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A Sticky Mess: Chocolate/Caffeine Poisonings


An innocent looking puppy that just got into a box of chocolates while you were away.

With holiday seasons, emergency hospitals pre-order extra stuff to treat the chocolate poisonings that are on the way. Your dog's great sense of smell and how they deal with boredom are reliable at getting them into trouble with sweets that are on the counter, under the bed, in the closet, or in your backpack! Chocolate is a favorite. And while we enjoy the festive odor of warmed chocolate in the air of the ER, it may cause a real problem for your pet!


Depending on the type of chocolate, the size of your dog, and how much they ate, they may be in real trouble... or it may just be a way to avoid the drama at home for a few hours when your enthusiastic but inebriated uncle decides to start talking politics. We're ok being the excuse you need to avoid that conversation for a few more hours... and we have coffee! We're here for you.


In a hurry? Click here for "What I would do for my dog." Click here for my over-the-counter supply list.


But It's So Delicious!


A dog enthusiastic about chocolate.

We can't argue with you there! But there are two things that cause problems for dogs in chocolate:


  1. Theobromine: these can cause agitation, seizures, excessive urination, stronger heart beats (sometimes too strong), and an upset stomach.

  2. Caffeine: this makes your dog's heart rate and blood pressure go up (it does the same thing to you).


In smaller doses, your dog might just feel funny. In larger doses, the heart beats so fast that it doesn't have time to fill up before beating again (meaning the heart doesn't work well) and seizures (which, if uncontrolled, lead to a body temperature so high that internal damage happens... your dog becomes their own sous vide). It may sound like a fancy thing you would want. It's not.


So Many Chocolates!


A wide assortment of chocolates.

There are many types of chocolate and we need the wrapper to know what we're dealing with. If you don't have the wrapper (or know the exact chocolate your dog ate), we will have to assume the worst case scenario. The best time to treat a poisoning, any poisoning, is now (there's only so much time we have to treat before symptoms appear or damage happens).


In order of most toxic to least toxic chocolates:

  1. Refined chocolate candies - it depends what's in them

  2. White chocolate - not really chocolate and usually not a worry

  3. Cocoa beans - a little theobromine with no caffeine


Thanks to years of experience and data, we know what to expect if we can calculate what your dog ate. Can we safely send you home with your dog or should we recommend keeping your dog here?


A very excited granny making infused brownies.

And then there are special chocolate varieties like:

  1. Marijuana infused chocolate (or magic mushrooms or whatever other recreational substance your nephew is into) - you're gonna have to tell us what's in it! See our "Jazz Cabbage" blog post for more.

  2. Artificially sweetened ("diabetic friendly") chocolates with xylitol: xylitol is as big (or a bigger) problem than the chocolate depending on how much is in there. See our xylitol blog post for more!


What do You Recommend?


A pet owner calling poison control after he ate chocolate. Their dog is with them.

If you want the best guidance, call ASPCA Poison Control at: 888.426.4435. Yes, they're going to charge you a fee... but they have also talked the manufacturers into sharing proprietary concentration information. They also have the latest scoop on treatment and outcomes gathered by people who just deal with poisonings for a living!


If you don't want to talk to the toxicologists, go ahead and give us a call. Doing the math on a chocolate toxicity that doesn't need to come in is a lot more fun than the paperwork it takes otherwise! Where we will fall short is when your dog eats something containing, say, xylitol. The manufacturer normally shares that information only with poison control (they don't want us quitting medicine for a lucrative career with their secret formula).


In the best case, we tell you there likely won't be a problem and that you should just keep an eye on things at home. In the worst case, we tell you to come in so we can start treatment and end up with a better outcome for you and your pet.


What is the Textbook Approach?


A dog reading a textbook.

First, we calculate how much your dog got into. If it's a problem, we treat. We also ask if there is anything else your dog might have gotten into that causes similar symptoms: your kid's Ritalin, your brother-in-law's cocaine, your mom's antidepressants... those sorts of things. If it's none of those, we decide if it's a good idea to try and get some of the chocolate back (we make them vomit if they aren't already).


There's about a six to eight hour window to get stuff back from the stomach before it moves past vomiting's reach. How do we do this? We use a special medication that makes your dog throw up that is safer than the home remedies. We may also pass a tube into the stomach and suction and flush out the stomach to get even more out than we can with vomiting if the poisoning is really bad. But vomiting usually gets enough back.

