Running head: SEZURING DOG 1

Case Study: Seizuring Dog

Rebecca M. England

Tarleton State University

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A long-term client calls our clinic regarding his 3-year-old Springer spaniel, named

Chase. The owner reports that Chase is on the kitchen floor shaking and kicking, in addition to

urinating and defecating. The owner also mentions that he has been doing this for two minutes,

he is not improving, and he has never seen him do anything like this in the past (Rockett &

Christensen, 2010).

Information should be given over the phone to help the owner in helping his pet and

protecting himself from physical harm. The owner should attempt to transport his pet to the

clinic as soon as possible, as a seizure that is not resolving can be a life-threatening emergency;

the help of another person may be useful in moving him to a vehicle. The owner (and assistant)

need to be cautious, especially when handling the pet, to prevent the possibility of being bitten.

Some pets exhibit flea-biting movement behavior of the mouth, so people or other animals

nearby may become injured. Placing a light towel temporarily over the pets face may calm the

pet, allow for easier transport, and assist with bite prevention. The owner should avoid any

attempts to give the pet any oral medications as well, to avoid being bitten. If possible, the owner

should also surround the patient with ice or cold packs, as this will aid in the prevention of

hyperthermia which may be caused by the prolonged seizure. Avoiding loud sounds may also be

helpful during this time, such as talking in a quiet voice and turning down the car radio; these

may help the pet be less reactive to stimuli during the seizure.

Seizures are not always emergencies. Those patients experiencing multiple seizures

without an intervening period, or whom continue to seizure without stopping or improvement

should be considered and treated as true emergencies. These patients require immediate

stabilization because they are at risk for developing hyperthermia, permanent neurological

damage, cardiac arrhythmias, pulmonary edema, and hypoxemia (Battaglia, 2007). In terms of
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the subject of this case study, Chase requires immediate medical attention because he continued

to convulse and was not improving. If the owner came home and found signs that the pet may

have had a seizure (such as urine or stool on pets coat or the floor, bruises on the body, bleeding

tongue, etc.) monitoring the pet at home may be an option, if the pet was now behaving

normally. The pet should still be seen by a veterinarian to rule out other problems; bloodwork,

monitoring, or other things may be recommended after a complete physical exam. However, if

the patient looks and behaves normally after suspect seizure activity, it is probably not necessary

to get the pet seen by a veterinarian immediately.

The acronym, LOC, stands for level of consciousness. The LOC is a measurement of a

patients arousability and responsiveness to stimuli from the environment (Norkus, 2012). There

are six levels of consciousness:

1. Alert: bright and responsive

2. Depressed: quiet, but responsive
3. Delirium / dementia: inappropriate response to stimuli
4. Obtunded: decreased alertness with arousable periods
5. Stuporous: unresponsive, except to painful stimuli
6. Coma: unresponsive to any stimuli

These terms have been described above, and they can be useful in helping us evaluate our

patients when comparing these standards to what is considered normal mentation for these

patients at home.

Seizures result from abnormal electrical activity within the brain. They may be congenital

or acquired later in life. Another name for a seizure episode is a convulsion (Rockett, et al.,

2009). Prolonged seizure activity is called status epilepticus (Moore & Rudd, 2008).

The owner brings Chase into the clinic. Chase is no longer thrashing and kicking but still

has some uncontrolled muscle movements and seems very disoriented (Rockett & Christensen

2010). Because of the signs that Chase is exhibiting now, he is in the post-ictal phase. There are
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three time periods associated with a seizure: the pre-ictal period (before the seizure), the ictus

(the actual seizure), and the post-ictal period, which occurs after the seizure (Rockett, et al.,

2009). During the post-ictal period, clinical signs (other than what Chase is already exhibiting)

may include (Rocket, et al., 2009):

1. Weakness
2. Blindness
3. Depression
4. Nervousness
5. Pacing

Residual twitching may also still occur after the primary muscle tremors have resolved. Any of

these clinical signs may be present up to a few hours after the ictus; however, they may last for

days, depending on the severity of the seizure and the underlying cause.

Upon physical examination, Chase is found to have a HR of 145 bpm, RR panting, and

T of 103.8 F. He is still having neurologic signs, has a few scrapes on his left shoulder, hip and

muzzle, and is dirty from having urinated and defecated on himself. He currently weighs 45

pounds (Rockett & Christensen, 2010). At this point, it would be difficult to do a thorough

neurologic physical exam on Chase because he is in the post-ictal phase. During this phase, as

just discussed previously, disorientation and other neurologic deficits may be present (Battaglia,

2007). The presence of any of these signs would alter the accuracy of the neurological exam.

The cause of Chases hyperthermia is easily explained, as dogs that exhibit seizures

secondarily are succumbed to hyperthermia. As seizure activity occurs, the prolonged rapid

muscle contractions and activity cause the body to overheat (Rockett, et al., 2009). In addition,

because the body is in a convulsive state, it is unable to activate natural cooling mechanisms

such as panting. Other technician assessments that are related to prolonged or consecutive

seizures include (Rocket, et al., 2009):

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1. Altered mentation
2. Hypovolemia
3. Risk of aspiration
4. Anxiety
5. Inappropriate elimination

Depending on the severity and whether they are resolving, some of these problems may need to

be addressed with medical intervention that may include monitoring, blood work, IV fluid

therapy, and administration of anticonvulsant medications.

