DEBATE ON DEX / SOLU-DELTA / CORTICO-STEROIDS

Okay, listen up. The subject of shock, treating shock, and the proper dosages and KIND of cortico-steroids one should use for a dog is a great topic to get clear amongst the users in this community :idea:

One of the members (Nut) challenged me in private saying that the dosages listed in my article on these drugs (and therefore The Pit Bull Bible) are wrong.

Now, I originally got my info from Doc, of Baystate Kennels, who has always been revered as a great medic in our sport ... and my own subsequent research confirmed that the "regular" dosages on the labels for most cortico-steroids are pretty much for swelling ... not shock ... and that the dosages to give these drugs for shock can be up to 10x the standard dose.

So I posed this basic question to FrostyPaws, our Moderator, who's completed a certain amount of medical training in his profession to help provide some clarity. However, rather than discuss such a matter "in private," I am opening up this discussion to public debate ... and I ask that all members making "claims" please cite their references, so we're not just making things up here.

My next post will be a statement/response dialogue with Frosty's response to my PM questions. I make this discussion "public" (in our private community) because it absolutely is a topic we all can learn from and help clarify ... so here goes ...

This is a good topic. Going over the recommended dosage is a scary thought for some that have limited knowledge in thr area

So much of the information for dosages are online for all to see. Once found, you should write it down, make a copy of it, print it off, etc as it IS one of THE most important bits of information you can have to save a life. If you can't hit IVs, you need to practice. SQ administration of fluids for a dog in shock is a waste of time. Yes, it is even harder to hit a vein when a dog is in shock or dehydrated, but it is vital to do so if you want dogs to live after contests.

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Originally Posted by FrostyPaws

So much of the information for dosages are online for all to see. Once found, you should write it down, make a copy of it, print it off, etc as it IS one of THE most important bits of information you can have to save a life. If you can't hit IVs, you need to practice. SQ administration of fluids for a dog in shock is a waste of time. Yes, it is even harder to hit a vein when a dog is in shock or dehydrated, but it is vital to do so if you want dogs to live after contests.

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just put in the vein in the neck

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Originally Posted by FrostyPaws

Most of these drugs, especially in humans, are given mainly for swelling, especially people that have respiratory problems, so yeah, I'd agree that most of the dosages you find, especially for dex, etc is for some type of swelling.

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That's what I thought.

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Originally Posted by FrostyPaws

I'll go through on a drug by drug basis.

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Okay, thanks for your time and for helping to clarify.

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Originally Posted by FrostyPaws

Dex has varying dosages to be used. I've seen 0.5 mg/kg to 5mg/kg. The 5mg/kg is about equal to your 2.5mg/lb dosage. I think the mg/kg is a little less.

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Exactly. Mg/kg would be a little less, but my article's recommendation is right about at the high-end of the the 5mg/kg max.

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Originally Posted by FrostyPaws

Dex Sodium Phosphate is one you left out. It has a much faster onset than normal dex, but has a shorter duration. There are 3 medical professionals that have varying dosages for Dex SP.

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I did mention this actually, as my article cites Azium and Dex. Azium = Dex sodium phosphate; Dex = Dex.
What I didn't do was clarify what you just said above, so I will, and thank you.

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Originally Posted by FrostyPaws

A. 3 mg/kg of body weight per 24 hours by constant intravenous infusion after an initial intravenous injection of 20 mg
B. 2 to 6 mg/kg of body weight as a single intravenous injection
C. 40 mg initially followed by repeat intravenous injection every 4 to 6 hours while shock persists.

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Interesting, and thank you. The 2-6 mg/kg ratio for B is 4-12x the low-end dose of .05mg/kg typically given for swelling.
Of these 3, which have you tried or would recommend?
My book essentially recommends Method B, well within the stated parameter.

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Originally Posted by FrostyPaws

Solu Delta is 2.5-5mg/lb as you have listed. The biggest difference is the amount of times you may give Solu Delta if needed. If needed, you can repeat q 1, 3, 6, or 10 hour intervals. For dogs under 40lbs, it's suggested to use 10mg/mL. For dogs over 40lbs, use 50mg/mL.

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Thanks again for clarifying as well as showing other options.
I think Doc mentioned something about giving this drug more often also, but that would be an each-case, individual judgement call I reckon.

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Originally Posted by FrostyPaws

Solu Medrol is suggested at 5-30 mg/kg IV for shock therapy.

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Thanks again for clarifying. 30 mg/kg = 13.6 mg/lb.
My article's recommendation, which came from Doc, said to use just over the high-end at 15 mg/lb, but certainly not by much.

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Originally Posted by FrostyPaws

When we're using things for people in shock, it's usually via IV push not mixed in the bag. If your vein were to blow, you want them to have that medicine in them before that happens. Most IV setups have an additional port that you can push meds through while administering fluids at the same time.

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Good point to clarify, and thanks for stating it. That is how I've typically don't things, via the side port.

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Originally Posted by FrostyPaws

But 10 times the dose? That's ridiculous.

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Not really. The shock dose is essentially 10x the swelling dose. Check your own numbers above.

