Hepatic injury secondary to diazepam?

RE: Hepatic injury secondary to diazepam?

Kara Gibson — Wed, 30 Sep 2015 06:15:25 GMT

Indeed it is not licensed in cats but as far as I am aware there is no licensed diazepam in cats.

RE: Hepatic injury secondary to diazepam?

Aine Seavers — Wed, 30 Sep 2015 02:47:16 GMT

I didnt think the Ilium one was licenced for use in cats and certainly not i/v esp as it has propylene glycol in it-does your Hong Kong registration for that drug include cats as it can differ from region to region-p.glycol normally more an issue with the kidney but we dont use it in cats and we discard within the 90 days once opened or well before that as so cheap that I like to discard it within 28 days since its going i/v.

RE: Hepatic injury secondary to diazepam?

Silvia Maldonado — Wed, 30 Sep 2015 01:05:28 GMT

[quote user="Kara Gibson"]

I am aware of this but everything I had read referred to repeated oral administration in cats causing hepatic necrosis.

I am based in Hong Kong, the brand we have is called Ilium

[/quote]

Me too. Afaik, the issues of liver necrosis only happens when diazepam is administered orally. However, given that the half life of ALT in cats is just 6h, I would consider repeating the biochemistry in 24-48h, and check if there is any remission or it is an ongoing injury. High ALKP in cats are more consistent with hepatic lipidosis, though. Checking if there is a low TP, specially albumin, can help ruling in or out a chronic liver disease as well.

RE: Hepatic injury secondary to diazepam?

Martin Atkinson — Tue, 29 Sep 2015 10:08:32 GMT

My understanding that liver toxicity occurred after long term oral therapy not a single dose of diazepam.

To diagnose liver disease you need a bit more than a raised ALT, so I would want Tbil, BA, proteins and GGT.

This cat is only 6 but it has a heart murmur. I know that they are usually hyperactive and hypertensive with hyperthyroidism but not always so thinking outside the box with a raised ALT I'd be feeling for goitres and get a T4 as well. Any history of weight loss previous polyphagia? Just a thought.

RE: Hepatic injury secondary to diazepam?

Kara Gibson — Tue, 29 Sep 2015 09:10:41 GMT

It is a multi-use bottle that has been open for under a month. I believe it was given as a bolus and the dose given according to the invoice was 5mg (which seems like quite a lot to me).

RE: Hepatic injury secondary to diazepam?

Aine Seavers — Tue, 29 Sep 2015 08:22:18 GMT

is it a single vial or a multi dose bottle?

How much has been used if the latter?

Did he give it as a bolus or via catheter ?

RE: Hepatic injury secondary to diazepam?

Kara Gibson — Tue, 29 Sep 2015 08:16:17 GMT

I am aware of this but everything I had read referred to repeated oral administration in cats causing hepatic necrosis.

I am based in Hong Kong, the brand we have is called Ilium

RE: Hepatic injury secondary to diazepam?

Aine Seavers — Tue, 29 Sep 2015 08:06:18 GMT

which brand of diazepam- the liver issues were not recorded with the Roche valium brand but were very much with a generic- do you have the name of the specific formulation she used?

RE: Hepatic injury secondary to diazepam?

Fable — Tue, 29 Sep 2015 08:05:24 GMT

How common is this? And in relation to what sort of doses? Curious as my clinic frequently uses diazepam/ketamine for anaesthetic inductions.

RE: Hepatic injury secondary to diazepam?

Kate Richardson — Tue, 29 Sep 2015 07:15:42 GMT

Just quickly- Diazepam has been reported to cause hepatic necrosis in cats- there are some papers on it. Can be fatal just to warn you.