overdose

[Rae]

Can an overdose of vetoryl cause kidney disease?
My dog was diagnosed with cushing's 3 weeks ago and was started on 60mg of vetoryl.
She hasn't eaten, and not drunk much for past few days and has had the runs and been vomiting and is really weak.
She is now back in the vets for fluids and more blood tests and they are suggesting she has kidney disease.
She is 14. She is not a big dog. Her weight was 'borderline' for the dose he gave.
I do trust our vet.
Thanks

[Squirt's Mom]

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[Squirt's Mom]

Hi Rae,

I am so sorry your baby is not well but do not continue the Vetoryl no matter what the vet says until we get a chance to chat with you and get a better idea of what may be going on, ok? We are not vets but we do have decades of first hand experience under our belts and we see more cases of Cushing's than any vet ever has - you can trust us. It is unfortunate but the very best vets can really be wrong when it comes to diagnosing and treating this disease. Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose.

Now some questions. What signs did you see that lead to the Cushing's testing in the first place?

What tests were given? If you would, please get the actual results of those tests and post them here along with the normal ranges for each value and the unit of measurement (ug/dl, mnol/L, etc) that follow the numbers. If she had lab work that shows things like ALP (or ALKP), BUN, and so on, post those results in the same manner. This will help us a great deal in helping you and your baby.

How much does your baby weigh?

How soon after the first dose of Vetoryl did you see problems? Did you call the vet then? What were you told to do?

How often were you giving the Vetoryl?

Is your baby on any other meds, supplements, herbs, etc? If so, what and what for?

To answer your question, yes an overdose of Vetoryl can cause kidney damage PLUS if the kidneys were already compromised, Vetoryl could put more strain on them. The lab work that shows BUN and so forth should have given a clue if there were kidney problems to start with. However, this sounds more like a reaction to the Vetoryl to me.

Your baby is right where she needs to be today. And you are right where you need to be - with us, your new family! :) Please keep talking to us and tell us all you can about your sweet girl. We will do all we can to help you. You are not alone, Rae, we will be by your side all the way.

Hugs,
Leslie and the gang

[Rae]

She wasn't on any medication prior to this, shes always been really fit and healthy.
Symptoms were - drinking a lot of water, always being hungry (but shes always been a scrounger!) and panting a lot. she also developed a bald patch - but this grew back.
It was around 10 days after starting the tablet that she became unwell. She has one 60mg tablet once a day.
They lowered the dose to 30mg but she hasn't had any of those yet
I don't have any lab results - sorry
She s such a lovely beautiful dog.

[Rae]

she had an acth test - and cushings was confirmed.

I spoke to the vet a few days ago and they gave her some pellets/medication for the runs - but she went completely off her food and hasn't eaten any. The vet wasn't unduly concerned.

I'm not sure how much she weighs - she certainly isn't fat, she hasn't got the 'pot belly' that seems typical of cushings. Ans she will definately have lost some weight now.

(sorry this is a very disjointed reply)

[labblab]

Hi Rae,

Your membership has now been finalized so you should not have any more trouble posting. I only have a moment to write, but from the sound of things, I would guess that your dog's cortisol has indeed been driven too low with the trilostane. This results in an Addisonian condition in which the body's hormonal levels and blood chemistries are thrown off. It is good that she is receiving IV hydration and support, because in conjunction with stopping the trilostane for now, this is most likely what she needs to recover.

I do want to tell you that an Addisonian crisis can temporarily result in abnormal kidney values. But this doesn't mean that the kidneys are the primnary problem -- it may just appear that way:


On examination of dogs with Addison’s disease one may see depression, weakness, dehydration, weak pulses and sometimes a slow, irregular heart rate.* Routine laboratory tests often show a low blood sodium and high blood potassium. Loss of water, in vomit and diarrhea, can lead to dehydration. Severe dehydration increases waste products in the blood (creatinine and blood urea nitrogen = BUN) that are normally eliminated by the kidneys. Addison’s disease can be confused with primary kidney disease.

