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Acetaminophen toxicity

ISSN 2398-2985


Introduction

  • Cause: ingestion of acetaminophen, a pain reliever for humans for control of fever, headaches, joint or muscle pain.
  • Signs: hepatic necrosis, methemoglobinemia and acute renal failure (rare).
  • Diagnosis: blood biochemistry: alanine aminotransferase, serum alkaline phosphatase, total bilirubin and albumin.
  • Treatment: emesis and/or activated charcoal, N-acetylcysteine, cimetidine, ascorbic acid.
  • Prognosis: poor.

Presenting signs

  • Initially there may be lethargy and anorexia.

Cost considerations

  • Treatment may be prolonged and expensive in some cases.

Pathogenesis

Etiology

  • Ingestion of acetaminophen (tablets or liquid), a pain reliever for humans for control of fever, headaches, joint or muscle pain:
    • Europe: paracetamol.
    • USA: acetaminophen.
  • In ferrets, glucuronidation of acetaminophen is relatively slow in the liver compared with all other species (except the cat). This makes ferrets (and cats) more vulnerable to acetaminophen toxicosis.
  • Ferret red blood cells appear to be sensitive to oxidative stress and may be prone to the formation of methemoglobinemia with exposure.
  • Hepatic damage may also occur; liver necrosis and resulting fibrosis may compromise long-term liver function.
  • Pulmonary edema and liver and kindey congestion may be seen.

Predisposing factors

General

  • Owners dosing their ferrets or ferrets gaining access to and ingesting acetaminophen.

Timecourse

  • Clinical signs are expected 12-48 h after ingestion of acetaminophen.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Court M H (2001) Acetaminophen UDP-glucuronosyltransferase in ferrets: species and gender differences, and sequence analysis of ferrets UGT1A6. J Vet Pharmacol Therap 24 (6), 415-422 PubMed.

Other sources of information

  • Fox J G & Marini R P (2014) Eds. Biology and Diseases of the Ferret. 3rd edn. Wiley Blackwell, USA. pp 835.
  • Mayer J & Donnelly T M (2013) Clinical Veterinary Advisor: Birds and Exotic Pets. Elsevier, USA. pp 752.