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KBr Side Effects?

Species: Dog
Breed: German Shepherd Lab
Age: 5-8 years
I read your answer about seeing severe side effects of KBR and would like your opinion on Rigby, rescued at 2, began monthly idiopathic epilepsy seizures at 5, he now is 7. He was started on phenol, which was upped as seizures more weekly than monthly. With limited success and huge weight gain, kepra was added. 4 months clean (yay)so the phenol was lowered, but weekly seizures started again. (3-4 times has had 2 consecutive seizures, but valium supp was used at home and that seemingly stopped it. All seizures were 30-90 seconds in length abnd 3-5 minutes post-ictal recovery.) Seizures continued weekly so kepra was upped to 750 mg x2, 3 times a day, and medium phenol kept (more than started but less than at its highest.) 2 months ago thyroxin was added due to a different staff vet seeing an older lab test result and wishing it.

Last week sorta out of the blue, Rigby had a seizure and kept having them. Valium supp did nothing. Due to distance and a car accident he was admitted to ER 80 minutes later, meanwhile 18 1-3 minute seizures were counted, temp was 108. IV valium did nothing altho they got temp down to 103 then 101. But it took continued propofol to cease them. Doc was fatalistic and I said my goodbyes. But he hung on, as KBR megadoses were adminsistered. He had 1 seizure controlled by valium the next morning and then 1 that needed propofol right after, but then went 30 hours seizure-free and was released to home.

Besides ALL his regular meds, Rigby was also given 6 x500mg KBR "loading dose" twice daily for 3 days, we are in day 2. I understand extended post-ict-phase, KBR sedation and side effects, brain damage, muscle and joint soreness/injury, and just being worn out can add up to make him a sorrowful pup. He's all that, barely knows me, looks confused and disoriented when not fully sedated/napping, voracious agressive eating and drinking, and ataxia so bad he could not stand up altho he tried, sitting a little, and was helped but no go. Bathroom accidents a plenty. It seemed like sure brain damage and/or paralysis and/or joint injury.

This morning before his KBR dose he got up and walked around the house, peeing in 2 places. Minutes after the dosage he was back to slumped down very bad ataxia frequent disorientation, misery plus. I contacted the vet and we agreed to change the KBR load dose to 5 x500mg twice daily, scared less would allow seizing to return.

Tonite as the morning dose wore thin Rigby got up and walked a bit, and like one of your recent inquiries also KBR-related, kept trying to squeeze into small places, nose first, very unresponsive, intermittent confusion and eyes looking distant at nothing, and by the way he's 120 lbs of lovable unyieldy cement bag. I gave him his nighttime 5 KBR without much enthusiasm, and eventually he slumped on the floor from the last corner I pulled him out of, and has been internittently dozing and waking and not moving from spot and disoriented for hours. BTW he hasnt pooped in 3 days altho ate LOTS!

I know an MRI and nuerologists would be nice but can't afford it, already has been a costly nightmare. My question is this please and sorry for the lengthy but hopefully thorough background: What is the likelihood these disturbing symptoms are mostly related
to the KBR effects rather than brain damage or something else? If it is some brain damage, is that likley to get better with excess TLC and retraining or a probable waste of time? If it is likely KBR-related am I near the point where I double-beg the vet to lower the KBR and take the risk and consequences of cluster-seizure return on? TY!

Online vet, Dr. Marie

Dr. Marie replied:

Oh this is a really difficult situation. I have to tell you that my least favorite cases have been seizure situations like you have been through. It is a horrible feeling as a vet to have a dog seizuring in front of you and nothing you are doing is working. I am so pleased that Rigby survived this. But now the question is whether or not he is going to return to normal afterwards.

Unfortunately no one knows the answer to this question. There are three likely explanations for the unusual behavior that we are seeing with Rigby now:

1. There may have been brain damage after the long seizure.

2. Rigby may be having an extended post-ictal phase where he is feeling very disoriented.

3. These may be side effects from the KBr.

There really isn't a way to tell the difference.

I really think though, at this point we don't have many options. If we lower the potassium bromide dose too quickly then we are much likely to go back into seizure mode again. Another bout of uncontrollable seizures is likely to be fatal.

