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  Discussion on Edema caused by allergic medication reaction
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New Member:
miley

Posted on Monday, May 26, 2008 - 12:38 am:

I have a 13 year old quarter horse mare who was given an IM injection in the neck of Xylazine, in order to be shod. She had never been given this medication before and has now had a severe reaction. She had an immediate swelling at the injection site, that did not disburse with rubbing and then swelled more. she came out of the sedative well and was even rode leisurely for about an hour. The next afternoon, she was down and had severe swelling of her entire neck and throatlatch area. the vet was called and he gave her a shot of dexamethasone and started her on penicillin twice daily IM. The next day the swelling was slightly worse in her neck and began to go don into her front legs. When I gave her the penicillin in the pectoral muscles, fluid began leaking severely from the injection site. The vet was called again. he said the edema was becoming dependent and the tissues will leak and break open. He started her on Gentamycin 12 ml IV for three days. The mare cannot move her front legs without great difficulty and pain. It is now been four days and she has shown very little improvement. both legs and her chest are leaking serous fluid and the swelling has not improved. The vet said we could give her bute, but doesn't want to because it could cause other problems. She has been eating and drinking and urinating up until today when she refused to drink only a few sips. We have been bringing the food and water to her because she cannot move. the vet says to leave her alone and don't try to make her move. How is she going to get rid of the edema in her legs if she doesn't move? Is there something else we can be doing for these tissues besides waiting for them to break open? We dont't feel that our vet is being proactive enough and would appreciate any advice or suggestions for our very sick girl. Thanks
Member:
scooter

Posted on Monday, May 26, 2008 - 7:09 am:

That sounds horrible, hope someone can ans. your questions. Sounds kind of like cellulitis?

Have you read the article on leg swellings?
I hope your girl gets better soon.
https://www.horseadvice.com/horse/messages/4/6244.html
Moderator:
DrO

Posted on Monday, May 26, 2008 - 11:06 am:

Hello miley13,
This is a very unusual reaction to the xylazine. The immediacy suggest reaction but the ongoing seriousness suggests infection. The problem is whether this is an allergic reaction or a serious infection secondary to the injection. Or both possibly. Sometimes it does appear that serious reactions in the neck result in areas of necrosis that "activate" dormant clostridial spores in the muscle.

Proper treatment will depend on a correct diagnosis and besides a good physical and CBD (blood work). I would also consider ultrasounding the original injection site: if there is an abscess there, opening, draining, and debridement might be the quickest way to fix this thing. If the vet is a bit overwhelmed perhaps referral to a hospital might be best.

If there is infection in the tissues of the legs, moving around a lot may spread the infection which is the reason the veterinarian would prefer for the mare to be quiet.
Wide spectrum antibiotics like penicillin AND gentamycin would be logical for infection. Dexamethasone would be logical for a allergic reaction. When uncertainty exists they have been used together with high doses of bacteriacidal antibitoics and low end dex doses though this is considered controversial.
DrO
Member:
quatro

Posted on Monday, May 26, 2008 - 8:05 pm:

Hi Miley, my horse Cody, went through exactly the same thing. It was traced back to the vet re-using a dirty needle, not that your vet did. My horse had a very serious infection, and was hospitalized for 6 days, on antibiotics. He did not eat for seems like forever. The swelling also worked its way down his legs. I think they did the DMSO on the leg swelling if I recall.
He did get better, but I would not sit back and wait. He got shots antibiotics twice a day, in large doses, but it definately was not a reaction, it was infection.
It is scarey, but with proper veterinary care, she should be fine.
suz
Moderator:
DrO

Posted on Tuesday, May 27, 2008 - 7:41 am:

Susan, did your horse have an immediate reaction to the injection?
DrO
Member:
quatro

Posted on Tuesday, May 27, 2008 - 9:57 am:

Come to think of it, no, he was fine that day, and the next day, his head was down, huge swelling on his neck, not eating. I did not notice anything immediately. But then again. I really did not look closely.
He was a very sick boy though.
after the fact, I learned that this vet was a cattle doctor, and frequently re-used needles. I could not prove this to be the case, but rumor had it.
suz
New Member:
miley

Posted on Wednesday, May 28, 2008 - 8:25 pm:

