Gelding complications/poss. penicillin reaction (sorry, a bit long)

[Blacktree]

Last thursday morning we took our yearling colt to the vet to be gelded. All went well w/ the actual procedure, but then when he was starting to come out of the anesthesia, the vet gave him a penicillin shot. He immediately dropped to the ground and had some pretty violent seizures.

Once he was given some more medication the seizures stopped, it took another 45 minutes for his heart rate/breathing to return to normal. Poor guy had some huge skinned 'road rash' areas on his side and some extra bleeding at the surgical site, but otherwise he seemed ok. The vet could only guess that even though she had drawn back first, that he must have moved a bit while she was injecting the penicillin, and it must have partially gone into a vein instead of the muscle. ug.

Anyway, we took him home and despite some extra swelling, all looked pretty good considering. The vet came out to check on him that night, too. Friday all looked good. Then on Saturday morning when I was feeding, I noticed that there was a considerable amount of blood in his urine. Called the vet, she came out to see him and took some blood to test. He looked ok still, cheerful, eating/drinking fine, and temp was normal. After the test results were back, she thought that he had some muscle cell damage from the sudden thrashing around of the seizures and now we were seeing that being filtered out. We have been watching his drinking closely since and it looks like so far we should be ok w/o starting him on an IV.

Sunday things looked better, there was some blood, but not much. I was feeling better until this morning when there was a lot in his urine again. I've got another call in to the vet now. His temp is still ok, he still seems bright and normal otherwise.

Has anyone had anything like this happen? How worried should I be?

Does this sound like all could be due to the way the shot was given as we are guessing, or should I be wary of giving him a penicillin shot ever again?

Thanks!

[Nootka]

I wish I could help but I have no useful information....


I just wanted to <<<<< Jingle>>>>>>> for the boy:yes:

[Equilibrium]

Yikes! I can't understand how she could get a bit of vein in with the shot. No I'm not a vet, but we have given pen quite a few times and were never in danger of hitting a vein.

No, I've never had anything like this happen, thankfully. Only complication we had was a bit of a bleeder and we need clamps overnight.

If it was me, I'd be just like you and quite concerned. And no I probably wouldn't ever give him pen again. I myself can't have sulfa drugs so I'm guessing they have some non sulfa drugs for horses as well.

Passing on some jingles as well.

Terri

[Laurierace]

There are two things that can cause a reaction to penicillin. One is when the procaine gets into the bloodstream via a nicked vein and goes straight to the brain causing seizure like episodes and general thrashing around. One is an actual allergy to the penicillin itself when can be mild to severe. Severe would cause anaphylactic shock and could cause him to be unable to breathe. From your description is sounds like it was most likely the procaine that caused the problem. That said, if there is another antibiotic that can do the job I would probably opt to go that route just for peace of mind.

[shawneeAcres]

It sounds like he had anyphylactic (sp?) shock. Why was penicillin given?? One shoild normally not need anitbiotics for gelding, and there is NEVER any reason to give ONE shot of antibiotics. Antibiotics used in this fashion lead to resistant strains of bacteria. I question your vet's giving this shot at all, much less the fact you had a reaction.

[JB]

Was the subsequent "medication given" some epinephrine? If so, that would make it an anaphylactic shock and not the procaine burst.

There are forms of pen that are used as a one-time deal, afaik. I don't think those involve procaine, so that would also rule out the p-burst.

Assuming it was a-shock, I'd be sure to never allow this horse to have penicillin again.

[Laurierace]

What makes you guys think this was an anaphylactic reaction? It doesn't sound the slightest bit like that to me. No swelling, hives, difficulty breathing, fluid in the lungs, etc.

[rcloisonne]

I agree with Laurierace's deduction. The rapid seizures reported by the OP are very unlikely to have been caused by anaphylaxis.

Penicillin can be a dangerous shot for both reasons Laurie stated (nevermind the difficulty of giving the shot itself). Vets around here don't like owners to do them and some will refuse to prescribe it stating they know of more than one horse who has dropped dead from owner injected pen.

If this horse has a noticable amount of blood in his urine he needs to go back to the vet clinic for a full evaluation, hopefully free of charge. He needs to be kept very well hydrated until kidney damage has been completely ruled out.

