From:
<grape_apes@charter.net>
Date: 2007-08-08 07:47:23 UTC
Subject: [ferrethealth] Fludrocortisone/Florinef overdose
To: ferrethealth@yahoogroups.com
Hi. I was wondering if an overdose of fludrocortisone over a short period of time might kill a ferret.
Case: My ferret Daisy, (Miss Daisy May Campbell, Princess Poopybum) aka "Timex" for all the medical issues she's had and survived, came to me two years ago; she was approximaterly 6 or 7 years old, maybe older as of this year-we aren't sure. She had one adrenal gland out two years ago when I took her in, and we also did a partial pancreatectomy for her insulinoma at that time; the second adrenal came out about a year later. Has been maintained on 0.2mg prednisone twice a day and 0.025mg of fludrocortisone twice a day (had been 0.1mg of pred the first year, and 0.025mg fludro once a day till this past March-responded well to increased meds, with fewer incidents of Addisonian/hypoglycemic episodes; whenever fludro was stopped, had episodes, so kept on fludro).
Daisy also had liver issues post biliary duct backup and resection 2 years ago-treated with 22.5mg once a day of SAMe for the past year, and her values have improved steadily on the SAMe. The biliary duct issue arose from scar tissue building up and blocking it after an undifferentiated pancreatic nodule removal from near there (pathologists could not tell what the tumor was-it was not an islet cell tumor) at the time of the partial pancreatectomy for confirmed islet cell tumors. A week after the biliary duct resection, she developed an ileus, which resolved after aggressive medical and fluid therapy. These were all two years ago.
Daisy has also had mild kidney issues in the past, and was being treated for unconfirmed IBD, but she responded very well to treatment for IBD. She had a brief (two-week) period of HIGH blood sugars and glucose in her urine about a week after recovery from her March 2007 exploratory; this resolved, and she was back to her insulinoma numbers and regimen after that.
At time of death, she was on:
Sucralfate 75mg three times a day
Prednisone 0.2mg twice a day
SAMe 22.5mg once a day
Famotidine 0.1mg once a day
Clavamox 31.25mg twice a day
Metronidazole 50mg/ml (80mg/ml benzoate solution) 0.13ml twice a day
Fludrocortisone 0.025mg (1/4 of a 0.1mg tab) twice a day.
The concern is that she may have gotten 1/2 of the fludro tab twice a day for two and a half days (so five doses)-in other words, 0.05mg twice a day instead of 0.025mg twice a day. Would this be enough to potentially cause a crisis where she became unresponsive and eventually started seizing, not responding to steroid injections, fluid therapy, or any other standard interventions? After one and half hours of two vets attempting to bring her out of it and about two to two and a half hours after she was first found to be crashing, the decision had to be made to let her cross to the Bridge. I could not be there because I was two days postop from a C-section, making it worse for me to make the decision.
Up until the evening my friend came home to give her her meds and found her dying, Daisy had been eating well, drinking, pooping, peeing normally, acting normally. They even gave her extra canned food (she got a little A/D and Eight in One's canned ferret food once or twice a day in addition to her mix of six or seven different premium ferret kibbles) that morning, which she ate voraciously (she was always a good eater), and she had been happy and active throughout the two and a half days before this incident.
This is a ferret that goes with me everywhere, even to classes and work, and I was concerned that her demise may have been affected by my being absent-the last time I went away in March, just before her potential blockage, she had an Addisonian and/or hypoglycemic incident. However, I went away for a week last year, and she was fine.
She has had episodes before where she was found to be unresponsive, and seemingly "out of nowhere," after having been fine just hours before, and has always come out of the episodes with appropriate interventions, such as fluids, steroid injections, etc. She had not had any such episode since late March, when she had an exploratory for a possible foreign body (we found something suspicious at the entrance to her stomach at that time, but nothing definitive of blockage), and she improved after surgery and responded to IBD therapy a few weeks later, after developing irregular bowel habits that continued postop, i.e. not pooping often, and when she did, it was small and harder than normal. After IBD therapy, her stools returned to normal frequency and consistency. (We didn't thinkl to biopsy her intestines during surgery, as she had not had the poop problem preop other than she stopped pooping briefly and we thought it might be b/c of a blockage, as there was a potential suspicious-looking "object" on ultrasound.)
I am asking because I just looked at the medication list I made for my friend who was taking care of my Daisy while I was in the hospital giving birth to my daughter, and I made the horrible discovery that I typed 1/2 tablet for the fludro on the list instead of 1/4. I can't believe I missed it, as I am normally anally thorough with that stuff, and I even typed out "0.025mg" after the "1/2 tab" (which would have only been the correct dosage for a 1/4 tab), and it said 1/4 tab on the med bottle, but I am afraid that Daisy may have crashed this time and died because I had my friend overdosing her at twice the fludro dose twice a day for two and a half days, according to the med list I gave her.
I feel terrible and can't believe I made and missed such an obvious and potentially fatal mistake. The print when the computer superscripted the fraction was very small, and somehow I missed the difference. I really can't believe I would make such a careless mistake after being a vet tech for this long. I know she had a lot of medical issues, but I feel like this mistake may have been what cost her her life, versus her medical problems. I just don't understand enough about this drug's pharmacology to know.
Please let me know-I just need to know.
Thanks.
-April (vet tech and ferret owner)
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