Your own listed range for Dex is 0.5 mg/kg to 5mg/kg.
5mg/ml is exactly 10x the low-end 0.5/dose.

Your listed range for Solu-Medrol is 5-30 mg/kg
30mg/kg is 6x the low-end dose of 5 mg/kg.

Perhaps the confusion was in thinking 10x the high-end shock dosages, which would indeed be too much. My point was the dosages for shock are usually MUCH greater than the low-end doses for swelling.
For example, many dogmen only give 3 ml of dex IM for a dog after a roll, to avoid swelling, whereas if that same dog were at death's door he might need 30 ml IV to save his life.

Thanks again for your time and effort.

Jack

i understood that the difference between dexa and delta are not that big

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Originally Posted by bulldoghistorian

i understood that the difference between dexa and delta are not that big

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Why don't you post the dosages of dex you would administer for anti shock purposes?

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Originally Posted by Nut

When u got the 2mg Dexamethasone u need about 1 cc, and not 50. That equals a whole bottle. You give 1 ml of Dexamethasone to your dog today and he will lose a kilo in fluids over a day. Now give 50 ml to a dog after a show who's in desperate need of fluids instead of losing them, and he will die.

As for Methylprednisolone Sodium Succinate, you say a 40 lbs dog needs 600 mg of the drug. That equals four of the strongest bottle's which are 62,5 mg/ml, 2 ml vials.

If for some reason I misinterpret your explenation than im sorry, otherwise it would be smart to change to dosages and let people know they got the wrong info.

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That's right, it's almost a whole bottle. Just because the thought of this "scares you," doesn't mean it's wrong. And, the truth is, I was never originally offended by your question. I actually invited you to go ahead and cite your findings. However, since you didn't actually have any findings (only "fear" and "opinions"), you never did. You always have to say how "offended" I get, and that is because YOU are offensive in how you word things. You can't just say something like, "Hey man, thanks for taking the time to put out all that information, but I have some concerns ..." No, that's not you. You're come at me like a fucking prick instead.

Now pay attention here: You THEORIZED above that 1 ml of dex is all a dog needs for shock (when this is actually laughably-incorrect), and you FEAR that a dog will die from loss of fluids, FORGETTING COMPLETELY the fact that you are supposed to give IV fluids concurrently. So, yes, if you have a dog suffering from hypovolemic shock, and you run a bunch of dex in him, while giving NO fluids, you bet he'll die. But you're supposed to be running fluids in the animal, while giving DEX, and that is clearly stated in the article ... if you bothered to actually read the whole thing.

So why don't you 1) ADMIT you actually were 100% wrong in saying that 1 ml of dex would treat shock (:lol:), and 2) that, in fact, my dosages are correct.

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Originally Posted by Nut

Jack's article advises the strongest dose of 30 mg. "GIVE" 15 mg per lb. Not speaking of a range and mentioning the dose varies up to 6 times less. 600mg for a 20 kilo dog are 4 of the strongest 2 ml vials 62,5 mg/ML. I have never seen somebody give more then one before, have you? Cheers

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The article presupposes that a dog is at death's door, and not needing "minimum" dosages. It is for dogs that are really bad off ...

However, ultimately yours is a good point, I should change the article to reflect the "range," not just state the absolute max dose, so your point well taken.

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Originally Posted by Nut

Well the dosages u and jack mention of dex are allot more then 10x.

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Again, if the range of dex is .05 mg/ml to 5.0 mg/ml, and we're stating the high-end of that dosage, then CLEARLY we're at the 10x the minimum dose.

This is a mathematical fact that only someone who can't comprehend basic math would try to debate.

The one reference (Method B) Frosty mentioned had an even higher-end of 12x the minimum recommended dose, not 33x.

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Originally Posted by Nut

Same story as above, the strongest dosage is advised. No range mentioned. This is 33 times the dosage for anti swelling purposes.

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I agree with you that I should give a range of all these drugs, not just the max dose. Again, point well made.

However, you have a severe mathematical disorder if you think the dose I gave is 33x the recommended dosage.

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Originally Posted by Nut

I give dexafort its 0,15 mg/kg for anti swelling purposes. If only administered at 1cc(instead of 25cc) any dog will lose allot of fluids, can't imagine such enormous high dosages being healthy for a dog that has just been matched. Dog should certainly not come off the IV fluids as long drugs are working with these dosages.

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What "you" give means nothing to anyone but you.

It's the recommended dosage for shock that is of relevance here, not "your" minimalist (and absolutely incorrect) dosage :idea:

The very first thing Doc says in his article is, "Most people do not give the correct dosages" ... and that, "The dosages (you give) have no importance for shock treatment."

Try reading, and understanding, the article before typing ... and calling "everyone else" wrong ... when you're the one who just doesn't understand.

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Originally Posted by Nut

I think dex is a very lousy drug for anti shock purposes. I prefer solu delta cortef, but can't get it anywere since a while so im very interested to read about what others do in PRACTICE.

