Q.  You are presented with a dog in fulminating hepatic failure with signs of hepatic encephalopathy including new onset of generalized seizures.  Explain why there may be concerns about using diazepam for immediate seizure control. 

A.  There are several biochemicals implicated in the propagation of hepatic encepaphalopathy including GABA-eric compounds.  Several natural and toxic benzodiazepine-like compounds exacerbate symptoms of sedation and can lead to coma.  Exogenous administration of diazepam can contribute to this.  Use of Diazepam is controversial in patients who have seizures from hepatic encephalopathy.  Many practitioners still feel comfortable using the medication judiciously (ie starting with ¼ of the typical dosage) and others feel it should be avoided and replaced by propofol which theoretically will not exacerbate GABA activation the same way but can carry its own complications including respiratory arrest, obtundation, and confusion of limb movements, tremors, and dysphoria on recovery. 

"Hepatic encephalopathy: etiology, pathogenesis, and clinical signs."

Salgado M, Cortes Y.

Compend Contin Educ Vet. 2013 Jun;35(6):E1-8