Abstract

New techniques for the diagnosis and treatment of pneumonia, such as lung aspiration and endotracheal antibiotics, will be presented. The medical management of sepsis and liver disease will also be briefly discussed. Emphasis will be placed on those diagnostic and therapeutic modalities that may be applicable for use in marine mammals.

Notes

Pneumonia: Pneumonia in marine mammals is caused by a variety of agents. Staph aureus, Klebsiella, Pseudomonas, anaerobes, Nocardia and other enterobacters can cause pneumonia, and all of these survive well in water.

Diagnosis

• Gram stain of the following

  • Routine sputum

  • Transtracheal wash

  • Lung tap - 25 gauge spinal needle, 1 cc saline injected into lung, then aspirate. Yield is good, no complications.

• Chest X-ray

• Sputum culture - tells a few days later which antibiotic is best.

• Blood culture - important.

Summary

A gram stain followed by the appropriate antibiotic or antifungal is first performed. The cultures are seen a few days later and if drug sensitivity indicates, the antibiotic is changed.

• Liver

  • Liver function tests:
    Cell necrosis SGOT, SGPT, GOT/GPT ratio, LDH, LDH-V, OCT, SDH, guanase, ICD, AD. Cholestasis Alkaline phosphatase Alkaline phosphatase isoenzyme and others.

  • Liver biopsy
    This is simple to perform and has few complications. It excludes hepatic disease in apparent hepatomegaly, and can rule out pre and posthepatic jaundice. Liver biopsy is contraindicated in:

  • uncooperative patients

  • depleted prothrombin status

  • local (i.e, skin) infection

  • ascites. This should be tapped since the gastrointestinal tract floats in ascitic fluid.

  • obstructive liver disease where bilirubin level exceeds 10. The pressure causes bile to leak out post-biopsy

  • anemia

  • prolonged bleeding from the incision

Complications include liver subserosal hemorrhage. Viral hepatitis can occur in marine mammals after contact with sewage contaminated water. There is an antigen available to detect hepatitis A and most labs will do this on a serum sample.

Septic Shock

At least 80% mortality occurs in septic shock cases. Solu-Medrol is the only steroid which has action on blood vessels. The others don't work well at decreasing vessel permeability during septic shock. Solu-Cortef has some action on vessels but the other steroids, especially dexamethazone, are useless.