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This is clearly stated in my article, that dex is a better drug for swelling, and that solu-delta(medrol) are better drugs for shock. If you formed this opinion, I would bet a million dollars to a penny you got this opinion from my article, or from someone who taught you, and got their opinion from my article. This article has been out there since 2000 ... and a lot of people have followed it, used it, and saved a lot of dogs with it, long before you ever petted your first bulldog :idea:

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Originally Posted by Nut

My conclusion is the dosages advised in the article are far from brilliant. Any newbee that is in a rush to safe his dog and counts on this information automatically gives the highest dosage Frosty speaks/heard of.

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My conclusion is that YOU are far from brilliant.

For whatever reason, you come off as a jerk trying to condescend to me, when you don't have any idea WTH you're talking about.

This should be a positive exchange, but you're more interested in trying to "make me look bad," somehow, than in actually understanding THE TRUTH.

If I am wrong in anything, it is in not putting out the whole ranges of drugs. You are 100% correct in pointing that out. So thank you for that.

However, for the most part, the information is spot-on. If you could learn how to distinguish what you THINK you know, from ACTUAL FACTS, you would do yourself a favor. And if you learned to phrase your questions in a HELPFUL way, rather than in a such a way as to try to kick me in the ass ... when I am just trying to offer the best advice possible ... then maybe my focus would be to work with you in providing clarity, rather than trying to kick you a flip in return.

Jack

I am going to get, and post, actual pharmacological references in a bit ...

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Now pay attention here: You THEORIZED above that 1 ml of dex is all a dog needs for shock (when this is actually laughably-incorrect), and you FEAR that a dog will die from loss of fluids, FORGETTING COMPLETELY the fact that you are supposed to give IV fluids concurrently. So, yes genius, if you have a dog suffering from hypovolemic shock, and you run a bunch of dex in him, while giving NO fluids, you bet he'll die. But, DUH, you're supposed to be running fluids in the animal, while giving DEX, and that is clearly stated in the article.

So why don't you 1) ADMIT you actually were 100% wrong in saying that 1 ml of dex would treat shock (), and 2) that, in fact, my dosages are correct.

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no i did not. 1 ml is for anti swelling purposes. and i certainly wont forget dog needs fluids as i also wrote in my previous post.

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Again, you must have a mental disability.

If the range of dex is .05 mg/ml to 5.0 mg/ml, and we're stating the high-end of that dosage, then CLEARLY we're at the 10x the minimum dose.

This is a mathematical fact that only an imbecile who can't comprehend basic math would try to debate.

The one reference (Method B) Frosty mentioned had an even higher-end of 12x the minimum recommended dose, not 33x.

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that range is the range for anti shock purposes. 0,5 mg is not the dose for anti swelling. just told u that 0,15mg for a kg so around 0,07 per lb





here is where i stopped reading your post and will stop responding to you. im interested to read what people with practical experience have to say.

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Originally Posted by Nut

no i did not. 1 ml is for anti swelling purposes.

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1 ml of dex is not a "recommended dose" anywhere.

Drugs are actually dosed in mg/kg or mg/lb ... based on WEIGHT.

For example, you could have a 28 lb bitch, or a 55 lb male, and the dose would be double for the latter ... half for the former ... and the fact that you can't comprehend this **is** your error, right there.

Saying you "give 1 ml of dex" for all swelling, to all dogs, regardless of weight (or trauma) is simply incorrect.

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Originally Posted by Nut

that range is the range for anti shock purposes. 0,5 mg is not the dose for anti swelling. just told u that 0,15mg for a kg so around 0,07 per lb
here is where i stopped reading your post and will stop responding to you. im interested to read what people with practical experience have to say.

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The fact that you "stop reading" so easily is your other problem.

Everything Doc and I have written in the article on treating shock *IS* correct ... while everything you have said has nothing to do with shock, and every a$$umption you have made has been wrong ... reflecting that (again) you haven't read (or understood) what's been posted.

Please cite references for any negation to what I have said ... I will be citing mine.

Thanks,

Jack

I was referring to 42 lbs dog like you mentioned with the advised dosage in your article. U make the assumption that i think there is 1 dosage for all size dogs.

Frosty or Jack can either of you clear one thing up for me here I'm trying to understand, is solo medrol only useful as an anti shock drug if givin intravenously ?? Otherwise it's only an anti inflametry?? Or have I picked that up wrong.

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Originally Posted by CA Jack

I am going to get, and post, actual pharmacological references in a bit ...

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Better not be a reference of a none beat up, hydrated dog with good working organs.

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Originally Posted by Nut

Better not be a reference of a none beat up, hydrated dog with good working organs.

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You'd better shut up, is what you need to do.

No "perfectly healthy" animal needs these drugs, genius.

Every animal that needs its life saved with anti-shock therapy is dying and fubarred by default.

You're not trying to help, you're just being an ass.

Seriously, just shut up with your attitude, and that is my last waring.

Sorry if this is off topic, but which is preferred of the 2.
Azium or biodipirona?

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Originally Posted by Macker

Frosty or Jack can either of you clear one thing up for me here I'm trying to understand, is solo medrol only useful as an anti shock drug if givin intravenously ?? Otherwise it's only an anti inflametry?? Or have I picked that up wrong.