So even though your dog's kidney values may be abnormal right now, this doesn't mean that they won't rebound now that she's receiving the IV hydration. Until this all gets sorted out, however, she absolutely should not be given any more trilostane and she may even need supplemental steroids to make up for the cortisol/aldosterone that she may be lacking from the overdose. From what you've told us, I am very worried that your vet may not have much experience with trilostane treatment. Her cortisol level should have been rechecked back when she stopped eating and acted "off." I'll stop back by later to talk some more.

Marianne

[Rae]

Thankyou
Shes coming home tonight, but probably has to go back in tomorrow. I will know more when i've spoken to the vet later - so i will update you then x

[Rae]

Hi everyone.
Marianne - you were pretty much spot on.
Vet thinks vetoryl has pushed cortisol too low and caused addisonian symptoms - which may be reversible. But he is also worried that she is in the early stages of kidney disease. They have given her fluids and something to settle her stomach/stop her feeling sick.

Lab results:
out of 13 tests - 4 were outside the normal range...

ALKP is raised at 2000 ul. (normal range is 23-212)
AMYL is raised at 1516 ul. (normal range is 500-1500)
UREA 15.2 mmol. (normal range is 2.5 - 9.6) and urine is dilute.
PHOSPHATE 2.30 mmol. (normal range is 0.81-2.19)

She has to go back tomorrow, so shes come home with a line in her leg, and she looks so so so sorry for herself!!! - but she has eaten a small spoonful of food - just the one but its the first in nearly 4 days!! She usually loves her food.

It's so weird at home without her! And so lovely to have her back.

Shes a small black and white cross breed, little face, big brown eyes, and scrawny legs. she has white socks, and a white tip on the end of her tail. we got her from a rescue centre when she was around 9 months old, she still thinks shes a puppy, and acts like one - except shes not very tolerant with other dogs if they're too boisterous around her these days - she can give it but not take it!! :o) And she has a few grey whiskers round her nose now :o)
Shes been Fantastic with the 3 kids growing up - perfect pet- she is funny, well behaved and gentle natured. She is a much loved, valued and important member of our family and everyone who meets her loves her.

[labblab]

Thank you so much for this update. With proper care, your dog should be able to bounce back from this episode. But to elaborate upon what I wrote earlier, in addition to just needing IV hydration, your dog may need ongoing steroidal supplementation if her adrenal glands are underproducing due to the medication overdose. You mention a diagnostic ACTH early on, but she should also have received a monitoring ACTH 10-14 days into treatment just for this very reason -- to nip an overdose. If not then, certainly at the point that she stopped eating. And if not then, certainly now when an Addisonian episode is suspected. Do you know whether an ACTH test has been done now during her hospitalization and what the results are? And in addition to cortisol suppression, aldosterone can also be oversuppressed with a trilostane overdose. Aldosterone is the hormone that coordinates the balance of sodium and potassium in the body. So it is critical that both those hormones be supplemented if need be. Once again, the kidney abnormalities may resolve by themselves once the Addisonian issues are properly addressed.

As I say, a dog can definitely rebound from an Addisonian crisis. But I encourage you to specifically ask your vet whether/how they've determined if your dog needs steroid supplementation in addition to the hydration. To better arm you with information for the discussion, here's link to a product insert for Vetoryl (brandname trilostane):

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

She sounds like a sweetie and it is clear she is dearly loved. So I am anxious for you to have as much info as possible to discuss with your vet!

Marianne

[Rae]

Thankyou so much - that she CAN bounce back is what i needed to hear!!! (i know theres no guarantee)
I've made lots of notes to ask the vet in the morning!
Thankyou - again! xx

[lulusmom]

Hi Rae and welcome to the forum.

