Apap Tylenol

Apap Tylenol toxicity in pets

Cats are highly sensitive to paracetamol, and there is no safe dosage; its use is strongly contraindicated. Clinical signs arise from hepatotoxicity and methemoglobinemia. The most common symptoms include brown mucous membranes, lethargy, vomiting, diarrhea, jaundice, and swelling of the face and paws. Cats are more likely to exhibit signs of methemoglobinemia, whereas dogs typically present with hepatotoxicity, along with gastrointestinal and central nervous system symptoms.
dog
  • Therapeutical 0-50 mg/kg
  • Case specific 50-100 mg/kg
  • GI 100-200 mg/kg
  • Methemoglobinemia 200-500 mg/kg
  • Irriversible liver damage 500< mg/kg
cat
  • Safe 0-10 mg/kg
  • GI 10-50 mg/kg
  • Mild methemoglobinemia 50-100 mg/kg
  • Severe methemoglobinemia 100< mg/kg

The accumulation of toxic metabolites and oxidative injury occurs when the metabolic pathways for glucuronidation and sulfation are absent or depleted, along with a reduction in glutathione levels. The binding of NAPQI to hepatocyte membranes leads to hepatocellular death, central lobular necrosis, and oxidative damage to red blood cells and hemoglobin.

  • Hepatotoxicity: Symptoms include hepatic failure, anorexia, nausea, vomiting, lethargy, abdominal pain, jaundice, hepatic encephalopathy, and coma. Coagulopathy may develop as a result of end-stage hepatic failure.

  • Methemoglobinemia: Signs of methemoglobinemia include shock (characterized by tachycardia, tachypnea, hypothermia, weakness, and collapse), brown mucous membranes, respiratory distress, cyanosis, lethargy, depression, coma, and swelling of the face and paws.

  • Renal/Urological Issues: Renal tubular necrosis may occur.

Emesis: Induce vomiting within 2 hours of ingestion if the patient is asymptomatic.

Activated Charcoal: Administer activated charcoal (1–3 g/kg) without a cathartic once, if ingestion occurred within the last 2 hours.

Appropriate Health Care:

  • Secure and protect the airway.

  • Provide oxygen.

  • Monitor and replace fluids and electrolytes as needed.

Antidote:
N-acetylcysteine (NAC) should be given as follows:

  • Initial dose: 140 mg/kg IV

  • Follow-up doses: 70 mg/kg IV every 4–6 hours for 7–17 doses.
    If the patient can eat, oral therapy may be continued. NAC should be administered for 36-72 hours after toxin ingestion.

Antioxidant Therapy:
Ascorbic acid at a dose of 30 mg/kg PO or SC every 6 hours.

If you suspect your pet has ingested Tylenol, it is critical to seek veterinary care immediately.

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