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You can give either IM ... but it is nowhere near as fast or as effective.

Will be compiling some data that I hope is useful.

Jack

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Originally Posted by CRISIS

Sorry if this is off topic, but which is preferred of the 2.
Azium or biodipirona?

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There is no "better" actually. (And, honestly, I have never heard of Biodipirona.)

There is simply selecting the right one for the job.

If you need a fast-action, the "sodium succinates" (or sodium phosphates) are faster-acting ... but dissipate quicker.

Once stabilized, the longer-lasting drugs can be used.

So it really depends on the individual case before you ...

♦ Dexamethasone (aka: Dex)
♦ Dexamethasone sodium phosphate (aka: Azuim),
♦ Prednisolone sodium succinate (aka: Solu-Delta Cortef)
♦ Methylprednisolone sodium succinate (aka: Solu-Medrol).


The sodium succinates (or phosphates) are salts ... that assist with delivery and assimilation of the drugs.

They are preferable for "immediate delivery" to reverse a life-or-death situation hanging by a string, but they are removed from the system more readily.

When I said 10x the dose, I misread the original message sent to me, so that's my bad in regards to that statement.

I've personally never seen OR heard of anyone using Solu Medrol for any anti-shock therapy. Considering it also comes in 125mg bottles, what difference does it make. If it were the only thing I had to use, and I had the correct information, I would use it. I'd rather use it and possibly save the dog as opposed to not using it and the dog dying. I also have some dex that is 10mg/mL. Lower strength med = give more.

The dex dose is a lot higher than a swelling dose because it's a possible LIFE SAVING dose. No one ever suggested to stop giving the dogs fluid. If your dog is needing anti-shock therapy, it is certainly needing fluids. You don't stop giving fluids simply because of the medicine. I have seen both types of Dex used for aftercare for shows. The dogs lived without any issues. I've seen Solu Delta used after shows. Some dogs lived and some didn't due to simply being too far gone. Given my druthers, I'd use Solu Delta also, but if I don't have any, I can simply use what I have on hand. Being in the medical profession, I've seen most of these drugs used for one purpose or another. Some people start off at the highest dose and work their way down. Some start at the lowest and work their way up. That is more based on personal experience and what has worked for someone time and time again. I personally start at the mid way point when it comes to dosages and adjust from there.

Any anti-shock therapy is BEST used IV and not IM. IM should be a last resort not a first one. Learn how to hit veins in your animal. Giving your dog IV fluids, and not sq, will go a lot further in saving your dog. I've seen some dogs pass simply due to not having any fluids to flush their kidneys free of myoglobin.

I would like to add also that I've given 1mL of dex many times, and I've never seen a dog lose 2.2 kilos from 1mL.

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Originally Posted by Nut

Why don't you post the dosages of dex you would administer for anti shock purposes?

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i follow my vet advise 4mg/kg

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Originally Posted by FrostyPaws

When I said 10x the dose, I misread the original message sent to me, so that's my bad in regards to that statement.

I've personally never seen OR heard of anyone using Solu Medrol for any anti-shock therapy. Considering it also comes in 120mg bottles, what difference does it make. If it were the only thing I had to use, and I had the correct information, I would use it. I'd rather use it and possibly save the dog as opposed to not using it and the dog dying.

The dex dose is a lot higher than a swelling dose because it's a possible LIFE SAVING dose. No one ever suggested to stop giving the dogs fluid. If your dog is needing anti-shock therapy, it is certainly needing fluids. You don't stop giving fluids simply because of the medicine. I have seen both types of Dex used for aftercare for shows. The dogs lived without any issues. I've seen Solu Delta used after shows. Some dogs lived and some didn't due to simply being too far gone. Given my druthers, I'd use Solu Delta also, but if I don't have any, I can simply use what I have on hand. Being in the medical profession, I've seen most of these drugs used for one purpose or another. Some people start off at the highest dose and work their way down. Some start at the lowest and work their way up. That is more based on personal experience and what has worked for someone time and time again. I personally start at the mid way point when it comes to dosages and adjust from there.

Any anti-shock therapy is BEST used IV and not IM. IM should be a last resort not a first one. Learn how to hit veins in your animal. Giving your dog IV fluids, and not sq, will go a lot further in saving your dog. I've seen some dogs pass simply due to not having any fluids to flush their kidneys free of myoglobin.

I would like to add also that I've given 1mL of dex many times, and I've never seen a dog lose 2.2 kilos from 1mL.

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no max a pound but that was more than 1ml

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Originally Posted by bulldoghistorian

i follow my vet advise 4mg/kg

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That is a reasonable dose, and on the high-end, given the 0.05 mg/kg - 5.0 mg/kg recommended range.

At your vet's recommended dose, this means a 42 lb dog would get 76.4 mg.

42 lb = 19.09 kg
19.09 kg x 4 mg/kg = 76.4 mg

If you had a 2 mg/ml bottle of dex, this would mean your dog would get 38.2 ml of dex for shock.

With a 4 mg/ml bottle of dex, your dog would get 19.1 ml for shock.

