Acetaminophen and cat emergency!!!???

[jillborbas]

Our 1 1/2 year old adopted cat, Tippi Jones, presented yesterday morning with severe facial swelling, discolored gums, and lethargy. She has been very healthy for the year she's been with us. The vet at the emergency hospital suspected Tylenol poisoning and sent Tippi home with Ab's and pain killers. Tippi was admitted to the hospital upon her second visit the same afternoon. Facial swelling has increased significantly this morning and she is being treated for Tylenol poisoning. Weight has dropped from 7# at her last well visit to 6.6#. Temp 105. No idea how exposure to Acetaminophen is possible! HELP! Insect bite? Toxic plant? Other ideas? No other cats and the dog is healthy. No puncture wounds obvious, no apparent head trauma. We can't lose this precious cat!!! Her old dog needs her and so do we!

[Love4himies]

I take it they have her on IV and had her drink charcoal to absorb anything left in her stomach?

Have they had her on antihistamines?

http://www.peteducation.com/article....1+2117&aid=152

[Love4himies]

Here is another link I found:

Facial swelling with a fever can be due to an infection? Could your kitty have a wound or abcess tooth?


http://www.petplace.com/cats/facial-...ats/page1.aspx

[Love4himies]

Good Luck, sending for your kitty to have a quick recovery.

[chico2]

Jill I bet you are incredibly worried,did the tests show Tylenol poisoning,specifically ??
It sounds to me like a severe allergic reaction,but that's just a guess,I am definetly not a vet.
for your poor kitty

[jillborbas]

Yes, we are very, very worried!! I am beside myself! In spite of all our rescue dogs over the years (and a handful of feral cats), my son especially is a cat person (maybe even a closet Republican?) No indication of an allergic rx. I believe the test for Tylenol poisoning takes days, therefore Tippi's current treatment. But I don't understand??? Why didn't they admit her when she first presented to the hospital? We have asked repeatedly about potential allergic reactions and/or infections--she is receiving IV Ab's. I am so afraid the phone may ring any minute....

[Tundra_Queen]

I am so very sorry to hear about Tippy. I hope the vet can figure out what is wrong with her so she will get better soon! *HUGS*

Debbie

[Dr Lee]

Originally Posted by jillborbas

Our 1 1/2 year old adopted cat, Tippi Jones, presented yesterday morning with severe facial swelling, discolored gums, and lethargy. She has been very healthy for the year she's been with us. The vet at the emergency hospital suspected Tylenol poisoning and sent Tippi home with Ab's and pain killers. Tippi was admitted to the hospital upon her second visit the same afternoon. Facial swelling has increased significantly this morning... Temp 105. No idea how exposure to Acetaminophen is possible!

Thanks, Rustycat for telling me about this thread.

Here are the clinical signs of acetaminophen (from the Med FAQs on www.vin.com): "Clinical signs of acetaminophen toxicity are related to methemoglobinemia and hepatotoxicity. Clinical signs include depression, weakness, tachypnea, dyspnea, cyanosis, icterus, vomiting, methemoglobinemia, hypothermia, facial or paw edema, hepatic necrosis, and death."

What is unusual in the history is the presence of a fever for which the MedFAQ states that hypothermia (too low a body temperature) is more common. Also the facial swelling is unusual. The other signs could be secondary to acetaminophen toxicity or a whole list of other possibilities. What exactly makes them so suspicious of acetaminophen toxicity?

Here is treatment information from the MedFAQ Sheet:
"How do I treat acetaminophen toxicity?

The objectives of treatment in acetaminophen toxicity are 3-fold:

1. to replenish glutathione,

2. convert methemoglobin back to hemoglobin,

3. prevent or treat hepatic necrosis.

Additionally, limiting absorption and promoting elimination (as with other toxicities) is recommended. Induction of vomiting and activated charcoal lavage if ingestion is observed or identified within 2-4 hours will help limit absorption. If methemoglobinemia develops, transfusions or oxygenated hemoglobin may be required. Oxygen and fluid support may be needed while combating the methemoglobinemia.

What drugs do I use?

1. N-acetylcysteine (Mucomyst) N-acetylcysteine acts to detoxify acetaminophen in several ways, but primarily by increasing the synthesis and availability of glutathione, which binds and inactivates the highly reactive and hepatotoxic acetaminophen metabolite NAPQI. NAPQI can be conjugated with glutathione after its formation, offering the body a "second chance" at reducing NAPQI concentrations. A 5% solution of NAC is given orally to dogs or cats at an initial loading dose of 140 mg/kg and then 70 mg/kg every q 4 h for at least 3-5 treatments. Intravenous use may be necessary with severe cases, however, a bacteriostatic filter should be used during administration.

