Xylitol Intoxication

We all know the classic foods to completely avoid letting our dogs sample such as chocolate and raisins, and many are becoming more familiar with the idea of using caution when it comes to xylitol. But it still feels relatively unknown. I wanted to share my first-hand experience to raise awareness and understanding of the effects of xylitol.

I didn’t have a lot of time, but I decided to swing by home to get a quick bite to eat on my lunch break and let my dogs out. After six hours in the house, I was sure they would be eager to stretch their legs. As I walked in the door, only one dog greeted me which was not abnormal if the other had gotten into something. I looked around for any evidence and saw an open and empty container of gum. My stomach sank as I called to her and moved quickly through the house to her regular hiding place. There she was, ears back with a guilty smile and wag, laying behind the pillows of the guest bed. She jumped up and ran to me to apologize. Outwardly, she looked perfectly fine but I was still suspicious, knowing the container of gum had not been empty when it had been forgotten in a bag lost in the closet some months ago. 

After checking the ingredients, my greatest concern stared back at me: xylitol was the main ingredient. Working at an animal hospital, I quickly called my work and was urged to bring her in immediately as we did not know when she consumed the gum; it could have been anywhere from ten minutes to six hours ago, meaning every minute was imperative. 

Upon arrival to the veterinary hospital, we induced vomiting which was minimally productive yet a minty fragrance emanated strongly from it. We also ran comprehensive bloodwork to check her liver values and glycemic index as these are the two areas most greatly affected by xylitol. Her blood sugar values were slightly decreased and her liver values elevated. Nova, my dog, was still alert, responsive, and looking for affection from all of the girls helping her. Had I not seen the empty container, I never would have suspected anything was awry. 

Here is a bit of background: Nova is a high energy 3 year old, 45 pound Border Collie mix. The maximum amount of gum she could have consumed was likely around 30 pieces but it could have been far less. 

So, what happens in the body? Dogs’ digestive systems are different from ours, this is why xylitol has no negative effects for us but can be lethal for dogs. Xylitol enters the dog’s blood stream far more rapidly than the body is used to, releasing an overabundance of insulin from the pancreas. Because there is more insulin than the body can digest at one time, a significant drop in blood sugar occurs (hypoglycemia).

This is the concern with xylitol consumption as outlined by VIN (Veterinary Information Network):  within 10 to 60 minutes, acute hypoglycemia can occur. This will cause extreme lethargy, vomiting, ataxia and incoordination, seizures, coma and death. Liver values can start to increase 8-12 hours after consumption. The odds are also extremely high for liver damage and/or necrosis. A dog can be asymptomatic for up to 48 hours until acute liver failure transpires, notated by lethargy and outward illness. A blood panel will show highly elevated liver enzymes conveying necrosis, poor to non-existent blood coagulation results, and thus hemorrhage. At this point for many dogs, the prognosis is poor. 

Here is the scary part: “Most of the dogs who developed acute hepatic failure and DIC [Disseminated Intravascular Coagulation] actually did not apparently show signs of hypoglycemia after ingestion of xylitol. These dogs then became acutely ill about 48 hours later… so far 5 of the 6 dogs I’m aware of who developed hepatic necrosis… have died.” (VIN)

So for Nova, we administered subcutaneous fluids to keep her hydrated and aid in flushing or at least diluting the toxin and started her on medication to help support and protect her liver. I brought her back in for a 24 hour recheck the next morning and, though her hypoglycemia was improving, her liver values had almost doubled. We checked her blood work every 24 hours for 3 days. The 72 hour mark was the most vitally informative as to her prognosis. To our relief, her levels were beginning to decrease, though they were still extremely outside of the normal range. We checked her blood levels again the following Monday, which was 2 days later and still good news, her levels were continuing to drop. 

At this point, we were comfortable enough to wait a week for follow-up bloodwork since she was still not showing any symptoms and the lab work was in a positive downregulation. 

One week later, Nova’s liver values were within normal limits, she has no irregularities in her glycemic index, yet there are still certain values that are fluctuating slightly between normal and abnormal. 

At her 30 day recheck, 5 days off of the liver support medication, Nova’s liver values were elevated again. We restarted her on the liver support, discerning that a longer regimen was necessary. A week later, her values are again within normal range. Though she is healthy and happy in most aspects, we are still needing to watch and recheck to ensure she is on the right track.

Take care in what items you allow in your home. Many, many products contain xylitol that we do not think to check and very few are labeled with a warning against pet consumption.

Here are some common household products and foods to watch for: 

• Gum and mints
• Mouthwash
• Toothpaste
• Powdered drinks
• Baked goods
• Peanut butter and jams/jellies
• Cereal
• Protein bars
• Products that are “naturally sweetened” do not have to specifically list the sweeteners and xylitol fits in this category
• “Sugar-Free” or “Reduced Sugar” products
• Chewable vitamins

This was a terrifying and humbling experience for me. Had I not seen the empty container, had I not known the possible concerns associated with xylitol, had I taken my dog simply at face value with all of her happiness and normalcy, this story could have been very different. Xylitol is an active killer, but it is also a silent killer that can sneak up without warning. Be diligent and observative of your pets and if you suspect the possibility of ingestion or intoxication, contact your veterinarian immediately, every moment counts for our furry loved ones.

 

Written by: Harriet Burquist

Sources:

https://vcahospitals.com/know-your-pet/xylitol-toxicity-in-dogs

https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs

https://www.merckvetmanual.com/toxicology/food-hazards/xylitol-toxicosis-in-dogs