History and physical examination
病史和体格检查
l         Owner giving animal over-the-counter acetaminophen
l         畜主投喂过量的扑热息痛
l         Toxicosis observed in cats more often than dogs
l         扑热息痛中毒猫多于狗
l         Depression and rapid breathing
l         沉郁和呼吸急促
l         Vomiting, salivation, tachypnea, abdominal pain, cyanosis
l         呕吐，流涎，呼吸急促，腹痛，发绀
l         Edema of feet and face
l         四肢和面部水肿
l         Hematuria or chocolate-colored urine
l         血尿或巧克力色尿液
l         Death due to liver necrosis in dogs
l         狗最终死于肝坏死
l         Death in cats from methemoglobinemia
l         猫死于高铁蛋白血症
Laboratory confirmation
实验室确诊
l         CBC
l         血常规
l         Serum chemistry profile
l         血生化
l         Urinalysis
l         尿检
l         Methemoglobinemia detection
l         高铁血红蛋白血症检测
l         Blood glutathione level after treatment
l         治疗后血液谷胱甘肽水平检查
CASE MANAGEMENT
病例管理
Medical and/ or Surgical Procedures
用药和/或手术操作
l         Must differentiate from other drug toxicities that cause methemoglobinemia
l         鉴别其它药物中毒引起的高铁血红蛋白血症
l         Obtain history of exposure to acetaminophen from owner
l         通过问诊获得接触扑热息痛的病史
l         Hospitalize animal if have dark or bloody colored urine or presence of icterus
l         如果出现暗色或血色尿及出现黄疸需住院治疗
l         Perform emesis and gastriclavage within 4 to 6 hours of acetaminophen ingestion followed immediately by activated charcoal ( 2 g per kg orally bid for at least 3 treatments)
l         服食扑热息痛2-4小时内应进行催吐和洗胃并立即口服活性炭（2g/kg,bid，po,至少3次）
l         Give N-acetylcysteine (orally or intravenous loading dose) and then orally or intravenously qid for 5 to 7 treatments
l         N-乙酰半胱氨酸（口服或静脉给药，起始剂量）并且每天4次，连续用药5-7次
l         Can use alternate drugs for treating methemoglobinemia in dogs and cats if N-acetylcysteine is not available
l         如果N-乙酰半胱氨酸无效可以使用其他药物治疗高铁血红蛋白血症
1.other sulfur drugs including sodium sulfate
其他硫磺药物如硫酸钠
2.1% methylene blue solution can be used without inducing hemolytic crisis
1%的美兰溶液可以使用而不产生诱导作用的溶血现象
3.ascorbic acid slowly reduces methemoglobinemia
维生素C可以缓慢降低高铁血红蛋白血症
l         Give whole blood transfusion if required for anemia, hematuria, or hemoglobinuria
l         贫血，血尿或血红蛋白尿时应输全血治疗
l         Give intravenous fluids and electrolytes to maintain hydration and electrolyte balance as needed
l         视情况补充液体和电解质以维持体液中水及电解质平衡
l         Do laboratory determination of methemoglobin percentage every 2 to 3 hours
l         每2-3小时进行高铁血红蛋白的实验室检查
l         Determine serum liver enzyme activities (serum ALT and ALP) every 12 hours to monitor liver damage
l         每12小时检测血清肝酶活性（ALT和ALP）来监测肝细胞损伤状况
l         Do laboratory determination of blood glutathione level to measure and provide evidence of effectiveness of sulfhydryl replacement
l         实验室检测血液中谷胱甘肽水平来提供硫氢基的替代效应
l         Provide water at all times and give food 24 hours after initiation of treatment
l         一直提供充足的水，治疗24小时后进食
Injections