2. Cimetidine (Tagamet) inhibits the P450 (CYP2E1) system in the liver and, theoretically may help slow the metabolism of acetaminophen into toxic metabolites. The dose of cimetidine is 5-10 mg/kg PO, IM, or IV every q 6-8 h in dogs and cats.

3. Ascorbic Acid (Vitamin C) may help to provide a reserve system for the reduction of methemoglobin back to hemoglobin. The effective dose of Vitamin C is 30 mg/kg q 6-12 h orally or intravenously.

4. SAMe (S-adenosyl methionine) has recently been used to treat hepatotoxicity in a dog, and investigated in an experimental feline model, and may offer additional benefit in treatment of acetaminophen toxicity.

The use of cimetidine in combination with NAC and ascorbic acid has been shown to be more effective than any of the agents alone in preventing acetaminophen-induced hepatotoxicity in animal studies. The additional use of SAM-e may also lead to greater chances of success with patients.

Note: Methylene Blue is commonly used to treat methemoglobinemias secondary to oxidative agents such as nitrates. However, it causes Heinz body anemias and methemoglobinemia in cats, so it should NOT be used to treat acetaminophen toxicity in this species."

Are these being done?

Also what are the blood levels? Is there significant liver changes to support acetaminophen toxicity?


The good news is that whether acetaminophen toxicity is present or not, intravenous fluids and antibiotics can solve or improve many problems: bacterial infections including abscesses, cellulitis, etc...; various toxins, dehydration and various metabolic disorders.

Can you provide some test results? Can you get a copy of the blood work and scan it in and post it?

Wishing you the best!

[Mat&Murph]

I just read this thread.* We are praying for Tippy!!!** Our hearts and thoughts are with you!!!

[jillborbas]

We visited with Tippi this AM. Facial swelling a bit better, especially the edema around her eyes. Was not able to talk with doc yet today, but do know that she is being treated for OD and infection--but still cannot imagine how she could have ingested any tylenol. I have not seen results of the blood work, just a large bill that states only 1st injection, 2nd injection, oral med given, and on and on....As of yesterday, liver function was normal and no signs of anemia which likely wouldn't show up for another day anyway. I specifically asked the Dr. yesterday about cyanosis and was told this is not a symptom of Tylenol OD (thanks for the info Dr. Lee). The high fever is very curious. Also was very interesting to find a deer tick on Tippi this morning considering she has been in the hospital for 48 hours! Some tick borne pathogen--there are many.....
Well, we got a weak purr out of her, thanks for all your prayers and good wishes!

[Dr Lee]

Originally Posted by jillborbas

I specifically asked the Dr. yesterday about cyanosis and was told this is not a symptom of Tylenol OD

Here are two resources you might want to point your veterinarian in:

1) Common Canine Liver Diseases (VET-196)
Western Veterinary Conference 2004
Robert J. Washabau, VMD, PhD, DACVIM
School of Veterinary Medicine, University of Pennsylvania
Philadelphia, PA, USA

"Acetaminophen Toxicity--Acetaminophen is a safe analgesic in most dogs and has been used without complication in many circumstances. Dogs apparently tolerate single doses up to 25-30 mg/kg with minimal clinical or laboratory changes. Higher doses of acetaminophen and overproduction of reactive metabolites (including paracetamol) rapidly deplete erythrocyte and hepatic glutathione. Central lobular hepatocytes are most sensitive to these reactive metabolites, and a severe central lobular necrosis ensues. Severe methemoglobinemia develops and animals may succumb to cyanosis before the full syndrome of liver failure has developed. If recognized, acetaminophen toxicity may be treated with acetylcysteine (sulfhydryl group donor), ranitidine or cimetidine (cytochrome P450 enzyme inhibition), ascorbic acid (anti-oxidant), and androstanol (constitutive androstane receptor [CAR] inhibition). Ranitidine and cimetidine bind cytochrome P450 enzyme systems and prevent the conversion of the non-toxic acetaminophen to the toxic paracetamol."

2)Toxicoses of Pain Meds: The Real Story
International Veterinary Emergency and Critical Care Symposium 2005
Tina Wismer, DVM, DABVT, DABT
ASPCA Animal Poison Control Center
Urbana, IL, USA

Acetaminophen.
"Methemoglobin values increase within 2-4 hours, followed by Heinz body formation. Clinical signs include depression, weakness, hyperventilation, icterus, vomiting, methemoglobinemia, hypothermia, facial or paw edema, death, cyanosis, dyspnea, and hepatic necrosis. Less common clinical signs include metabolic acidosis, renal insufficiency/damage, myocardial damage, coma, and thrombocytopenia. Liver necrosis is less common in cats than in dogs. Clinical signs of methemoglobinemia may last 3-4 days. Hepatic injury may not resolve for several weeks. Hepatotoxicity has been reported in dogs at 100 mg/kg and 200 mg/kg caused clinical methemoglobinemia in 3 out of 4 dogs. Doses of 40 mg/kg have resulted in KCS 72 hours after ingestion. Cats develop clinical signs at doses > 40 mg/kg. No dose is safe in cats since they are deficient in glucuronyl transferase. Ferrets are considered to be as sensitive as cats."

