Complaint about rectal diazepam

RE: Complaint about rectal diazepam

Bob Russell — Tue, 07 Jan 2020 10:45:39 GMT

Having been epileptic all my adult life, nobody has even mentioned the possibility of SUDEP!!!

Accompanied bathing was a bit of fun. Quite justified in case my head went under, not to reappear above the surface!

Nobody gives a to+s nowadays when I have a bath. (link to the thread about hearing aids etc?).

In the meantime I will be off to Google to see what people have kept from me!

RE: Complaint about rectal diazepam

Julian Earl — Mon, 06 Jan 2020 18:15:23 GMT

I thought that I'd posted this but it has goe if I do. Anway, I was told by a GP that diazepam is virtually impossible to give a toxic dose! Victims who try to take it as a suicide drug invariably fail and just fall into deep sleep for many days. I have always presumed it is the same for dogs? Although it can be acutely very hepatotoxic in cats, as far as I'm aware it does not happen in dogs. Ithink that something else must have been going on with this dog. A post-mortem is/was required I think. Sigs of lever damage rectal puncture circulatory collapse etc. Actual level of diazepam in the dog's tissues.

I have e-mailed VMD to ascertain if they received any or many adverse reaction reports after diazepam administration.

I might have to wait up to 15 days for a reply though.

HTH?

RE: Complaint about rectal diazepam

Julie Innes — Mon, 06 Jan 2020 13:17:33 GMT

Like everyone else, I have no doubt that it was not the diazepam that killed this dog! It is not on for her to be coming into the clinic to scream at staff, she needs to be made aware of that! I would write to her expressing sympathy but advising that you can't have her coming in to upset staff and clients. If she feels she has a genuine grievance she needs to go through the proper channels- I imagine dealing with the RCVS would be preferable than having her in to shout and scream!

RE: Complaint about rectal diazepam

Julian Earl — Mon, 06 Jan 2020 13:10:19 GMT

Since my post just above I have-mailed the VMD to try and get a definitive answer to this. I shall pass their response on in due course. I presume deaths would be notified as an Adverse reaction!!?

RE: Complaint about rectal diazepam

Julian Earl — Mon, 06 Jan 2020 12:44:10 GMT

dose of diazepam would very unlikely to have caused the death of the dog.

Are we sure? I was informed by a doctor that diazepam is reardedas ultra-safe in humans and excesive dosnig such as people trying to commit suicide always survive the diazepam but sleep for extraordinary lengths of time until it wears off. I had always hoped it was the same in dogs. Very, very difficult to overdose dangerously. I await correction or otherwise from someone. Thanks in advance..!

RE: Complaint about rectal diazepam

Stigen — Thu, 02 Jan 2020 15:51:28 GMT

Thank you for the response everyone! I am very happy to see that I did`nt do anything wrong. 12 years of small animal practice , and never really had any complaints before. Even if I don`t feel too much guilt it is such a headache cause my surgery is really busy these days, and this woman comes in every day to scream at receptionists and staff.And now she wants 5000£ from my clinic cause dog died.

RE: Complaint about rectal diazepam

Arlo Guthrie — Thu, 02 Jan 2020 12:11:24 GMT

[quote userid="12670" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28763/complaint-about-rectal-diazepam/218469"]There was probably some intracranial condition (tumor, thrombus, whatever) and he would have as well without his rectal diazepam.[/quote]

Or I wonder whether SUDEP (sudden unexplained death in epilepsy) is as likely in dogs as humans - where the person just dies for no apparent reason.

RE: Complaint about rectal diazepam

Silvia Maldonado — Mon, 30 Dec 2019 09:49:02 GMT

I agree. His death was not caused by an overdose of diazepam. There was probably some intracranial condition (tumor, thrombus, whatever) and he would have as well without his rectal diazepam. It's a bad coincidence.

RE: Complaint about rectal diazepam

Iain Richards — Sat, 28 Dec 2019 14:55:40 GMT

Nothing more to add, other than support.

RE: Complaint about rectal diazepam

Bob Russell — Fri, 27 Dec 2019 11:58:12 GMT

Unless the owners managed to stick something through the rectum and trigger disastrous bleeding then there is not a lot the diazepam Never seen or heard of this happening!

Absorption is not that great so I doubt blood levels would show any diazepam in the circulation so unlikely to be related to the diazepam.

Just had a seizure, probably related to a brain lesion, popped its clogs at a very inconvenient moment, shortly after having diazepam administered.

Therefore coincidence the likely explanation.

Write this out, send it to Vet defence for a bit of tweaking and the owners can complain as much as they like!

Bad luck and unfortunate timing.

I would state sympathy for their loss and regret that the diazepam did not have time to work!!

Hope you have a better New Year but now't as queer as folks!

RE: Complaint about rectal diazepam

Julie Turner — Thu, 26 Dec 2019 17:49:59 GMT

Dear Stigen

so sorry that you have this case hanging over you at this time of year in particular. It sounds very much like the dog had had an extended period of medical neglect but it’s pretty difficult to convey this to owners, particularly once it had died and in the natural course of grief they would be looking for someone or something to blame - in this not unusual instance the vet!
I would have followed a similar course to you and since there’s a few of us on this forum saying the same, you have a body if backing, I would also agree to be sympathetic but don’t accept any blame. Write it all down and contact the VDS at the soonest opportunity - they are usually extremely reassuring and helpful.
Best Wishes, Julie

RE: Complaint about rectal diazepam

Gillian Mostyn — Wed, 25 Dec 2019 12:35:07 GMT

Your treatment and prescribing were fine, and extremely unlikely to have been the direct cause of its death. Whatever caused it to start having seizures at 15 yrs old caused it's death.

The owners are just upset and looking to lay blame somewhere that isn't them. (Sometimes there is more than meets the eye with these cases, such as longer term illness than they admitted).

Try to simply feel sympathy for the owners and enjoy this festive period. Merry Christmas.

RE: Complaint about rectal diazepam

Stigen — Wed, 25 Dec 2019 09:52:11 GMT

Thank you very much :) Merry christmas!

RE: Complaint about rectal diazepam

Stigen — Wed, 25 Dec 2019 09:51:35 GMT

Thanks :) I also feel strongly that this patient was handled appropriately, and will respond to this effect to the woman.

RE: Complaint about rectal diazepam

Neil Wheadon — Wed, 25 Dec 2019 00:21:25 GMT

I have locummed in lots and lots of places including working for Vets Now for 9 years and can’t think of a practice without this drug in the drugs cupboard. Conclusion that it’s use is widespread and I would use it. So let them write a letter, get it off their chest, politely reply and move on because you have done what everyone else would do. Merry Christmas Neil

RE: Complaint about rectal diazepam

Sara Ramsey — Tue, 24 Dec 2019 22:18:36 GMT

Sorry to hear you have this hanging over you at Christmas. I would also be thinking along the lines that a 15 year old dog having seizures probably had a serious underlying cause, such as an intracranial lesion. My thoughts would be that dose of diazepam would very unlikely to have caused the death of the dog.