Jack

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Originally Posted by FrostyPaws

When I said 10x the dose, I misread the original message sent to me, so that's my bad in regards to that statement.

I've personally never seen OR heard of anyone using Solu Medrol for any anti-shock therapy. Considering it also comes in 125mg bottles, what difference does it make. If it were the only thing I had to use, and I had the correct information, I would use it. I'd rather use it and possibly save the dog as opposed to not using it and the dog dying. I also have some dex that is 10mg/mL. Lower strength med = give more.

The dex dose is a lot higher than a swelling dose because it's a possible LIFE SAVING dose. No one ever suggested to stop giving the dogs fluid. If your dog is needing anti-shock therapy, it is certainly needing fluids. You don't stop giving fluids simply because of the medicine. I have seen both types of Dex used for aftercare for shows. The dogs lived without any issues. I've seen Solu Delta used after shows. Some dogs lived and some didn't due to simply being too far gone. Given my druthers, I'd use Solu Delta also, but if I don't have any, I can simply use what I have on hand. Being in the medical profession, I've seen most of these drugs used for one purpose or another. Some people start off at the highest dose and work their way down. Some start at the lowest and work their way up. That is more based on personal experience and what has worked for someone time and time again. I personally start at the mid way point when it comes to dosages and adjust from there.

Any anti-shock therapy is BEST used IV and not IM. IM should be a last resort not a first one. Learn how to hit veins in your animal. Giving your dog IV fluids, and not sq, will go a lot further in saving your dog. I've seen some dogs pass simply due to not having any fluids to flush their kidneys free of myoglobin.

I would like to add also that I've given 1mL of dex many times, and I've never seen a dog lose 2.2 kilos from 1mL.

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Nicely said. I have some comments, that I will save for later, but surprised to hear what you said on Solu-Medrol.

Very much appreciate your response.

That said, Solu-Medrol and Solu-Delta are almost the same thing:

Solu-Delta = Prednisolone sodium succinate
Solu-Medrol = MethylPrednisolone sodium succinate

I am curious what difference the "Methyl" prefix brings to the table?

It is my understanding that Solu-Medrol offers a medium between the anti-swelling properties of Dex, and the anti-shock properties of Solu-Delta.

I have used Dex on innumerable occasions, Solu-Delta only a handful of times, but never used Solu-Medrol.

Doc is the one who extolled the use of Solu-Medrol, and he did use it regularly.

Just curious on your thoughts, thanks.

Jack

PS: Solu-Medrol actually comes in a variety of sizes.

And here is the benefit (as Doc told me) stated on the product label:

"Methylprednisolone is a potent anti-inflammatory steroid with greater anti-inflammatory potency than prednisolone and even less tendency than prednisolone to induce sodium and water retention."

Just to clarify for other readers:

• Dexamethasones = best choice for swelling / not as active for shock (better than nothing, though);
  
  • Dex (straight Dexamethasone) doesn't act as fast, but lasts longer in the system;
  • Azium (Dexamethasone sodium phosphate) is faster-acting, but doesn't last as long.
  
  
• Solu-Delta (Prednisolone sodium succinate) = fast-acting / best choice for shock / disappates quickly / not so good for swelling;
• Solu-Medrol (Methylprednisolone sodium succinate) = excellent choice for shock also, with superior anti-swelling than Solu-Delta (though not quite as good as Dex).

That is the best of my understanding, based what I have been told, my experience, as well as what I have researched.

I have never used Solu-Medrol, but trust what Doc told me about it, which info is confirmed on the label indications I posted above.
I also know that Frosty's own training makes him an invaluable resource here, so maybe he can help shed some more light on these topics.

What Frosty said about hitting the vein is critical, because NONE OF THIS MATTERS unless you can hit a vein reliably and consistently. One of the best ways to practice hitting the vein is doing progesterone tests on your bitches. Like anything else, you get better with practice. Don't think you can have no experience and suddenly hit the vein on a dying dog, with collapsed veins, in a critical emergency. You will fail. Make sure you have practiced this often enough to get it right whenever you want.

Jack

Shock Therapy & Cortico-Steroids
(now-Revised)

PS: I have highlighted more areas in color that people seem to miss.
Please read it over, and give any corrections, and I will tweak it again if need be. Thanks.

Great information, thank you Jack for addressing it here and Frosty for your contribution.

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Originally Posted by S_B

Great information, thank you Jack for addressing it here and Frosty for your contribution.

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Absolutely.

We're all laymen here. We're all trying to do the best we can.

Doc was a vet tech, who actually did many full-on veterinary operations/procedures where he worked, and (I believe) is now in the pharmaceutical sales industry. He opened the doors for me many moons ago. He was an invaluable resource for me, even though he is out of dogs now.

Frosty has his own medical training now, that I am sure will continue to be a boon for all of us here.

I made this matter "public" so that everyone could benefit.
It doesn't do the community any good to speak of these things "in private" with one person.

