Case 13

Within one week, the owner reports that Olivia is much better, that she seems to be drinking less and isn't having accidents in the house, and that her activity level is back to normal. Because Olivia is improving, the owner would like to continue medical therapy.

One month later, Olivia presents for evaluation of acute onset of seizures. The owner reports that Olivia appeared to have a seizure last night-she fell over, paddled, and urinated. The seizure lasted about 30 seconds and, though she had no other seizures, she was “out of it” all night afterward. The owner also mentions that for the past week Olivia has been slightly lethargic, has had a decreased appetite, and hasn't received lactulose and neomycin because the owner hadn't requested refills.

On presentation, Olivia is obtunded and slightly tachycardic, but the rest of her physical examination findings are normal.

QUESTION 7

What do you recommend for the acute management of Olivia's clinical signs?

a) Immediately resume the oral lactulose and neomycin.

b) Initiate treatment with lactulose enemas and intravenous fluids and antibiotics.

c) Initiate treatment with intravenous diazepam to decrease the risk of further seizure activity.

d) Recommend emergency surgery to correct the shunt.

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