DEBATE ON DEX / SOLU-DELTA / CORTICO-STEROIDS

[Officially Retired]

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

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 ...

[Black Hand]

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

[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.

[bulldoghistorian]

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.

just put in the vein in the neck

[Officially Retired]

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.

That's what I thought.

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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

But 10 times the dose? That's ridiculous.

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

[bulldoghistorian]

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

[Nut]

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

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

[bulldoghistorian]

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

i follow my vet advise 4mg/kg

[Officially Retired]

i follow my vet advise 4mg/kg

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

[Officially Retired]

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.

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 (), and 2) that, in fact, my dosages are correct.

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

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.

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

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.

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

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.

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.

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

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.

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.

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

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.

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