If anyone (including me) is wrong, we should be helping to correct the errors, not kicking each other in the ass, so that we may continuously improve the community data for one and all, so that everyone can benefit. It boggles the mind to think of all the great dogs that have been lost to inadequate care, ignorant application of meds, and straight malpractice. The whole idea behind my book, this place, and continuously upgrading articles is to keep current as best we can as laymen, and adjust where necessary.

If this info helps someone here adjust their own methods, and by doing so helps them save one game dog that would otherwise have been lost, than it was worth all this typing and effort :)

:cheers:

Here's an interesting viewpoint:

Generalized trauma / Heat Stroke. There is no data supporting the use of GC in generalized trauma (i.e. hit by car, dog fights, etc.) or heat stroke. In fact GC may increase morbidity and mortality due to the numerous adverse effects. Supportive care such as crystalloids and colloids, pain management with opioids, and body temperature are the primary recommendations along with stabilization of blood loss and fractures. Antimicrobials may also be indicated.

Considering dogs suffer from hypovolemic shock, the primary focus should be fluids more than anything else. The only benefit I've read that GCs contribute is increased cardiac output and decreased peripheral resistance. Pushing GCs create a euphoric effect in humans when pushed, and I'd bet it does the same for dogs. That may be one of the reasons dogs tend to look better? Who knows really.

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Originally Posted by FrostyPaws

Here's an interesting viewpoint:

Generalized trauma / Heat Stroke. There is no data supporting the use of GC in generalized trauma (i.e. hit by car, dog fights, etc.) or heat stroke. In fact GC may increase morbidity and mortality due to the numerous adverse effects. Supportive care such as crystalloids and colloids, pain management with opioids, and body temperature are the primary recommendations along with stabilization of blood loss and fractures. Antimicrobials may also be indicated.

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It's funny, I was going to bring up a similar topic. There are different types of shock, so different (or, as you say, in some cases NO) cortico-steroids should be considered.

For septic shock, such as with pyometra, or abscess, etc. (which involves bacterial growth and therefore the need for immunity) it is widely held NOT to use any cortico-steroids, because they suppress the immune system as a side-effect.

Therefore, as you point out, some of this is all "spit-balling" so-to-say. I do believe, however, that for generalized trauma cortico-steroids are indicated. They create a sense of euphoria, first of all, and reduce swelling, secondly.

However, we as dogmen need to really analyze what has happened to our dogs, in order to properly-assess which cortico-steroids need to be used. There is both traumatic shock as well as hypo-volemic shock (as well as some degree of both) in a dogfight. There is simple, and absolute fatigue/heat stroke, etc.

So what do we use? Dex, Azium, etc.?

I am no expert, but my own belief is, if your dog was severely traumatized by a hard biter (with associated muscle swelling, etc.), then you should lean toward Solu-Medrol or Azium. If your dog is straight fatigued, or straight loss of blood from a bleeder (hypo-volemic), then Solu-Delta.

Maybe Frosty could comment/correct, but these are all considerations that we should be thinking of in our drug selection at the time ...

Jack

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Originally Posted by FrostyPaws

Considering dogs suffer from hypovolemic shock, the primary focus should be fluids more than anything else. The only benefit I've read that GCs contribute is increased cardiac output and decreased peripheral resistance. Pushing GCs create a euphoric effect in humans when pushed, and I'd bet it does the same for dogs. That may be one of the reasons dogs tend to look better? Who knows really.

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I would say, sure, of ALL the things that are the most vital, fluids would be it.

But I do think that the proper selection of cortico-steroids (if needed) is a vital and worthy topic.

Quote:

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Originally Posted by FrostyPaws

Considering dogs suffer from hypovolemic shock, the primary focus should be fluids more than anything else. The only benefit I've read that GCs contribute is increased cardiac output and decreased peripheral resistance. Pushing GCs create a euphoric effect in humans when pushed, and I'd bet it does the same for dogs. That may be one of the reasons dogs tend to look better? Who knows really.

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frosty thats a good point , I seldom use them unless absolutely necessary

especially with deep punctures and mouth wounds I also saw very slow healing

best to use this stuff at deaths door

vet also gave me a long lecture of the some side effects on solu delta cortef and better use of solu medrol or even dex

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I would like to add also that I've given 1mL of dex many times, and I've never seen a dog lose 2.2 kilos from 1mL.

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Do you mean lbs? I said a dog can lose about one kilo over a day. Depending on strength of the drug and size of the dog. I have seen people weighing in a pound under from giving half a cc in the morning.

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PS: I have highlighted more areas in color that people seem to miss.
Please read it over, and give any corrections, and I will tweak it again if need be. Thanks.

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Think you can't highlight those text enough. It could be a fatal mistake to inject these dosages any other way than intravenous and then find out you can't hit a vein thus cannot give enough fluids. I think you made a typo on the minimum Dexamethasone dosage.
Seems I was wrong about the high end dosages. But it's a good thread anyway and I think the article only got better.

I have 3 questions regarding the subject.

1.

Quote:

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The second major side-effect of these drugs is that they are diuretics. This means they draw fluid out of your dog. For these two reasons we recommend that any time you use any of the above-mentioned drugs you use them concurrently with fluid therapy

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When you use the high end dose of Dexamethasone; I suppose the dosage listed in the IV fluid therapy article will be increased?