Thank you for the information Suz and Dr. O. What is DMSO?
I have to admit, I did use a needle that was previously used. Update: Day
6 - She is moving a little better - still very very slow - Swelling is starting to go down in her legs - oozing continues and she has open wounds in her "armpits" of her front legs and in her chest.She will eat if we bring it to her but has walked to pasture for the last three days and goes to the tank to drink. We have 2 days left of antibiotics. Our concern now is the swelling in her neck ( abscess ). My feeling is that it should be drained but vet doesn't think so. I also don't know what we should be using for sure to keep the flies & infection out of the open tissue (where it is draining)on her legs and chest. What is your opinion? I am concerned about stopping antibiotics while she still has this abscess on her neck. I would guess that her problem is more from the needle than from the Xylazine.
Will be using a new needle from now on for sure. Would spraying the wounds with betadine help?
Moderator:
DrO

Posted on Thursday, May 29, 2008 - 6:36 am:

Hello miley13,
Using a non-sterile needle greatly increases the chance you have a infection and if an abscess is present the quicker you get it drained the quicker all the other complications will subside, see my first post for more on how to diagnose this.

In an attempt to put together the history with what appears to clearly be a problem with infection I am curious in nailing down some details. When you say there was an immediate swelling can you further describe how quick this happened and how it developed. Also I am curious as to what the needle had been used for before and if the syringe had been previously used? Lastly what had been previously in the needle and syringe? Thanks I believe your answers will help others avoid problems.

Concerning the proper procedure for giving IM injections see our article Diseases of Horses » First Aid » Giving Injections and Anatomy Orientation.
DrO
New Member:
miley

Posted on Thursday, May 29, 2008 - 12:40 pm:

Dr. O, I am a registered nurse and I feel ashamed that I gave this horse an infection by using a non-sterile needle. I have used this practice in the past with animals with no problems. I can narrow it down for you. I used a needle from either EEW, tetanus vaccine or West Nile vaccine, that was either used on this mare or my mare who is her pasture mate. I know my vet will not I&D the abscess. My own personal physician has given me instructions on how to perform the proceedure and I have assisted with this proceedure many times.My Dr is very concerned and asks me daily about the horse. Is the technique the same for animals as for people? I surely would need to use lidocaine injection first. How much?Should this mare be kept on gentamycin or go back to penicillin every 12 hr?It is my sisters horse, who lives at my house. It is her decision. Thanks for any advice.miley
New Member:
miley

Posted on Thursday, May 29, 2008 - 12:52 pm:

Oh sorry I forgot to say that the syringe I use was new, just reused the needle. Also I can describe the swelling. at first it was just a small knot but I thought it was just from the fluid so I rubbed it to disperse. Then, within 10 minutes there was a raised area about softball sized, that looked like a whelt, and was immediately tender to palpation. It did not get any bigger around just more raised. The next day the lymph nodes in the neck were swollen. Can I ask you, what is the best way to treat the areas that are breaking open and to remove the exudate coming from the tissues?Thanks DR. O
Moderator:
DrO

Posted on Thursday, May 29, 2008 - 9:56 pm:

Without a clear indication of cause and with clostridial being of primary concern in cases like this I would use both as described in the articles on the respective antibiotics.

Prior to ultrasound we would use a long (at least 1 and 1/2 inch) large gauge (18 or bigger) needle to locate the abscess and once located infusion of 10 ml lidocaine may help. However the environment around an abscess becomes somewhat acidic so "caines" are not as effective. Heavy sedation is a more effective tool. Assuming a potable water supply I would use a water hose and debride and treat as described in Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care.
DrO
Member:
paul303

Posted on Thursday, May 29, 2008 - 10:25 pm:

DMSO-Dimethylsulfoxide. It is a powerful industrial solvent. It has ( unapproved ) medicinal uses. It's sometimes used topically with various medications to aid in absorption through the skin. It's been used to disperse edema and ease swelling.
Moderator:
DrO

Posted on Friday, May 30, 2008 - 7:05 am:

Thanks for picking up the missed question Lee. I should also note that while I have mixed feelings about its use at all, most consider it contraindicated in cases of infection.
DrO
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