Marianne has done her usual good job of providing you with great information but I would like to add that unless your dog's kidney values were elevated on the prescreening blood chemistry your vet should have done as part of testing to confirm the diagnosis, I would not assume your dog has the beginning of kidney failure. I also would not assume that a Vetoryl overdose has thrown your dog into kidney failure. If kidney values were normal on the last bloodwork, I think it's safe to say that the abnormal values after being admitted to the er are a result of an addisonian crisis brought on by too high of a dose of Vetoryl. High urea (BUN) and amylase are seen in dogs with kidney failure as is high phosphorus, however, all three are also seen in dogs in addisonian crisis who are dehydrated and have an electrolyte imbalance.

Based on the limited information you have provided thus far, I would have to agree with Marianne that your vet does not seem to be well versed in cushing's or addison's. This is not uncommon with general practioner vets and unfortunately neither is a sick dog who would otherwise do quite well under the care of an experience vet. Many of us have learned that our dogs pay the price for placing blind trust in our gp vet. We pay the price too on an emotional and financial level. It's horrible to watch our dogs when they are this sick and er treatment is costly.

It would help us greatly if you could round up all of the testing that was done on your dog to confirm the diagnosis and post the results here. With respect to bloodwork, you need only post the highs and lows and please include the normal reference ranges. Did your vet tell you that your dog has pituitary dependent cushing's or an adrenal tumor? Can you also tell us how much your dog weighs?

I am so sorry that this has happened to you and we'll all do whatever we can to help get your dog back on the right track. We'll be in a better place to do that if you can share as much information as possible.

Glynda

[molly muffin]

Hello and welcome from me to. :)

If they did not do an ACTH test in the ER, then they need to do one. It's as simple as that, you need to know what you are dealing with so that you can treat it appropriately and the best outcome can be had. I know that does sound kind of dour but truly an Addison crisis can be overcome, but they do need to know how bad it is and what kind of rebound her little body is making on its own and if steroids are needed and they need to know that asap. (and treat)
Gosh she just sounds like such a sweetheart! What is it about rescue babies that just tug at our hearts. Mine is a rescue too.

We'll all be waiting for the next results and hoping for a calm peaceful night with no problems.

Sharlene and Molly Muffin

[Rae]

Hello
Whitby had a steroid injection at the vet this morning and is home again now. She still has the line in her leg. She has to go back again tomorrow. She came home and ate another very small bit of food, but that's progress! And, she does look a tiny bit brighter today.

She isn't dehydrated anymore so she didn't need more fluids at the vets.

How long do you think it will take for her levels to get back to normal? What questions do i need to ask about the steroid injections?

THANKYOU xxx

[Rae]

Kidneys were tested and were ok, and diabetes was ruled out - prior to the acth test 3 weeks ago.
I think she weighs/weighed around 22lb xx

[labblab]

I'm so relieved that Whitby is doing even a little bit better!! Hopefully she'll continue to perk up more today.

The main question I would ask the vet is whether an ACTH test was performed when you first took her in, and if so, what were the numbers (so you can post them here). Then, what is their gameplan going forward re: re-checking her cortisol level and administering additional steroids if she needs them. After an Addisonian crisis, many dogs need to continue to take oral prednisone for varying lengths of time. And some also need a supplement to help with the low aldosterone level. If her general blood chemistries are OK, Whitby probably doesn't need help with the aldosterone. But the only way to know about the prednisone is to do repeat checks of the cortisol. Most types of supplemental steroid that she would receive will skew the cortisol results, so your vets need to know what they are doing re: the timing of the testing.

Right now, it is impossible to know how long it will be before she is off the steroids and needing trilostane again (at a lower dose). For some dogs the adrenal function returns rather quickly. Some dogs actually never return to the level of adrenal overproduction that requires treatment. And a few dogs continue to require supplemental prednisone from that point onward. For each dog it's different. So the key issues are her ongoing blood results and your observations as to how she is doing outwardly.

Hope this helps! Please give her a big hug for all of us, and do let us know what you find out from the vet.

Marianne

[molly muffin]

I'm very glad to hear that she is doing a bit better. Crossing fingers that each day will see an improvement.

Sharlene and Molly Muffin

[mytil]

How are things going?!
Terry