Mr. Castro leaves Chase at the clinic for monitoring, blood work, and IV fluids. He was

cleaned up and had an IV catheter placed in his cephalic vein, and is now receiving IV fluids.

Your veterinarian gives you a standing order to administer 0.5 mg/kg of 5 mg/ml diazepam IV if

Chase seizures again. An hour later, Chase has another seizure (Rockett & Christensen, 2010).

Calculation of diazepam 5 mg/ml:

45 # dog dosed at 0.5 mg/kg

45 # / 2.2 = 20.45 kg
20.45 kg x 0.5 mg/kg = 10.22 mg
10.22 mg / 5 mg/ml = 2 ml

Given the calculation steps above, Chase would receive 2 ml of diazepam IV.

After this seizure, Chases temperature is 105 F (Rockett & Christensen, 2010). There are

several technician-driven interventions that could be initiated to address Chases hyperthermia.

These include:

1. Cooling the extremities with the application of isopropyl alcohol to the feet, tail, and ears
care must be taken to not get alcohol in the eyes and prevent the fumes from being
inhaled by the patient

2. Placing a damp towel over the trunk of the body and placing ice packs near the flanks,
axillary regions, and groin

3. Administration of room temperature IV fluids

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Hyperthermic patients should be cooled (Moore & Rudd, 2008). This will help prevent the

negative and possible permanent side effects that may be associated with a prolonged elevated

temperature.

Chase is monitored for the rest of the day and throughout the night, and has no more

seizures (Rockett & Christensen, 2010). In addition to monitoring for seizures, it is important

that Chase be monitored for other possible problems. These things may include (Rockett, et al.,

2009) and (Tilley & Smith, 2011):

1. Respiratory distress or depression

2. Hypoglycemia
3. Changes in behavior or decline in LOC
4. Pre-ictal signs including nervousness, pacing, or whining
5. Increased liver values (or other blood work abnormalities) due to anticonvulsant drug
therapy
6. TPR and BP regularly to assess patients status regularly

Chases blood work values are all within normal ranges and there is no sign of his seizure being

caused by a toxin or trauma. He is diagnosed by the veterinarian as having idiopathic epilepsy.

He is started on phenobarbital (Rockett & Christensen, 2010). Client education should be

provided to the owner regarding his medication regimen and care at home. Chase should be

monitored for recurring seizures at home indefinitely; and even when Chase is at home alone, the

owner should look for signs associated with seizure activity (as discussed previously) when he

returns home. It is also important that Chase should not be allowed to swim, since he is on

anticonvulsant therapy this is to prevent the possibility of drowning (Rockett, et al., 2009). The

owner should keep a seizure log or calendar at home that details the date, time, severity, and

length of any seizures he may have (Tilley & Smith, 2011). This can help the owner and

veterinarian determine whether the anticonvulsant medication is working.

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The owner should not skip doses of medication unless told to do so otherwise, even if his

pet is doing well and not having seizures. Doing this may suddenly cause Chase to seizure. When

starting phenobarbital, the patient may be drowsy or agitated for several days to weeks. As their

body adjusts to the medication, these signs should resolve (Plumb, 2011). If it doesnt, the owner

should notify the veterinarian, as a trial of another medication may be necessary. Chase may also

exhibit increased thirst, urination, and appetite, which should also resolve over time. Regarding

long-term medication use, Chases liver values should be monitored regularly (Tilley & Smith,

2011), as anticonvulsant therapy may cause liver problems. It is also important for the owner to

understand that even with the use of medication, the seizures may not go away or resolve

completely. Unless the cause of the seizures is determined, it can be difficult to control them. So,

the goal of medication is to reduce the frequency, length, and severity of the seizures, so as to

improve the quality of life for the patient.

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References

Battaglia, A. (2007). Small animal emergency and critical care for veterinary technicians, 2nd ed.

Philadelphia, PA: Saunders.

Moore, A. H., and Rudd, S. (2008). BSAVA manual of canine and feline advanced veterinary

nursing, 2nd ed. Gloucester, UK: British Small Animal Veterinary Association.

Norkus, C. L. (2012). Veterinary technicians manual for small animal emergency and critical

care. Ames, IA: John Wiley & Sons, Ltd.

Plumb, D. C. (2011). Plumbs veterinary drug handbook, 7th ed. Ames, IA: Wiley-Blackwell.

Rockett and Christensen (2010). Case Studies in Veterinary Technology: A Scenario-Based

Critical Thinking Approach. Heyburn, ID: Rockett House Publishing LLC.

Rockett, J., Lattanzio, C., and Anderson, K. (2009). Patient assessment, intervention, and

documentation for the veterinary technician. Clifton Park, NY: Delmar Cengage

Learning.

Sirois, M. (2010). Principles and practice of veterinary technology, 3rd ed. St. Louis, MO:

Mosby Elsevier.

Tilley, L. P. and Smith, F. W. K. Jr. (2011). Blackwells five-minute veterinary consult: canine

and feline, 5th ed. Ames, IA: Wiley-Blackwell.