anoxia due to a left-shift of the haemoglobin-oxygen dissociation curve and paradoxical cerebral acidosis as carbon dioxide (not bicarbonate) crosses the blood brain barrier.