What Sent Kuma to the Emergency Hospital?

Here's the short version that I just figured out yesterday: The antibiotics I was giving Kuma sent her into a continous seizure and coma.

Their effect was reversable in 2 to 7 days. The drug warning says to use with caution on dogs  with previous history of seizures. This antibiotic and the pain pill I gave Kuma both are listed on the epilepsy website as drugs that can cause seizures.

Kuma was sent into continuous seizures because of the medicine I was giving her.

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Kuma's last seizure was 14 days ago and each time I was able to shorten it with ice packs on her back. Now with Valium we had an even better chance. So why did she all of a sudden go into a continuous seizure?

At around 9 pm on Saturday night, October 3rd, 2015, Kuma had a seizure while I went out for groceries. It was the first time ever that I was not with her during a seizure. When I came back she was passed out unconscious with her tongue hanging out and unresponsive. She had both peed and pooped herself. It looked like a really bad seizure but it had stopped on its own. Kuma had never lost consciousness before right after a seizure so this was the first. She regained consciousness in 45 minutes and in 5 hours was walking and drinking water.

Earlier that evening, I gave Kuma a half tablet of Tramadol at 6:30 pm. I had also started her on an antibiotic called Semplicef three days earlier.

At 12 midnight, I gave Kuma her fourth tablet of Simplicef an antibiotic for her boil on her right lip. Its a pill that is given once every 24 hours.

At 2:40 am Kuma went into 4 violent seizures and then continuous seizures and into unconsciousness and later a coma from which she only woke up two days later just before being put to sleep.

There really seemed no reason or outside cause why this happened. The only difference was the antibiotic.

Well yesterday, I researched and found that this antibiotic is normally safe and is used to treat skin infections, but the first caution is to be careful with dogs with previous seizure history.

Here is what I found:

Simplicef is a brand name for the generic Cefpodoxime proxetil which is a third generation cephalosporin. And this is what NIH says about it:

Cephalosporins

Neurotoxicity has been reported with first generation cephalosporins such as cefazolin, second generation such as cefuroxime, third generation such as ceftazidime and fourth generation such as cefepime and can range from encephalopathy to non-convulsive status epilepticus [13] (Table 1). This is particularly true in the setting of renal impairment though cases also exist in those with normal creatinine clearance. Previous CNS disease has also been suggested as decreasing the threshold of nervous system toxicity with use of third and fourth generation cephalosporins [14]. In addition to pre-existing CNS conditions, reduced creatinine clearance, impaired renal function and excess dosage of medication have been described as independent risk factors for neurotoxic effects [15]. The typical time period for encephalopathy induced by cephalosporin use is a latency of 1 to 10 days following start of medication, and resolution in 2 to 7 days following discontinuation [16].

Clinical presentations of cephalosporin-associated neurotoxicity include tardive seizures, encephalopathy, myoclonus, truncal-asterixis, seizures, non-convulsive status epilepticus (NCSE) and coma [13]. One case series described eight patients who developed neurotoxicity with use of cephalosporins in the setting of renal failure. Their myriad of neurological symptoms included lethargy, confusion, agitation, global aphasia, chorea-athetosis, seizures, myoclonus and coma, which were slowly progressive in evolution. EEGs of all patients demonstrated diffuse slowing with triphasic waves suggestive of toxic-metabolic encephalopathy (without any epileptiform features) [17]. Mortality was high in all cases.

Here is the study:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175508/   Neurotoxic effects associated with antibiotic use: management considerations

 

Also here is a website that lists drugs that can cause seizures:  https://www.aesnet.org/sites/default/files/file_attach/ClinicalResources/PracticeTools/MedsthatProvokeseizures/drugsthatcancauseseizuresup72009.pdf

Both Simplicef and Tramadol are on this list, the two drugs I gave Kuma her last night at home before going to the hospital.

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At the hospital, Kuma was given Manitol to help reduce the inflammation in her brain. Manitol is basically a sugar that is also a deuretic. But its most special quality is it is one of the few chemicals that can pass through the blood brain barrier - a strong barrier which filters out any small and large chemicals that should not go to the brain and does not let the normal blood supply go into the brain. I am wondering if her brain had inflammation which would comprimise her blood brain barrier and Manital is able to transport itself through this barrier, did this allow the Simplicef in her blood which would now be at their highest levels to get through to the brain? The way this antibiotic works is it brakes down cell membranes of bacteria and if it got into the brain, it may have broken down any bacteria there from an inner ear infection and caused bleeding. I am not a doctor and this may be a stretch and totally wrong but I wonder if this is what happened and why the Valium was not effective in stopping her seizures.

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Kuma had tolerated Tramadol before but it made her very anxious for two hours after taking it, to the point where I had to give Valium to calm her down. I mentioned to her vet a week ago that I read studies that Tramadol can trigger seizures because it is 25% opiate and causes excitablity and she said there are many studies that say different things and old people need reading glasses. The only other pain pill for Kuma was Gabapentin and the vet said that this may have caused her previous seizures.

Kuma was doing the best she could and the medicine is what made her sick starting with the too deep anasthesia which started causing the seizures in the first place, the Gabapentin which caused more anasthesia to be required, the Tramadol that possibly provoked her 9 pm seizure and then the antibiotic to send her into continuous seizures and coma. I then gave her 14 Valiums and then at the hospital they gave her tons of Valium and Phenobarbital which sent her into a deep coma. The induced coma I think was actually good because it gave her brain a rest and a chance to heal. She was expected to wake from the coma in 3 to 4 days, but I woke her up aftter only 48 hours and because she wasn't given her anticonvulsant she got excited and went back into a continuous seizure again. Then she was immediately put to death. Kuma did her best to recover, it was people who took away her chance to live. People who thought she should be "let go" without any knowledge of what was actually going on.