The best thing that I can advise is to do what you are already doing and work with your vet to lower the dose at a rate that they feel is safe.

The only other option at this point would be to consider euthanasia, but I can't see that being fair after all that you and Rigby have pulled through already.

I think that there is a decent chance that what you are seeing is temporary. I think there is a good chance that given some time (perhaps a few days or even weeks) you and your vet will be able to lower the bromide dose enough so that there aren't as many side effects and Rigby will feel better.

The symptoms should continue to improve from day to day. If you feel that they are getting worse or if there has been no improvement in a week or two then I think you may need to discuss euthanasia with your vet.

I really hope things improve soon. Please let me know if you have more questions.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you Dr. Marie for your kind thoughts and learned helpful reply.

Customer reply:

Hi DR. Marie.
It's NO problem at all to start a new question and do a new PayPal, for this sort of follow-up. I know you are a dedicated wonderful person, but your time effort resoources are of course limited and very valuable way beyond your kind pricing, and you have expenses! So let me know.

My Vet clinic and I use several of their 7 docs and they are a good place for pet treatment but there is more redtape, delays, and such to do a face-to-face talk with an overloaded rushed doc, that it becomes almost impossible for the client (or one shy like me). I wish THEY had an email consult service! What a great idea!

I really didn't get an answer to the brain damage scenario, which I suspect is some (maybe all) of the hard-to-tell problem. At 60 bending down constantly to stroke and talk and try to reassure him and get him to recognize me and try to get him to stand up and such...takes a huge toll, but I am willing if going the extra mile might be helpful, like reading to someone in a coma, etc. He actually seems worse and less responsive today, and I am more suspicious of brain problem than ever, but what i've learned from you and others about medicine side effects, esp KBR, gives me hope it may pass. But I would think that THAT hopeful scenario would find him doing better even 1 day later, and so forth, but:
So Rigby got all excited after one nose-in-a-corner episode last nite, and was up and shakily walking. He is obviously very weak and ataxic. Twice when he stood moved 2-3 steps and peed in the house and I put a pot under him, he eventaully just collapsed on top of the pot, I think from the strain, not sure.
Suspecting bathroom needs (he hasnt pooped in 3 days now) when I removed him from nose-in-cormner he headed towards front and I let him outside and he wobbly went(unfortunately extreme cold right now here NJ). After I grabbed my coat and went outside, I found him laying across the street and wouldnt get up. I half dragged half carried him back, i dont think he did his business but probably wanted to. This was repeated again a few minutes later, i sensed bathroom needs and let him outside. This time he sorta walked 8-9 steps when i lifted his butt and pushed or directed him and finally got inside.

Most of the nite he alternated between dozing peacefully, asnd lifting his head and looking into space and from side-to-side, perhaps enjoying my affection when I conforted him but not really recognizing me, although I did seem to be able to get him back to napping with enough attention. He sometimes sensed when I left and would start his head bobbing over.

Unlike yesterday morning when he got up and walked and peed twice (before meds) he was in same spot this morning, before meds, with less appetite, less recognition, and less movement than yesterday. Its 2PM almost he is still in same spot, he ate a little plus I gave him his chewable KBR. He's ultra fussy but ate these 2 days ago but now wouldnt touch them (return to normal, haha?) so i had to hide it in food. But my question is, besides the general futility (or NOT?) if there is a fair amount of brain damage and whether this seemingly worsening suggests anything (or maybe he is still worn out from last nite, but 18 hours in one spot seems bad) - is what efforts by me might really be helpful enough to continue if I can. I mean I can leave him sitting there sometimes dozing sometimes looking miserably intospace and from left to right, for hours, not moving. Or I can engage him, or try to, try and make him stand, recognize me, look at me, etc. THANK YOU AGAIN!

Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome. I feel so badly for owners in your type of situation.

I think the reason why no one can answer your questions about whether or not there is brain damage is because no one really knows the answer. I suppose in a person they can do all sorts of EEG tests and other types of tests to determine if there is damage, but even if you were willing to spend thousands more on Rigby there is unlikely to be a test that can tell you whether damage has been done. Only time will tell. And on top of that no one can tell you how much time it may take.