2. Lot of times organs shut down and can take a while for the kidney's to start back working. If you're going to lose allot of fluids due high end dosages of Dexamethasone can't this be a big problem?

3. What do you guys think of Voluven in case of hypovolemic shock. http://www.nps.org.au/__data/cmi_pdfs/CMI9946.pdf

Great info, thanks for taking the time to share everyone.

Quote:

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Originally Posted by Nut

Do you mean lbs? I said a dog can lose about one kilo over a day. Depending on strength of the drug and size of the dog. I have seen people weighing in a pound under from giving half a cc in the morning.

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The fear of losing water is a legitimate one (especially water + electrolytes, etc.).

Even drinking a cup of coffee can cause you to piss several EXTRA times/day and get dehydrated, so shooting cortico-steroids (a pharmaceutical diuretic) should be taken seriously.

Pissing out an extra cup of water, a couple times/day, is very easy to envision ... and it adds-up quick.

1 cup = 8 oz = 240 ml = .25 k
2 cups = 16 oz = 480 ml = 1 lb of fluids
4 cups = 32 oz = 960 ml ~ 1 IV bag of fluids

This is absolutely why you need to be running fluids concurrently with any type of cortico-steroid therapy.

A bag of fluids = 1000 ml ~ 4 cups of fluid.

A dog might piss-out an extra few cups/day, so you must monitor what is happening with your animal, and it's all based on his size. Remember, all of this (the amount a dog pisses, the amount of drugs/fluids you give) is based on WEIGHT. If you monitor, and give the proper doses, it should be a seamless process, so there is no way ANY dog is going to "piss-out" more fluids than he's taking in, IF he's getting the proper amount of IV fluids throughout the day ...

Your concerns are also why you take the dog OFF these drugs, ASAP, as soon as they eat/piss on their own :idea:

Quote:

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Originally Posted by Nut

Think you can't highlight those text enough. It could be a fatal mistake to inject these dosages any other way than intravenous and then find out you can't hit a vein thus cannot give enough fluids. I think you made a typo on the minimum Dexamethasone dosage.

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I think the highlighting helps, definitely. As a key, as you read the article, realize that

Red = Warning
Green = Benefit

Still, a person needs to take the time to read the whole thing, digest, assimilate, and be willing to re-read the article. They say it takes 5 readings just to be able to remember 65% of anything we read ... so this material is serious enough to read, and re-read ...

You were right about the typo, thanks for pointing it out.

Quote:

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Originally Posted by Nut

Seems I was wrong about the high end dosages. But it's a good thread anyway and I think the article only got better.

---

They do seem like crazy doses, but again we're trying to jump start the body, and save a life, so drastic doses are needed.

These drugs have short half-lifes, and are out of the body fairly quick, so it's an intense regimen to make a dog "snap out of it" (or, perhaps, back into it), to get him feeling good again, so that he goes back to normal. Once he's back to normal, there is no reason to continue these drugs.

And, I agree, if the end result is we ALL learn a little bit more, and refine our understanding, than that is the bottom line.

Quote:

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Originally Posted by Nut

I have 3 questions regarding the subject.
1. When you use the high end dose of Dexamethasone; I suppose the dosage listed in the IV fluid therapy article will be increased?

---

No. That is what the original, bolus, dose is for in the IV Article ...

Keep in mind that, even when the dog is losing extra fluids, it isn't all at once ... but over several hours ... and fluids are going into him just as fast, or faster.

Further, this action of fluids-in/fluids-out actually helps flush the dog of all the "broken pieces of himself" that occurred in the fight, so it's a good thing, quite frankly.

Quote:

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Originally Posted by Nut

2. Lot of times organs shut down and can take a while for the kidney's to start back working. If you're going to lose allot of fluids due high end dosages of Dexamethasone can't this be a big problem?

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The #1 cause of kidney failure is dehydration. However, if you're running the proper amount of fluids into the dog, he is NOT dehydrated any longer.

Further, associate factors of kidney failure are "clogging" of the kidneys with body waste, which is exacerbated by dehydration.

When your dog is done with a fight, he is flushing out the "broken pieces of himself" through his kidneys. Many times, the kidneys "shut down" and the dog will die, precisely because he's not passing this garbage or flushing anything.

The act of giving fluids, and the act of encouraging urination, actually accelerate the cleansing process to get that $#!^ out of the dog, and thus his body back to a clean, normal state.

This is also why you cease cortico-steroid use as soon as the dog is "up and eating" again, as well as pissing and shitting, because he is now capable of doing these things without drugs.

Quote:

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Originally Posted by Nut

3. What do you guys think of Voluven in case of hypovolemic shock. http://www.nps.org.au/__data/cmi_pdfs/CMI9946.pdf

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I have never used it, and for some reason the link isn't working for me.

Jack

Quote:

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Originally Posted by Macker

Great info, thanks for taking the time to share everyone.