These conference proceedingsx are easily found on www.vin.com If your vet does not have vin. I can email you the entire lectures if you need.

The veterinary economists say that the vet with the most educated clients wins. I think the reverse might be true as well.

Good luck and let us know how it goes!

[chico2]

Jill,so sorry to hear that,but hopefully now when the Tylenol toxiciti is questionable hopefully they can find out whats really wrong
Sorry I can't help...just for little Tippi and lots of

[sugarcatmom]

Originally Posted by jillborbas

We suspect the new food we gave her the night before she got sick may be the culprit.

What was the food? That's a pretty severe allergic reaction.

Originally Posted by jillborbas

We've given her Benedryl and used hydrogen peroxide on her open wounds.

I wouldn't use the hydrogen peroxide, it can actually interfere with new cell growth. Something like pure aloe vera gel or juice (as long as it isn't preserved with sodium benzoate; Lily of the Desert is a good brand) would probably be more soothing and help with healing.

Originally Posted by jillborbas

She is eating rice and turkey for the time being. Any ideas????

She doesn't need the rice, just turkey would be better, and only for a short while (2-3 days) as it isn't a balanced diet.

[sugarcatmom]

I forgot to ask, could there be any new chemicals in your home, like a new cleaning product or laundry detergent? New carpet or furniture? Was she vaccinated recently?

[jillborbas]

Originally Posted by sugarcatmom

I forgot to ask, could there be any new chemicals in your home, like a new cleaning product or laundry detergent? New carpet or furniture? Was she vaccinated recently?

No to all of the above, but there is one other thing I forgot to mention. I found a tick (smaller than a dog tick and larger than a typical deer tick) on Tippi when I visited her on her second day in the hospital. We have a very large dog and large fenced-in half wooded yard. I got Lyme disease myself this summer.

[Karin]

Originally Posted by jillborbas

No to all of the above, but there is one other thing I forgot to mention. I found a tick (smaller than a dog tick and larger than a typical deer tick) on Tippi when I visited her on her second day in the hospital. We have a very large dog and large fenced-in half wooded yard. I got Lyme disease myself this summer.

Crap! You could have more than one thing going on here. Please say you brought this to their attention. I am not blaming one tick encounter, we have ticks everywhere here in the south, but this must be mentioned to your vet.
It's been a long while since I have seen a case of tick fever, well, since topical flea & and tick products arrived.

[sugarcatmom]

Originally Posted by jillborbas

The food was a dry seafood mix (funny she prefers dried food, but is eating the turkey--thank God she's eating something).

Glad that she's eating, especially since she's on antibiotics (which one?). Watch out if her appetite wanes as antibiotics frequently cause digestive issues in cats. Try not to give them on an empty stomach, and if you can get her to take some probiotics (you can mix it in with food), that should help replenish the intestinal flora that are getting wiped out.

As for that dry food, even if it isn't the culprit, I wouldn't feed it again. For one, cats really shouldn't eat a steady diet of seafood (fish is a common allergen, among other reasons). What kinds of wet food have you tried in the past? How have you introduced them? A canned or balanced fresh meat diet is significantly healthier for cats than any dry food, but unfortunately many cats get addicted to kibble. With plenty of patience and persistence, it is possible to change even the most die-hard addict over to wet food. Read the "Tips for Transitioning" at this link: http://www.catinfo.org/

Originally Posted by jillborbas

The vet said they sell a hypoallergenic food for cats,

I would stay away from this or any other prescription vet food. Far too expensive for the poor quality ingredients they contain. If you are interested in a less allergenic food, look for a novel protein source canned (or raw) with no grains. Innova Evo 95% venison or duck, and Nature's Variety Instinct rabbit, venison or duck are good choices. If you can't find those Natural Balance venison (or duck) and green pea should be widely available.

Originally Posted by jillborbas

We are worried about infection--her wounds look nasty, hence the H peroxide.

Hydrogen peroxide isn't as antibacterial as it was once thought to be, and like I said, can cause tissue damage: http://www.emedmag.com/html/pre/err/0804.asp

Hydrogen peroxide solutions are corrosive and can cause tissue necrosis. In addition, they release oxygen into the tissues when they come in contact with peroxidases and hemoglobin.