I would suggest that you do very little with Rigby while he is in this recovery time. (Hopefully it is recovery.) If he has laid in one spot for a few hours in a row, if you can, it would be good to help him to lay on the other side. You can bring food to him, but don't try to force him to eat. Going without food for a few days will not be harmful to him.

I think, after 2-3 days you will know if there is going to be any improvement. I really hope there is.

Dr. Marie.

Customer reply:

I wrote up my thoughts on the last few days developments with Rigby and the latest current state of affairs. Perhaps it is just therpeutic or cathartic for me, or perhaps you'll have something helpful or hopeful to suggest. Anyway, thanks again, and here goes:

OK, so I got Rigby to go for a late evening walk hoping he would do some bathroom habits, and sleep well. It was the
longest walk of the week, and he did urinate once, sniff a few places, stop with interest near 2 different barking neighborhood dogs. Twice he sorta collapsed with exhaustion or discomfort, but managed to get up both times after a brief rest, and finally made it home, though it was more of an ataxic wobble than a walk at the end.

Once inside, he drank and ate with gusto, although he still seemed to barely know me, and if a morsel of food was more
than a few inches from his nose or sight, he couldn’t sense it, despite being ravenous. He then sorta dozed off, but it
was a troubled dozing, and I don’t think from dreams of huge cats. By the way, he is on the last day of the mega-load-dosage of KBR, and tomorrow starts just 3 x 500mg a day, along with phenol b. and kepra.

And this following observed behavior has been observed 5 or 6 times over the last 3 days. He starts to doze off, especially if I am petting him or talking to him or otherwise comforting him, and even starts to snore and look gloriously asleep. And then he jerks awake and leans his head out, like a driver trying not fall asleep on the road. This will occur for hours, maybe 40-50 times or more. I can (and do) sometimes keep caressing or talking to him while he sleep-snores, and that will seem to prolong the sleep and ward off the jerking-wakes. I used to think if I didn’t sneak off quietly, like made noise or a movement,
he would sense it and wake. But he will do the jerk-wake a few minutes after I successfully sneak off. So I have a new (for me) theory about this:

His epilepsy, or brain-tumor or liver-kidney-thyroid induced seizures are in high gear, ready to explode save for the therapeutic sedative effects of KBR and related drugs. The high sedating dose is properly restricting brain activity, and as a result the seizure fails to outright materialize. But it’s constantly trying to. And each jerk is the seizure starting, and now that I theorize this I note that the look on his face sorta resembles the pre-seizure looks he gets. The sedative stupor, maybe responsible for his dysfunctional senses or knowing me (or brain damage does that, but anyway), is thankfully stopping the seizure “almost” before it starts. It actually looks extremely discomforting by the way, so this theory gives me no quarter... most sorrowfully means that he continues to have severe epilepsy out of remission, or brain tumor or something else organically wrong, and the seizures are just waiting to burst forth when we do lower the KBR dosage. And maybe walks ward them off somewhat as well, but his collapsing ataxia might also be the result of seizure-start meets sedative.
So as I sit here watching maybe hours of sleep-jerk sleep-jerk, I rue the discomfort he’s experiencing as well as the mini-damage and mini-post-ictal recovery each seizure “try” probably or possibly puts on him.

He eventually seems to stop the cycle, and sleep longer, for awhile. I think maybe he is so worn out from the struggle, that this adds to the sedating effect that wards off the seizure brain impulse activity so that eventually sedation wins out.
As I write this, it has been going on for 2-3 hours, and I had to cease the side-by-side comfort help just cause I was
worn out. SO what does this add up to? Unfortunately that a seizure-causing extreme serious condition continues to
lurk, and with the next days lower sedating dosage (and/or getting used to it which might mean it becomes less
effective) if there are not outright uncontrolled seizures, there is going to be continued prolonged and perhaps more
intense waking-jerking.