[JB]

I leaned towards the a-shock because it was said that "medication" brought him out of it (makes me think epinephrine). I am unaware of a "medication" you can give a horse in a procaine burst seizure to stop it (that is, if you could even get close enough).

It would help to know the exact penicillin used.

[TKR]

One of my stallions reacted to penicillin and the vet said it was most likely the procaine. I gave him a shot in the muscle (neck) and he bounced off the walls and staggered around his stall briefly (seemed like forever), was almost falling down. It was a second round of antibiotics for a nasty abscess, but that's the last time he'll get it. He was fine afterwards -- I lost a few years of life!
PennYG

[Laurierace]

I leaned towards the a-shock because it was said that "medication" brought him out of it (makes me think epinephrine). I am unaware of a "medication" you can give a horse in a procaine burst seizure to stop it (that is, if you could even get close enough).

It would help to know the exact penicillin used.

Most likely a sedative of some kind.

[Janet]

Having dealt with several procaine reactions over the years, I would think that the "blood in the urine" has NOTHING to do with the penecillin shot.

If your vet isn't taking the blood in the urine seriously, I would call another vet for a second opinion TODAY.

Geldings usually are very straightforward. But when they "go bad" they can go bad VERY quickly.

[Blacktree]

Thanks for the replies, guys. Good to know that I'm not just overreacting/obcessing to still be pretty concerned here.

Yikes! I can't understand how she could get a bit of vein in with the shot. No I'm not a vet, but we have given pen quite a few times and were never in danger of hitting a vein.

I know, I was pretty surprised, too.

There are two things that can cause a reaction to penicillin. One is when the procaine gets into the bloodstream via a nicked vein and goes straight to the brain causing seizure like episodes and general thrashing around. One is an actual allergy to the penicillin itself when can be mild to severe. Severe would cause anaphylactic shock and could cause him to be unable to breathe. From your description is sounds like it was most likely the procaine that caused the problem. That said, if there is another antibiotic that can do the job I would probably opt to go that route just for peace of mind.

The procaine thing is what vet #2 described to me as being what they thought had happened. Our colt didn't have any breathing issues, so it probably wasn't a reaction based on what you guys have shared, but I think I'll try to avoid having penicillin given to him again just in case.

Why was penicillin given?? One shoild normally not need anitbiotics for gelding, and there is NEVER any reason to give ONE shot of antibiotics. Antibiotics used in this fashion lead to resistant strains of bacteria. I question your vet's giving this shot at all, much less the fact you had a reaction.

I thought this, too. I'd never had a 1 shot dose of antibiotics given before, either.

Was the subsequent "medication given" some epinephrine? If so, that would make it an anaphylactic shock and not the procaine burst.

There are forms of pen that are used as a one-time deal, afaik. I don't think those involve procaine, so that would also rule out the p-burst.

Assuming it was a-shock, I'd be sure to never allow this horse to have penicillin again.

I don't remember what was given to him during the seizures, unfortunately. It is on my receipt at the barn (I will have to check it again when I go back). I'm sure the penicillin shot that he was given had procaine in it though, based on what vet #2 said. Vet #2 is the main vet that owns the clinic, he came in to help during the seizures.

What makes you guys think this was an anaphylactic reaction? It doesn't sound the slightest bit like that to me. No swelling, hives, difficulty breathing, fluid in the lungs, etc.

Nope, he had none of that. Now I'm pretty sure it was the procaine, but wanted to hear what any of you had experienced as a reaction, too - just in case that was also a possibility.

If this horse has a noticable amount of blood in his urine he needs to go back to the vet clinic for a full evaluation, hopefully free of charge. He needs to be kept very well hydrated until kidney damage has been completely ruled out.

Vet was out Thursday night after the surgery to check on him, then again on Saturday after I noticed the blood. I was not charged for those visits or for the medication that was given to him during the seizures (I did have to pay for the bloodwork done saturday though). We've been monitoring his water intake closely and reporting back to the vet on that each day.

I leaned towards the a-shock because it was said that "medication" brought him out of it (makes me think epinephrine). I am unaware of a "medication" you can give a horse in a procaine burst seizure to stop it (that is, if you could even get close enough).

It would help to know the exact penicillin used.
Most likely a sedative of some kind.

I think it was a kind of sedative. What he was given may not have "brought him out if it", he may have been close to stopping anyway, I don't know. The thrashing around was pretty extreme, so it took (what seemed like) a long time to get it in him. I'm sure the kind of Penicillin used is also on my receipt. I'll check.