In reviewing the utility of hydrogen peroxide in emergency practice, we find that there are actually no situations in which this agent can be recommended as the primary approach to wound management.

If you can find some 50 or 100 ppm colloidal silver from a health food store, this has much safer and stronger antibacterial properties.

[sugarcatmom]

Originally Posted by jillborbas

I found a tick (smaller than a dog tick and larger than a typical deer tick) on Tippi when I visited her on her second day in the hospital.

Uh-oh. I don't know much about tick-borne diseases as they aren't typically a problem where I live, but it would definitely be worth mentioning to the vets, like Karin said.

[Love4himies]

Originally Posted by jillborbas

No to all of the above, but there is one other thing I forgot to mention. I found a tick (smaller than a dog tick and larger than a typical deer tick) on Tippi when I visited her on her second day in the hospital. We have a very large dog and large fenced-in half wooded yard. I got Lyme disease myself this summer.

Cats rarely get infected with Lyme's disease and if they do it is usually mild, unlike humans or dogs.

Just wondering if you use plastic bowls for your kitty?

[Love4himies]

I agree with Sugarcatmom's advice, change her food to a better quality food. I found my cat's love the Nature's Variety Instinct Venison, even the pickiest of the three. I don't have any experience with Evo.


Here is a link to the ingredients in the Instinct:

http://www.naturesvariety.com/instinct_cat_can

[chico2]

L4H,good point,one of my cats from ago had his mouth area swell up,at the time I never knew plastic-bowls,were bad for my cats.
I am certainly no cat-food expert,but try my best and my cats all do well on Wellness no-grain canned.
I would think eating fishy dry food for a long period of time could cause health-problems,for sure
Jillborbasfor Tippi and you..

[jillborbas]

Originally Posted by chico2

L4H,
I would think eating fishy dry food for a long period of time could cause health-problems,for sure
Jillborbasfor Tippi and you..

Tippi probably only ate the new "fish" food twice which is why we considered an allergy. I know fish oils are recommended for cats, but wonder of they'd be safe for her. I used to do research on omega-3 fatty acids from algal sources as a replacement for fish oil, and while they are now sold OTC, they are very expensive.

[sugarcatmom]

Originally Posted by jillborbas

Clindamycin.

Make sure you follow the clindamycin with a chaser of water or some food to avoid it getting stuck in her throat. More here on why that's important: http://www.catinfo.org/pillingcats.htm

[Love4himies]

http://www.peteducation.com/article....+1461&aid=1488

I would, however, contact your vet to get his/her approval before using any topicals as cats are so sensitive to toxins.

[Love4himies]

Here is another one:

http://www.acatdog.com/dogcatwoundcare.aspx

[jillborbas]

THANK YOU!!!

[Love4himies]

Originally Posted by jillborbas

Fortunately, the clindamycin is in liquid form. We' re going to take her back to the vet today so she can look at Tippi's face, but I know she is going to say take her to a specialist.

and some for Tippi. There is no reason to waste any more money on your vet if she is at a loss, a specialist may be able to come up with an answer very quickly.

[sugarcatmom]

Originally Posted by jillborbas

Fortunately, the clindamycin is in liquid form.

Is she taking it okay? That is serioiusly the nastiest tasting med of all time. If you keep it in the fridge it might be slightly less noxious, but I personally will never use it on my cat again because of how bad it tastes. That and the fact that he got diarrhea on it. If Tippi shows any sign of intestinal upset, stop it immediately and call the vet. It can cause colitis. http://www.marvistavet.com/html/clin...ochloride.html

The only side effect of concern is upset stomach including diarrhea (which can be bloody) and vomiting. If your pet develops an upset stomach on clindamycin, please discontinue the medication and notify your veterinarian.

Probiotics would definitely be a good idea with this antibiotic.

Good luck at the vet, and let us know how it goes.

[hazelrunpack]

Originally Posted by jillborbas

We tried to contact the specialist this afternoon unsuccessfully, then the vet tried. We can not get an appointment until Monday. What do we do until then? The ER cannot diagnose her either.

Most specialists (especially if it's one at a teaching college) will take patients very short notice if you call it in as an emergency. Perhaps your vet would be willing to try again and tell them that it's critical that Tippi be seen asap?

[rainbow]

I just read this thread now and so sorry to hear about Tippi. :sad:

Are you far from the specialist? What if you just walked in with your cat?

I've been at the vet lots of times when someone has walked in with an emergency and they get seen right away. It puts the rest of the appointments behind but everyone understands.

Good luck.