Concerns about trilostane dosage

[Mnam98]

Hi everyone,

My 13 lb. 12 yr. old Maltese was diagnosed with cushings and diabetes a few days ago. He was prescribed 30 mg vetoryl daily. After some research I voiced my concerns with my vet about overdosing he suggested splitting the pill in half and giving just half a day. Well when I got home and opened the package I realized they are capsules so I call the vet again and he told me to go ahead and give the full pill.

I gave my dog the 30 mg and about 4 hrs later he vomited. I called the vet today and was told to hold off on the meds and he changed his dosage to 10 mg twice a day. He didn't say anything about bringing my dog in to check on him but today he's now refusing food, which has never happened. Ever. I noticed him heaving, like he wants to vomit but trying to hold it back.

Should I insist on being seen by the vet? How do I know 20mg will be the right dose? Is there something to counteract the overdose?

Any feedback would be very helpful.

[Simba's Mom]

I'm surprised your vet started your fur baby on 30mg, my dog weighs 21 pounds and was started on 20mg. He now is on 25mg and with symptoms returning might have to go up, but he started low. Good luck, and welcome, this is a great site with lots of info and kind gals and guys.

[frijole]

Wow. Thank God you found us. That dose is too high to start out at! 10 mgs is where most vets would start. Also it clearly states on the pill inserts (and vets should know this) that you cannot open up the capsule and give partial dosing.

Vomiting is a sign of overdose. Please please please please do NOT give any more trilostane.

You said your dog was diagnose with both diabetes and cushings. Let me explain that the symptoms are identical. Chances are VERY good that your dog does not have cushings. We see this a great deal! When a dog has another illness such as diabetes they can frequently have false positives on the test.

There is absolutely no rush to treat the cushings should your dog even have it. It is MUCH more important to treat the diabetes. So for now please just skip the trilostane and focus on getting the diabetes under control.

When you can please get copies of the labwork for blood and cushings tests so we can look it over and comment. But again, please know it is very likely your dog doesn't have cushings and giving trilostane could harm your dog if he/she doesn't have it.

Kim

[frijole]

Regarding the vet not wanting to see him. That is pure BS. Any vet who has a CLUE about how to treat cushings knows that vomiting is a sign of overdose. So if your dog is dry heaving and vomiting you have a dog that is crying out for help meaning NO MORE TRILO.

To be honest I would get copies of the records and find a new vet. How he/she could say there is no reason to visit is a sign to me they are clueless or heartless. Neither one works for me.

Sorry to be so blunt but your post really upset me. You deserve better.

Kim

[Mnam98]

Thank you for replying so quickly!! For the diabetes, my dog is on the prescription diet food now. The vet is thinking the diabetes is brought on by the cushings and suspects he's had cushings for much longer that just recently. He doesn't want to over treat the diabetes and have his sugar levels drop too low with insulin on top of his new diet food and the vetoryl I only noticed the thirst and urinating while sleeping recently which is why I brought him into the vet. But he's had some hair loss and a dull coat for awhile which I assumed was from being 12!! He also has a huge potbelly. Which again I assumed was weight gain from not exercising because of his age ....

Is there anything to counteract with too high of a dosage? He hasn't eaten all day. How long do I wait before I need to take him in?

[frijole]

Yes. Your vet should have given you prednisone to have on hand for an emergency. How many days did you give trilostane? If you cease giving it now it should all be out of the system by tomorrow (that is the good news) and the appetite should come back.

If he doesn't eat tomorrow then go to the vet and TELL them to give you prednisone and explain what is going on. (though I'm not sure they will even understand) I don't think permanent damage could have occurred so quickly but you never know.

You can also buy pedialyte (non flavored like you buy for babies) and mix it 50/50 with water. It provides electrolytes which are affected if cortisol has gone too low from the trilostane.

If your dog is just not eating that should resolve tomorrow. Serious signs of overdose are vomiting and diarrhea (watch him when he goes out so you can see for yourself). Also if he acts lethargic as in he can't walk, hold head up that is because the cortisol has gotten dangerously low. That is when you go to the animal hospital and get prednisone immediately.

Sounds like you aren't there though.

Re the diabetes thing... seriously your vet is choosing to treat it with dog food? No way. I am now even wondering if your dog is diabetic.

Please please please have that vet scan and email you OR go pick up all tests. Get copies of every test and post them here. No more trilostane.