Having dealt with several procaine reactions over the years, I would think that the "blood in the urine" has NOTHING to do with the penecillin shot.

If your vet isn't taking the blood in the urine seriously, I would call another vet for a second opinion TODAY.

My understanding is that the vet thinks that the blood in the urine was due to the sudden muscle use while he was thrashing around, not to the penicillin shot itself. She seems to be taking the blood in the urine seriously, but I've never had this happen before, so I'm not sure what else could be done for him, apart from what we are doing - watching him closely to make sure things don't get worse and watching his water intake especially.

I had to run back to work for a while, but one of my students just checked him for me, he is still looking alert and eating fine. She said that it looked like he had peed again and it appeared almost normal. I'm cautiously optimistic, but then again he looked ok yesterday, too, then this morning again had the issue. *stress*

[Laurierace]

I just had a three year old gelded and he had penicillin for a while afterwards. I think it was given right after the procedure then once a day for three more days. Thankfully he had no reactions. Maybe they planned on giving him more than one dose but based upon what happened decided it wasn't worth the risk?

[shawneeAcres]

I just had a three year old gelded and he had penicillin for a while afterwards. I think it was given right after the procedure then once a day for three more days. Thankfully he had no reactions. Maybe they planned on giving him more than one dose but based upon what happened decided it wasn't worth the risk?

If I had a vet recommending penicillin as a "preventative" as this sounds like, I would really be questioning that vet. Anitbiotics are given FAR too often for all the wrong things, and there is no reason for it. Perticularly with penicillin which can cause many adverse effects, the aforementioned seizures, prolonged use can cause a reaction, diarrhea, colic etc. Penicillim is NOT a "preventative" medication, it is a medication that can be effectively used for an active infection but meds such as this should not be used to "prevent" infection. addtionally anitbiotics should never be given for three days (with the exception of some very expensive, long lasting ones), but for minimum 5 days, with 7 - 10 being a normal course.

[Blacktree]

I just had a three year old gelded and he had penicillin for a while afterwards. I think it was given right after the procedure then once a day for three more days. Thankfully he had no reactions. Maybe they planned on giving him more than one dose but based upon what happened decided it wasn't worth the risk?

Entirely possible. This isn't my normal vet though - you'd think that they would have asked first if I was comfortable giving any follow-up shots if that was the case. Maybe it was assumed, since I told the office (when I made the appointment) that I had immunized him for tetanus myself a month ago.

Ironically, I used these guys instead of my normal vet because they have a mini-hospital down the street from me. I thought it may be safer to haul him there, instead of having him done at home. :(

[JB]

Pen CAN be used as prevention in certain situations, such as when you are afraid a viral infection might open the door to an even nastier bacterial infection.

I didn't think there was any forumulation of procaine pen that was suitable for a one-time shot though, so that's a concern if that's the case.

I initially thought procaine burst, but the "medication to bring him out" swayed me to the a-shock :)

[Hillside H Ranch]

One thing to consider is are you sure that is blood in the urine? Or is the urine itself dark reddish/brown in color? Horses that have a "tying-up" episode will often have reddish/brownish urine afterward and it is indeed due to the muslce damage caused by the episode (and seizures can do the same thing). But it isn't blood; I believe it is myoglobin from muscle damage, but I would have to look that up, so don't quote me. Your vet is incorrect in thinking there would be blood in the urine from muscle damage. There could be blood in the urine, but not from muslce damage. It could be damage to the bladder, etc from thrashing around, or it could be coming from the castration site. I would try to determine if it is truly blood or not. You said bloodwork was run, and if the muslce enzymes were very high, then I would tend to believe that the strange colored urine is indeed from that.

[Iron Horse Farm]

One thing to consider is are you sure that is blood in the urine? Or is the urine itself dark reddish/brown in color? Horses that have a "tying-up" episode will often have reddish/brownish urine afterward and it is indeed due to the muslce damage caused by the episode (and seizures can do the same thing). But it isn't blood; I believe it is myoglobin from muscle damage, but I would have to look that up, so don't quote me. Your vet is incorrect in thinking there would be blood in the urine from muscle damage. There could be blood in the urine, but not from muslce damage. It could be damage to the bladder, etc from thrashing around, or it could be coming from the castration site. I would try to determine if it is truly blood or not. You said bloodwork was run, and if the muslce enzymes were very high, then I would tend to believe that the strange colored urine is indeed from that.

