You have arrived home from work and your Labrador Retriever Gary has upended your backpack and all of its contents. You attempt to call Gary over, but he barely wants to get up from his bed, and when he does he is stumbling and unsteady on his feet. You quickly assess what was in your bag to see what could have caused a reaction like this:
A half eaten Hershey’s mini milk chocolate bar
A destroyed travel-size ibuprofen bottle, which had previously contained 1 remaining tablet
A pack of sugar-free gum
A snack-sized mini guacamole
Milk chocolate – chocolate toxicity is based on type of chocolate and amount ingested relative to the animal’s size. Milk chocolate has one of the lower amounts of methylxanthine (the toxin to dogs in chocolate), and a mini bar for a labrador is likely only to cause mild signs including excitement, mild elevation of heart rate, vomiting or diarrhea. Pure cacao or baker’s chocolate would have been much more dangerous. Regardless of type of chocolate or quantity, it is always best to contact poison control or your veterinarian in the event of a possible exposure.
Ibuprofen – it is never recommended to give your pet any medication or supplement without consulting your veterinarian. While most human medications are dangerous for dogs and cats, a large dog can ingest smaller quantities of ibuprofen without causing toxicity. Likely one tablet for a dog this size would not be in the toxic range, nor cause these clinical signs.
Guacamole – the pit of an avocado can be a dangerous foreign body for dogs to ingest, and avocado is high in fat which can cause stomach upset or pancreatitis. Typically, pit-less avocado ingestion in smaller quantities for large dogs will at worst cause vomiting and diarrhea, not these symptoms.
Chapstick- Why do dogs love eating chapstick??? While it will be greasy to clean up and cause stomach upset, there are not usually any fast-acting toxins in chapstick that would cause Gary’s symptoms.
If you said sugar-free gum you are correct!! Most brands of sugar-free gum contain a dangerous animal toxin called xylitol.
Xylitol is a 5-carbon sugar alcohol that is present naturally in some edible plants and mushrooms. It has become popular as a sweetener alternative as it has 40% fewer calories than sucrose (hello bikini season!). The scary thing about xylitol is that it can be hiding in many different types of foods and over the counter medications – candy, gum, baked goods, jelly, condiments, syrup, flavored drinks, peanut butter, toothpaste, oral hygiene products, liquid Benadryl, vitamins, supplements, cosmetics, deodorant, sunscreen, and hair care products. Fun fact – because of its cooling and antimicrobial properties, xylitol can also be found in some types of sport clothing, although the impact of ingestion of these clothings is unlikely to be dangerous.
How does xylitol work to make your pet sick?
Xylitol is rapidly absorbed after ingestion. In horses and humans, xylitol does not stimulate any insulin release, resulting in little or no alteration of blood glucose. In cows, rats, and goats, xylitol stimulates a small amount of insulin release (less than or similar to that of normal sucrose). Rabbits are partially at risk to the negative effects of xylitol at high doses. Cats are presumed to be at a low risk level based on scientific studies. However, in dogs, even small doses of xylitol cause a large amount of insulin release that is 3-7 times that caused by equal amounts of natural sugars. Large amounts of insulin release without need (i.e. not after a big meal), cause a dog’s blood sugar to drop rapidly. Just like in humans, very low blood sugar can lead to a slew of dangerous clinical signs: 30-60 minutes after xylitol ingestion you may notice unwillingness to eat, vomiting, diarrhea, lethargy, unsteady while walking (ataxia), restlessness, collapse, seizures, or coma.
What happens next?
Dangerous low blood sugar is only the first effect of large quantities of xylitol, what may happen next is a poorly-understood injury to the dog’s liver. Some dogs only have the initial low blood sugar (hypoglycemia), other dogs have both hypoglycemia and a liver injury, and a third group of dogs may seem fine initially, then develop liver injury 4-40 hours after ingestion. For this reason, your veterinarian may recommend blood testing initially and a few days later depending on the quantity of xylitol your pet ate. Some signs of liver disease that may occur 12-72 hours later are: yellow color to skin, vomiting, diarrhea, abdominal pain, or lethargy.
My dog ate my gum – now what?!
It is very important to first determine which brand of gum (or other product) your dog has ingested. Some sugar-free gum has 9 mg xylitol per piece, and others up to 700 mg! Some manufacturers are unwilling to provide this information clearly or in an easily accessible way on the packaging. Therefore, if your dog eats any brand of sugar-free gum it is best to immediately contact your veterinarian or poison control. While you are calling, or if there may be any unavoidable delay in seeking care for your dog, see if he or she will eat a meal for you. Some dogs may feel too sick to eat, in which case you should not force them. If they are able to eat a meal, this will give them some counteraction against low blood sugar while you make a plan. If you keep corn syrup or maple syrup in your home, and your pet will not accept a meal or treat, you can apply some of this sugary mixture to their mouth or gums. This solution is temporary. The xylitol will cause additional low blood sugar episodes, so we still recommend seeking care from your vet or contacting poison control.
*Tip*: forcing a pet to eat or drink anything when they are not feeling well can result in dangerous aspiration of food or liquids. Please use extreme caution.
Testing and Treatments
Your vet may induce vomiting depending on how recently the xylitol was ingested. They will also stabilize any low blood sugar with injectable sugars or a meal if able. Next, depending on severity of toxicity, they may recommend hospitalization for fluids and blood sugar stabilization if needed. Some pets are able to have continued care at home that will likely include small frequent meals for the first 12-24 hours. They will also advise if you need to return for blood checks over the following days. The most important thing is getting your dog to the veterinarian as quickly as possible.
Back to Gary
While you called poison control, Gary was given a small meal that he quickly ate (in true Labrador fashion). This seemed to help him feel less unsteady on his feet after a few minutes. Poison control recommended going to the local emergency room, where Gary was admitted for blood sugar monitoring, fluids, nausea medication, and some blood tests with liver monitoring. Gary was able to come home the next day once his blood sugar remained stable. He was prescribed some medications to help protect and support his liver. Over the next few days, he returned to his veterinarian for two additional liver value blood checks. The good news is that by the final blood check Gary’s liver was still functioning normally, and he had made a full recovery!
While xylitol toxicity is scary, you now have the knowledge to quickly handle a potential ingestion situation. Check the ingredient labels on your products, and remember that “Sugar-Free” isn’t always best for all creatures!
Sources: vin.com associate article on Xylitol Toxicosis. Revised by Sharon Gwaltney-Brant DVM, PhD, DABVT, DABT Original author was Linda G. Shell DVM, DACVIM (Neurology), 2/2/2006
Author: Dr. Annie Howell