While not a good thing, the fact that your dog is only not eating is actually a good thing. It makes me presume that his cortisol is too low but not to the point of going to ER. If he vomits more you'll need to take him in. You have to be the judge of how serious it is. One vomit = so/so Multiple = get him in because he is losing fluids and it is a sign of seriously low cortisol.

I hope this is making sense. I am going to wait for your response and any questions and then I have to get to bed. So if you have any more questions, hit me up fast! :) Hang in there. Kim

[Mnam98]

Thanks Kim! I'll be stopping by the vet tomorrow for copies of the blood and urine work. I'll ask for the prednisone. I'll definitely be looking into a second opinion. But I don't want to to jump the gun and freak out and run a million tests and put this little guy through so much stress as I don't know how many more years his body can handle it. Thankfully he's had solid stool, I've been checking. I be keeping on eye on him.

I'll update tomorrow with tests levels

[frijole]

The reason for getting the test copies is so you can take them into another vet and NOT have to do any more tests... Also if you post here we can give you advice for free. We aren't vets but we have seen more cush dog cases than most vets have since we get all the problem cases here. :) Trust me we've seen a TON.

Have a good night! Kim

[SoggyDoggy]

I'll second that re. the tests. :) I took the advice here and managed to catch my vet in an overdose and later an even more colossal stuff up, thanks to the advice of folks here. :eek: As soon as you get those test results, post them up. The wealth of knowledge available on this forum is incredible, with both diabetes and cushing's. There is a sister site for diabetes too, and I know the folks talk frequently, as I've seen a few cross posts in the last week alone.

As I said, for a first stop, you can't beat this place. They will arm you with information that you can then take to your vet, or better yet an Internal Medicine Specialist (referred to frequently here as IMS) and get you the best result.

Good luck!

Naomi.

[molly muffin]

Hello and welcome. Just checking in to see if you got the test results and how your little guy is doing.
We worry you know. :)

Sharlene and Molly Muffin

[Mnam98]

Hello,

Just got back from the vet with some bad news. He has deteriorated significantly since the start of this on Tuesday. Here's the break down of what's happened...

- Monday: blood and urine work showed cushings and diabetes
- Tuesday: started perscriptive diet with 30mg of vetoryl; vomited once but everything else okay, just kind of tired after the vomit
- Wednesday: no meds but refused food and drank little water
- Thursday: ate chicken and rice and 10mg of vetoryl; vomited several times through the night; didn't want to get up, just wanted to lay down
- Friday: in the morning i noticed he couldn't walk without falling over and i rushed him to the vet

At the vet, they were going to do more blood work, but he had so much bruising from the 1st round of blood work and wasn't healing. The vet did a spot blood check instead and the glucose was through the roof. She kept him through the day while I was at work and gave 2 doses of insulin and it didn't make a dent in his numbers. His levels went beyond the numbers the test will report. She noticed neurological deterioration. The sugar levels were so high that she suspected his central nervous system is shutting down. She explained options to take him to the emergency vet to more drastic emergency care.

I'm not quite sure I want to go that route, because ultimately he has these diseases that will continuously be a battle. Just looking at his quality of life... even if he were to get over this hurdle, I know there are many more hurdles coming his way.

I've gone through the emergency vet before and how tramatic that was! About 5 years ago he ingested salt dough from a school project and had serious salt poisoning. After a stroke, blindness, memory loss, and seizures he actually recovered! Now at the age of 12, I don't think his little body will be able to handle the stress.

I'm listing his blood test results from Monday because a few asked..
Alkaline Phosphatase 1790 u/l (range 23-212)
Glucose 492mg/dl (range 70-142)
Phosphorus 7.8 mg/dl (range 2.5-6.8)
Bilirubin 1.1 mg/dl (range 0-.9)
BUN 39 mg.dl (range 7-27)
lymphocyte 7% (range 12-30)
urine protein 100 (range 0-30)
urine ketone 0.015 (range 0-0.001)
urine glucose 500 (range 0-0.001)

Right now he's just snoring away... but he's still not eating or drinking. Unfortunately I'm thinking I'll have to put him down tomorrow. He's just so uncomfortable and I don't want to drag him along just because I can't let go.

I retrospect, I should have taken him to the vet sooner and not just assume these changes were just from old age, but rather symptoms of a bigger cause.

[frijole]

Thanks for coming back.. I was worried. Obviously only you can make the tough decisions on whether to treat etc. I can only share based on my experience with cushings and those with diabetic dogs that have come here.