Very sadly, I don’t see that horrible scenario abating on its own, even if KBR-related side-effects or post-ictal
dysfunctionality improves with time and dosage normalization. I think I have just convinced myself that above and beyond any other quality of life measurements, if this sedative-seizure struggle continues for any length of
time or worsens, it may well be time to stop it with the “E” word.

Online vet, Dr. Marie

Dr. Marie replied:

I have found that when it comes to deciding upon euthanasia most of my clients just seem to "know" when the day has come.

There still is a chance that these are side effects from the high doses of KBr. And unfortunately we won't know until the dose is lowered significantly.

I think at any point if you decide on euthanasia, that is ok. We still don't know why Rigby had this latest bout of seizures. There is no guarantee that they will be able to be controlled even with an appropriate level of KBr.

I don't envy you your decision in this difficult time.

Dr. Marie.

Customer reply:

HI Dr. M. Just wanted to let you know that with 6 days without a seizure, Rigby is hangin in, doin well at times, so-so at other times. Overall its an improvement, altho some aspects wax and wane and are worrisome.
My 120 pound ball of fluff still mostly doesnt know me, and barely ever will wag his tail, but does know the word WALK? and responds as the old Rigby to that. Back to being a super-picky eater, LOL< that was one side effect I enjoyed, as some canned prescription formula dog food he just hated, seemed delicious to him for 2-3 days!

KBR down to 3 (500mg)per day, supposed to be administered once daily, but i spread it out for the sake of my sanity due to his usual disdain for medicines no matter how well hidden. He's still doin morning and nite PB x2, and 3 x a day Kepra (750mg ER x 2) plus the twice daily thyroxine. If some of the ataxia or other signs of possible bromide toxicity dont abate significantly, I may cut out one of the 4 PB under the 25% rule (i discussed this with my vet).

No need to reply, just thought you might like an update. Thanks Dr. M.

Customer reply:

Rigby is more than 2 weeks without a seziure, knock on wood. He is perhaps 50-60% mentally recovered, in awareness, alertness, cognizance, personality, etc. The moderation and adjustment to the meds are surely a main reason for the recovery, as Dr. M so ably forecast as a possibility. After 18 clustered seizures and 108 fever, the lack of lasting extensive or obvious incapacitating brain damage is amazing.

Unfortunately, a diagnosed ACL tear on the rear right leg makes walking more than a few steps difficult, even with daily metacam for inflamation and pain. As Rigby is already acting like a 90-year old man a lot of the time(age is 7) he is not getting much activity and exercise. He needs an operation, or the other ACL may go. Vet clinic wants him to lose about 20 pounds (and stabilize on the meds) before they will do it, assuming the high price can be accomodated financially. I see this all happening as remote. For starters, the abundance of favorite foods to get the meds down and give some quality of life to a basically sedentary life style makes weight loss difficult. Maybe when the warm weather comes a backyard pool he can swim in will help, although his disdain/fear for a $300 dog-ramp I purchased makes that also possibly remote.

All in all, a miracle dog of sorts, with great pleasure and gratitude in his recovery to this point.

Online vet, Dr. Marie

Dr. Marie replied:

It does sound hopeful that Rigby is improving.

The ACL tear is not good news though. :( Rigby sure is lucky to have such a loving dedicated owner!

Dr. Marie.

Customer reply:

I am not sure if any readers are following this thread or if there is continued interest by a very busy doctor or others. Anyway, in case there is interest, heres an update.

Rigby went 18 days without a seizure on his path to hopeful recovery. Then yesterday he had a moderate seizure, followed by recovery in about 20 minutes. Then a second one struck, and two syringes of valium were administered at home rectally.

Unfortunately, a third seizure came on strong 5 minutes later. We rushed to the vet clinic. There were no additional seizures on the way (perhaps the valium kicked in?), and 30 minutes later he was generally back to his latest "normal self" upon clinic arrival.

He is being kept 24 hours for observation, and the Phenolbarbitol and KBR are both increased 25%, kepra staying the same. Its a tenuous wait and see.

Online vet, Dr. Marie

Dr. Marie replied:

Oh how frustrating. Thank you for keeping me updated. I am concerned by the return of seizures though. Hopefully the increase in drugs will work and not have severe side effects.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.