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PROTOCOL
FOR THE EMERGENCY
MANAGEMENT OF CLUSTER
SEIZURES IN
DOGS
This
protocol combines 2
approaches for the
emergency management of
cluster seizures in dogs
at home and has proven
to be very effective.
Valium and its generic
name diazepam are used
interchangeably
throughout. As always,
consult with your
veterinarian before
trying anything
different.
Something
which has been highly
effective is to add oral
valium to the liquid
valium to maintain the
level until you feel
that the cluster period
is past for a safe
period.
The
other approach is to
administer an extra dose
of whatever
antiepileptic drugs
(AED) the dog is on
after the 1st seizure
and after each
successive seizure in
the cluster.
Some
key points:
- You
must hit the cluster
as early as possible
with administration
of the liquid valium
administered rectally
to be most effective.
Liquid valium should
be administered
rectally immediately
after the 1st seizure
or definitely after
the 2nd seizure
within a relatively
short period of time,
say 30 minutes or
less. The more
seizures that they
have in a cluster
before starting
treatment, the harder
it is to break the
cluster. Dr. Podell's
article has
guidelines of a low
dose of 0.5mg/kg to a
high dose of
2.0mg/kg. It is
important to use
valium or the generic
equivalent diazepam.
There are other
varieties, i.e.
oxazepam that have
different half lives
and periods of
efficacy and do not
apparently work as
well.
- ABSOLUTELY
necessary to be
effective is to hit
the cluster hard with
enough liquid and
oral valium. You are
not going to kill
them by giving them
too much valium
unless you gave them
massive doses. There
are guidelines in Dr.
Podell's article on
his research on the
use of rectal valium
on how much to use
per kg of the dog's
weight.
These
guidelines are a low
dose of 0.5mg valium
per kg of dog's
weight to a high dose
of 2.0mg valium per
kg of dog's
weight.
- Maintain
valium administration
with oral doses once
the dog comes around
and can swallow the
tablets until you
feel they have gone a
"safe" period seizure
free. This "safe"
period would normally
be at least 12 hours,
perhaps as long as 24
hours depending on
the individual case.
For a 100lb dog
(±45kg), this
maintenance dosage
would be about 30mg
of valium every 3
hours, again needing
to be adjusted for
the individual
case.
NOTE:
The only difference
with the use of the
rectal and the oral
valium is how quickly
it gets into the
bloodsteam and is
effective. The liquid
valium administered
rectally is absorbed
quickly and begins
being effective
within 10 minutes,
whereas the oral
valium could take 30
minutes or longer.
Also, the liquid
valium can be
administered rectally
even while the dog is
having a seizure,
which would not be
possible with the
oral valium.
Therefore, liquid
valium is used
rectally for the 1st
dose to start having
an effect to break
the cluster as
quickly as possible.
After the 1st dose of
rectal valium, you
can use the oral
valium to maintain
the
level.
- Valium
has a short life,
therefore you need to
give additional oral
valium every 3 to 4
hours to keep the
level
up.
- After
the 1st seizure and
again after the 2nd
seizure, (if the 2nd
follows within 4
hours of the 1st,) an
additional dose of
the AED drugs is
administered (in this
case, Pb and
Kbr).
In
summary:
a)
during the 1st seizure,
administer liquid valium
per rectum in a dosage
at least equal to the
recommended low dose.
After your dog has
started to come out of
the seizure and you feel
they can once again
swallow safely,
administer additional
oral valium tablets to
bring the total dosage
of combined rectal
liquid valium and oral
valium tablets into at
least the mid-range of
recommended dosages. At
the same time,
administer an extra dose
of the antiepileptic
drugs that they are
normally on.
b)
if a 2nd seizure occurs
within a fairly short
period of time, say
within 4 hours, repeat
step a).
c)
if there is not a 2nd
seizure within 3 hours
after the 1st,
administer additional
oral valium to maintain
the level. Continue
every 3 hours until you
feel the emergency has
passed, usually for the
period of the next 12 to
24 hours
NOTE:
Once again, you should
always consult with your
veterinarian. The
dosages and timing of
administration would
need to be adjusted to
your individual case.
The key point is use of
the rectal valium early
in sufficient dosage to
be effective, followed
by oral valium to
maintain the level, and
additional dosages of
the AED that your
particular dog is
on.
The
main approach this
protocol is based on is
described in Dr.
Podell's
article:
Podell,
M. The use of diazepam
per rectum at home for
the acute management of
cluster seizures in
dogs. J Vet Int Med
(1995)
9:68-74.
The
address for reprint
requests is:
Michael
Podell,
DVM
Department of Veterinary
Clinical
Sciences
601 Tharp
Street
College of Veterinary
Medicine
Columbus, OH
43210
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