Looking at the blood results without a doubt your vet should have started treating the diabetes - those are very high numbers. I am confident that the cushings test was a false positive because the body was fighting diabetes. It very well could be that giving the trilostane to a non cush dog which not only lowered cortisol but caused vomiting just made things worse. Every single thing you described this week is a sign of trilostane overdose. (lethargy to the point they can't walk, vomit, etc)

Dogs can overcome this - they need electrolytes and I assume your dog is hooked up to IVs and is getting them as well as prednisone. If not, please check because it is imperative. But don't think for one minute that they can't rebound if given electrolytes. The trilostane is out of the system now. Prednisone mimics the cortisol that was taken away when giving the trilostane and it works real fast.

Re the diabetes - my aunt has a diabetic dog and she ignored signs and it was in shock when she took him to the vet. He spent 3 days there and it was touch and go but he made it, is regulated and that was 4 years ago. Happy go lucky guy.

Again, I do not believe for one second your dog ever had cushings. I think it was a false positive - trust me we see this so often. So just focus on the diabetes and getting that under control while maintaining the electrolytes and cortisol that were lost due to the trilostane.

I know things seem dire but I share these stories because trilostane overdose produces exactly what you described and dogs do look like they are almost dead. One little prednisone pill and 2 hrs later they are acting almost normal. Add to that the untreated diabetes and no doubt you were scared to death.

Sorry for rambling - I hope it helped a bit. I'll include you guys in my thoughts and prayers this evening. Take care!!! Kim

[frijole]

I just realized that your dog is at home and not at the vets. I have to tell you I can't believe they let you take him home.

We have a sister forum k9diabetes.com and I am going to see if someone can come over and read this thread and offer some advice.

The lack of appetite and thirst is probably due to the low cortisol. Do you have prednisone on hand? If not you really need to get some. Like I said it makes the body think there is cortisol and makes them feel well again in a matter of a few hours. After a few days the eating and drinking should return.

Hang in while I try to get someone over here. Thanks! Kim

[molly muffin]

I really just sat looking at the computer monitor in shock.
I just read on Dr. Petersons blog yesterday how a dog with diabetes, if they do have cushings, has to be on twice a day dosing, as when they are given once a day, their sugar levels will spike something awful. Talk about timing.
So, yes, I'm seconding every thing Kim just said. This is recoverable, but it is important to get the electrolytes back to normal, so all those spiked values can start to come down. It really does sound like trilostane overdose, which is recoverable.
This is all something to think about and Kim is trying to get hold of one of our sister site people to come over and have a looksee. They deal with diabetes every day, just like we deal with cushings every day. So many times these two things either overlap each other. :(
We would never presume to tell you what to do as, this is your life, your furbaby and you know him best.
We will however, try to make sure that you have as much knowledge about your options as possible.
Hang in there till someone gets over here. I know this is awful sucky. :(
hugs,
Sharlene

[frijole]

I have contacted the owner of the board and one of the admins and linked them to this thread so that when they see my message they can come quickly. Kim

[frijole]

I see that you have logged off. In case I have gone to bed when you return I'll throw out a couple of ideas.

1. check here to see if there are posts from those that have firsthand experience with diabetes.
2. register quickly at www.k9diabetes.com/forum and just copy the results from your thread here to save time.

3. try somehow to get some water in him - that is the most important thing

4. If you don't have prednisone please call your vet in the am and get some. I understand they didn't want to do another blood test to confirm the cortisol level but every sign points to low cortisol and without it he can die. The pills are cheap too.

5. If you have one of those medicine drops for kids use it to get water in him. Go to the grocery store, Walmart or drug store and get pedialyte like you give to babies. Look on the label to make sure there is no SUGAR or fructose product in it. No sugars of any kind. (I have no idea but am just being safe) Get the flavorless kind. Put some in the medicine drop and give it to him. Pedialyte has electrolytes that your dog is lacking. If he isn't on an IV it is another way to get him some electrolytes. Don't overdo it - do it very slowly a few drops at a time at first and wait 30 mins, give some more, repeat.

THat's all I got right now. Take care!!! Kim

[k9diabetes]

Please take your dog to the emergency vet tonight. With such high blood sugar, ketoacidosis is a very real possibility that would explain all of the behavior that you've been seeing.

Ketoacidosis is fatal without treatment but can be overcome with emergency care.

Forget about Cushing's right now - the diabetes is the critical thing to deal with. Please take your dog to the ER.