I'm glad that somebody said it, indeed, tying up episodes use the same kind of muscle energy as a seizure and often result in coffee ground coloured urine which can easily be mistaken for blood. It is myogloben, the byproduct of mass muscle cell death. And certainly, valium could have been used to stop the seizure.

Several years ago I was holding a colicking horse for a friend. She gave an IV injection of Banamine and hit the Corroitod (sp) artery. The horse dropped instantly and seizured. When he came out of it,he was fine (and no longer colicky).

[Blacktree]

One thing to consider is are you sure that is blood in the urine? Or is the urine itself dark reddish/brown in color? Horses that have a "tying-up" episode will often have reddish/brownish urine afterward and it is indeed due to the muslce damage caused by the episode (and seizures can do the same thing). But it isn't blood; I believe it is myoglobin from muscle damage, but I would have to look that up, so don't quote me. Your vet is incorrect in thinking there would be blood in the urine from muscle damage. There could be blood in the urine, but not from muslce damage. It could be damage to the bladder, etc from thrashing around, or it could be coming from the castration site. I would try to determine if it is truly blood or not. You said bloodwork was run, and if the muslce enzymes were very high, then I would tend to believe that the strange colored urine is indeed from that.

The vet saw the pee on saturday, it was on the stall floor so she couldn't get a sample to test, but she pressed a paper towel into it and said that it looked red, not brownish. That was before the blood tests were back, so the muscle thing was just being thrown around as one of the things it could be at the time. I thought of asking if that could be related to a form of tying up, but forgot. I will ask her to clarify when I check in with her tonight.

The bloodwork results were what made her think later that day that it was a muscle thing. I think she said it was liver enzymes that were high, but we had a mare ready to foal at any time when she called w/ that info, so I could be remembering that a bit wrong. Hopefully I don't sound like a total space-case about this, having all this happen around foal watch has me feeling a bit scatterbrained.

[Blacktree]

Ok, the penicillin given was written down as being "PPG", and the medication given to him during the seizures was listed as "diazepam" and "xylanzine". Does that sound like treatment for a reaction or for a P-burst to you guys?

This morning he's still got some red in his pee (it's not nearly as bad as it was on saturday, but it's no better than yesterday). I'm getting pretty worried. Temp is fine, he's still cheerful and eating/drinking ok. I just talked to the vet again and she agrees that I need to bring him back to the vet hospital today to put him on an IV and to have him monitored more closely.

Please send good thoughts his way!

[Laurierace]

That would have been my guess as to the medications used. The common names are valium which is used for sedation as well as relaxing seizure activity, and rompum which is a tranq with some analgesic properties as well. That definitely points to a procaine reaction and would not be useful for anaphylactic shock.

[Tiki]

The PPG is procaine penicillin G. One time doses of antibiotics are very common in humans as prophylactics for surgery. Not that unusual.

[JB]

The PPG is procaine penicillin G. One time doses of antibiotics are very common in humans as prophylactics for surgery. Not that unusual.

But is that same common use one reason why we have so many issues with pen-resistant bacteria?

[AKB]

Many of the vets in our area give antibiotics after gelding, particularly if it is going to be difficult for the owner to keep the area very clean. We have so much mud around here right now that I can't imagine how anyone could keep anything clean.

I know of several horses who have reacted to the procaine in procaine penicillin. It is easy to hit a vein if the horse moves at all during the intramuscular injection. Then, blood levels of the procaine are very high, triggering a seizure. Procaine makes the penicillin last longer, so it is commonly added to penicillin that is used for intramuscular injections.

Can you collect a urine sample and take it to the vet? A urinalysis would show if there is blood in the urine or if the red color is from myoglobin/tying up related to the seizure. A urinalysis might give you peace of mind.

[Blacktree]

We've been trying to get a pee sample since saturday. He is very sneaky about when he pees though! :) That's a lot of the reason we're bringing him back to to the vet hospital, since the techs will be able to watch him non-stop. Also, I want to get him on an IV.

I sure hope we can figure out what is going on soon. I'm encouraged that he still seems cheerful, etc. but am pretty worried that we're still seeing this. I'll feel better at least w/ him being there, in case I'm missing some important indicator.