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You're welcome :hatsoff:

Quote:

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Originally Posted by CA Jack

Quote:

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Originally Posted by Nut

Do you mean lbs? I said a dog can lose about one kilo over a day. Depending on strength of the drug and size of the dog. I have seen people weighing in a pound under from giving half a cc in the morning.

---

The fear of losing water is a legitimate one (especially water + electrolytes, etc.).

Even drinking a cup of coffee can cause you to piss several EXTRA times/day and get dehydrated, so shooting cortico-steroids (a pharmaceutical diuretic) should be taken seriously.

Pissing out an extra cup of water, a couple times/day, is very easy to envision ... and it adds-up quick.

1 cup = 8 oz = 240 ml = .25 k
2 cups = 16 oz = 480 ml = 1 lb of fluids
4 cups = 32 oz = 960 ml ~ 1 IV bag of fluids

This is absolutely why you need to be running fluids concurrently with any type of cortico-steroid therapy.

A bag of fluids = 1000 ml ~ 4 cups of fluid.

A dog might piss-out an extra few cups/day, so you must monitor what is happening with your animal, and it's all based on his size. Remember, all of this (the amount a dog pisses, the amount of drugs/fluids you give) is based on WEIGHT. If you monitor, and give the proper doses, it should be a seamless process, so there is no way ANY dog is going to "piss-out" more fluids than he's taking in, IF he's getting the proper amount of IV fluids throughout the day ...

Your concerns are also why you take the dog OFF these drugs, ASAP, as soon as they eat/piss on their own :idea:

Quote:

---

Originally Posted by Nut

Think you can't highlight those text enough. It could be a fatal mistake to inject these dosages any other way than intravenous and then find out you can't hit a vein thus cannot give enough fluids. I think you made a typo on the minimum Dexamethasone dosage.

---

I think the highlighting helps, definitely. As a key, as you read the article, realize that

Red = Warning
Green = Benefit

Still, a person needs to take the time to read the whole thing, digest, assimilate, and be willing to re-read the article. They say it takes 5 readings just to be able to remember 65% of anything we read ... so this material is serious enough to read, and re-read ...

You were right about the typo, thanks for pointing it out.

Quote:

---

Originally Posted by Nut

Seems I was wrong about the high end dosages. But it's a good thread anyway and I think the article only got better.

---

They do seem like crazy doses, but again we're trying to jump start the body, and save a life, so drastic doses are needed.

These drugs have short half-lifes, and are out of the body fairly quick, so it's an intense regimen to make a dog "snap out of it" (or, perhaps, back into it), to get him feeling good again, so that he goes back to normal. Once he's back to normal, there is no reason to continue these drugs.

And, I agree, if the end result is we ALL learn a little bit more, and refine our understanding, than that is the bottom line.

Quote:

---

Originally Posted by Nut

I have 3 questions regarding the subject.
1. When you use the high end dose of Dexamethasone; I suppose the dosage listed in the IV fluid therapy article will be increased?

---

No. That is what the original, bolus, dose is for in the IV Article ...

Keep in mind that, even when the dog is losing extra fluids, it isn't all at once ... but over several hours ... and fluids are going into him just as fast, or faster.

Further, this action of fluids-in/fluids-out actually helps flush the dog of all the "broken pieces of himself" that occurred in the fight, so it's a good thing, quite frankly.

Quote:

---

Originally Posted by Nut

2. Lot of times organs shut down and can take a while for the kidney's to start back working. If you're going to lose allot of fluids due high end dosages of Dexamethasone can't this be a big problem?

---

The #1 cause of kidney failure is dehydration. However, if you're running the proper amount of fluids into the dog, he is NOT dehydrated any longer.

Further, associate factors of kidney failure are "clogging" of the kidneys with body waste, which is exacerbated by dehydration.

When your dog is done with a fight, he is flushing out the "broken pieces of himself" through his kidneys. Many times, the kidneys "shut down" and the dog will die, precisely because he's not passing this garbage or flushing anything.

The act of giving fluids, and the act of encouraging urination, actually accelerate the cleansing process to get that $#!^ out of the dog, and thus his body back to a clean, normal state.

This is also why you cease cortico-steroid use as soon as the dog is "up and eating" again, as well as pissing and shitting, because he is now capable of doing these things without drugs.

Quote:

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Originally Posted by Nut

3. What do you guys think of Voluven in case of hypovolemic shock. http://www.nps.org.au/__data/cmi_pdfs/CMI9946.pdf

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I have never used it, and for some reason the link isn't working for me.

Jack

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Well said, I agree with everything Jack said, which begs the question. Why on earth dry a dog out completely depriving him of fluids and giving the kidneys a death sentence. Would you drain your radiatorbbefore a race?

Even though they have short half life dosage. My concern was fluid would withdrawal at a much higher rate as the dosage for anti swelling purposes. Thanks for giving a better understanding.

Hope this link works: Volvulen It opens in PDF so it probably doens't work on phone.

Quote:

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Why on earth dry a dog out completely depriving him of fluids and giving the kidneys a death sentence. Would you drain your radiatorbbefore a race?

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Because stupidity. But it was just to indicate the amount of fluid loss in short time.