Natalie


Hello,

Just got back from the vet with some bad news. He has deteriorated significantly since the start of this on Tuesday. Here's the break down of what's happened...

- Monday: blood and urine work showed cushings and diabetes
- Tuesday: started perscriptive diet with 30mg of vetoryl; vomited once but everything else okay, just kind of tired after the vomit
- Wednesday: no meds but refused food and drank little water
- Thursday: ate chicken and rice and 10mg of vetoryl; vomited several times through the night; didn't want to get up, just wanted to lay down
- Friday: in the morning i noticed he couldn't walk without falling over and i rushed him to the vet

At the vet, they were going to do more blood work, but he had so much bruising from the 1st round of blood work and wasn't healing. The vet did a spot blood check instead and the glucose was through the roof. She kept him through the day while I was at work and gave 2 doses of insulin and it didn't make a dent in his numbers. His levels went beyond the numbers the test will report. She noticed neurological deterioration. The sugar levels were so high that she suspected his central nervous system is shutting down. She explained options to take him to the emergency vet to more drastic emergency care.

I'm not quite sure I want to go that route, because ultimately he has these diseases that will continuously be a battle. Just looking at his quality of life... even if he were to get over this hurdle, I know there are many more hurdles coming his way.

I've gone through the emergency vet before and how tramatic that was! About 5 years ago he ingested salt dough from a school project and had serious salt poisoning. After a stroke, blindness, memory loss, and seizures he actually recovered! Now at the age of 12, I don't think his little body will be able to handle the stress.

I'm listing his blood test results from Monday because a few asked..
Alkaline Phosphatase 1790 u/l (range 23-212)
Glucose 492mg/dl (range 70-142)
Phosphorus 7.8 mg/dl (range 2.5-6.8)
Bilirubin 1.1 mg/dl (range 0-.9)
BUN 39 mg.dl (range 7-27)
lymphocyte 7% (range 12-30)
urine protein 100 (range 0-30)
urine ketone 0.015 (range 0-0.001)
urine glucose 500 (range 0-0.001)

Right now he's just snoring away... but he's still not eating or drinking. Unfortunately I'm thinking I'll have to put him down tomorrow. He's just so uncomfortable and I don't want to drag him along just because I can't let go.

I retrospect, I should have taken him to the vet sooner and not just assume these changes were just from old age, but rather symptoms of a bigger cause.

[k9diabetes]

Get him through this emergency and diabetes is a very manageable disease, certainly no reason to let a dog go.

But first he has to get through this crisis. Sadly, the approach you got from the vet happens all too often with practitioners not well-versed in treating either disease.

I wouldn't have that vet do anything more ever. You will need a new one.

But the critical thing is to get him emergency treatment tonight to save his life.

Natalie

[k9diabetes]

Looks like you've been bouncing on and off... if you haven't before, check the "Remember me?" box when you login and your login won't time out.

Natalie

[CraigM]

Mnam98,
I'm another member of k9diabetes.com. I have little knowledge of Cushings, but diabetes can usually be controlled. My 11 year old pup has been diabetic for five years and is doing well.

As Natalie suggested, please see a vet ASAP, and come over to k9diabetes. We would be happy to have you join our forum!

Craig

[Tina]

I hope you have seen the other posts and have taken your baby to the emergency vet to get the diabetes stabilized. Please do not do anything drastic and seek emergency care. I can't speak to the diabetes, but my baby had a crisis due to his cortisol crashing from the Cushings meds. It required hospitalization, IV fluids, electrolyte replacement and injectable steroids (a form of prednisone) to pull him out of the crisis. This is an emergency that your pup is in and he needs emergency intervention and hospitalization. As Natalie said, the diabetes is manageable once he is through this crisis, and so is Cushings, if he even really has it.

Tina

[Rubyterrier]

I saw Natalie's post over at k9diabetes and came over here to encourage you to join k9diabetes.

My dog was very sick when I joined and has multiple issues that some folks would have given up on and each disease makes the other more problematic. The guidance I have received at k9d far exceeds what I have received through my vet. My vet is a good doctor just hasn't made diabetes a specialty the way k9d folks have.

An overdose of cushings meds coupled with very high diabetes numbers would make your dog very sick indeed, but is fixable.

I do hope you have taken Natalie's advice to take him to a vet to rule out Ketoacidosis as that can be fatal and can progress quickly.

Tara

[Squirt's Mom]

How is your baby this morning?