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10 Acetaminophen Toxicosis

• Motor vehicle accidents/hit by car: History • Considerable knowledge is available on animal welfare organization or veterinary
association.
helps to differentiate (e.g., is the animal ever injuries specifically associated with child • In some circumstances, the veterinarian may
VetBooks.ir does physical exam (animals hit by cars often abuse injuries is needed. The medical experi- feel that the welfare of the animal is so
abuse. Further research on equivalent animal
allowed out or is always kept in house?), as
ence of child abuse injuries provides a useful
have tattered nails, skin abrasions, and dirt
severely compromised that client confiden-
in the haircoat).
starting point for researchers.
• It is highly desirable that an experienced tiality should be breached. In the United
Kingdom, this is fully recognized in the
Initial Database veterinary pathologist, preferably one with comprehensive Royal College of Veterinary
• Much of the diagnostic information in cases forensic experience, perform a necropsy of Surgeons Guide to Professional Conduct.
of abuse is obtained from the history and fatal suspected abuse cases. The veterinarian is advised in the first
physical exam. • Injury from sexual abuse may be absent. instance to attempt to discuss concerns with
• Ancillary diagnostic tests depend on the Common sense dictates that injury depends the client. In cases where this would not be
specific details of each case. on animal size and the actual type of sex appropriate or the client’s reaction increases
○ Radiographic examination, particularly act, which can be variable. rather than allays concerns, the veterinarian
for fractures; fractures of differing ages • It is not the veterinarian’s remit to prove should consider whether the circumstances
may be found abuse. That is the responsibility of the are sufficiently serious to justify disclosing
○ Necropsy of fatal cases. Radiographic courts. The veterinarian’s responsibility is the client’s information without consent.
examination can also be helpful in fatal limited to provision of veterinary evidence to Appropriate contact details are listed in this
cases before necropsy. the court. guide. Advice with contact details is also
• In so doing, it may be reassuring to be aware given on the reporting concerns about child
TREATMENT that investigation of an abuse case is multi- abuse or domestic violence to appropriate
disciplinary (e.g., animal welfare organiza- authorities, regardless of whether animal
Acute General Treatment tions, police) and that there may be lay abuse is present.
As dictated by nature and extent of injuries witnesses of the abuse.
• The veterinarian may feel that in some cases Technician Tips
PROGNOSIS & OUTCOME there are extenuating circumstances with Clients who have an abused pet may be more
regard to the person perpetrating the abuse comfortable speaking about this situation with
• Depends on the severity of the abuse. Fatal (e.g., emotional problems, other personal a technician rather than the attending veterinar-
cases occur. difficulties) (see Etiology and Pathophysiol- ian. The technician should listen neutrally and
• Can be poor with fabricated or induced ogy section). These feelings may influence without passing judgment. Since repeat offenses
illness (Munchausen’s syndrome by proxy) the veterinarian’s decision to report a case. are common, it is in the best interest of animals
if the pet remains with the owner These circumstances are not the veterinarian’s for the technician to share this information
responsibility, nor does he or she have the with the veterinarian afterward and to docu-
PEARLS & CONSIDERATIONS relevant expertise to judge them. In the ment it in the medical record.
United Kingdom the law courts consider
Comments these circumstances. SUGGESTED READING
• No single injury or group of injuries, when • Each veterinary practice needs to consider Tong LJ: Identifying non-accidental injury cases in
divorced from the circumstances surrounding its own procedures in relation to this difficult veterinary practice. Br Vet Assoc Pract 38:59-68,
a suspect case, can be considered to conclu- area. It is advisable to have a practice policy 2016.
sively indicate physical abuse. available for guidance. All staff members
• More than one type of abuse may be present need to be familiar with this policy, which AUTHOR: Helen M. C. Munro, BVMS, MRCVS
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
at the same time. For example, physically should undergo regular review.
abused animals may also suffer neglect from • The law varies from country to country
malnourishment or from lack of veterinary and within countries. Currently, reporting
treatment for naturally occurring illness. systems for dealing with child abuse cases
• When contact with the perpetrator of abuse are in place in many countries but in general
ceases (e.g., when the animal is hospitalized), have not been developed for animal abuse
no further injuries occur. cases. Advice may be available from an

Acetaminophen Toxicosis Client Education
Sheet

BASIC INFORMATION Epidemiology GEOGRAPHY AND SEASONALITY
SPECIES, AGE, SEX Toxicosis is common year-round, but more
Definition • Cats are more sensitive than dogs. cases are reported during winter months
An acute toxicosis from accidental ingestion • All breeds, ages, and sexes are susceptible. coinciding with cold and flu season and
or owner administration that may result in increased human use of over-the-counter (OTC)
hepatotoxicity, methemoglobinemia, and rarely RISK FACTORS pain relievers.
keratoconjunctivitis sicca (KCS) • Access to the medication Clinical Presentation
Synonyms • Owner unaware of species sensitivity to HISTORY, CHIEF COMPLAINT
acetaminophen
Tylenol, APAP, paracetamol, nonaspirin pain • Patients with pre-existing liver issues • Most common is witnessed or suspected
reliever exposure

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