Along with physical examination (legally required to give you treatment advice), we pay close attention to the heart rate and pulses. A heart rate under 200 beats per minute is usually slow enough to let the heart fill up before it beats again. A heart that's not full before it beats doesn't get important stuff where it needs to go (like oxygen... oxygen is important). Caffeine can also make the heart have "hiccups" (a beat without a pulse). As you can imagine, this isn't very effective.

We should check the blood pressure (BP), the electrical activity of your dog's heart (ECG), and some blood work so we know salt and blood sugar levels (important for some of the medications we may give so we don't inadvertently cause another poisoning).


A veterinarian closely watching a dog that is closely watching the veterinarian.

Now we treat what we find and closely monitor your dog until things are more normal. We have medications that can slow the heart, improve abnormal heartbeats, lower the blood pressure, control nausea and vomiting, keep your dog hydrated, and chill your dog out (from that feeling you get when you're on your third pot of Black Rifle Coffee).

We may give a medication called activated charcoal with sorbitol. This depends on the toxicologist you are chatting with that day and how much chocolate your dog ate. Activated charcoal helps absorb some toxins and keep it from recirculating. Sorbitol helps speed whatever is left to the butt (for those of you who don't know... and there seem to be a lot of you... the mouth is connected to the butt).


The problem with charcoal (beyond conflicting opinions on how well it works) is an increased risk of causing a salt poisoning. It's customarily frowned upon when we poison your dog with something new. While it's not common, I've seen a few dozen dogs in my career with salt poisonings that were mistaken for new seizures. Note: this is the reason bloodwork to check salt levels in the body is important.


Since the toxins in chocolate (caffeine and theobromine) leave the body largely through the urine (pee), we will make your dog pee more by giving extra fluids. In bad poisonings, we keep the bladder empty by using a urinary catheter so the caffeine doesn't get re-absorbed through the bladder wall. The faster we get the toxins out, the faster things get back to normal. Your dog re-poisoning itself again with a full bladder isn't helpful (but I know they're trying their best!).


Now we wait and keep monitoring and treating until your dog is back to normal. When this will be depends on how much they ate, when we started treating, and how much you allow us to do. The closer to the textbook approach, the faster things will go (but the more expensive).


When your dog has a safe heart rate and blood pressure without medications and isn't vomiting, we send them home with you. Trust me, our goal is to get your dog home as soon as we safely can. We want lunch (or to empty our own bladders). The more animals we get to send home when they are safe, the more chances we get to eat (or answer nature's call for ourselves).


What Would I Do if It Were My Dog?


I'd ask a veterinarian and I'd say, "Hey me, what do you think I should do?" I'd then tell myself:


  1. Calculate the chocolate toxicity with a reliable, online calculator like here at the Merck Veterinary Manual. I need my dog's weight to get this right. It tells me if I should worry or not (but won't handle other ingredients like xylitol or weed).

  2. If it's a mild or moderate case, I'll likely just keep an eye on it at home. Most mild to moderate chocolate poisonings just cause the dog to have a bad time for a while (agitation and some drooling from nausea with maybe some diarrhea in a day or two). I will head into the clinic:

    1. if my dog starts to vomit, I'll get an anti-nausea shot for my dog (Cerenia) that will last for 12 to 24 hours or, if I'm feeling particularly cheap, I'll reach for Dolasetron or Ondansetron (they don't last as long but are usually much less expensive and last long enough).

    2. if the heart rate is over 150 for my giant breed dogs (Cane Corso, Great Dane, Leonberger) or over 200 for my non-giant breed dogs. I'll check an ECG and treat it if needed (this requires ongoing monitoring, medicating, and hospitalization but can be life saving).

  3. If it's a severe poisoning, I'll make my dog vomit. This can turn a severe chocolate poisoning into a moderate poisoning (more chocolate vomit = less poison in your dog). The reason vomiting is a bit risky (and the reason I treat vomiting when it happens) is that inhaling vomit will cause a pneumonia. Pneumonia is often much more expensive to treat than a chocolate poisoning and can be even more life threatening. I prefer to make my dogs vomit with some apomorphine (you can't get it at Walmart). If I'm not near the hospital, I'll use some hydrogen peroxide and give a teaspoon per 10 pounds. Then I'll spin my dog around, massage their stomach, and wait for about 15 to 20 minutes. I will repeat the dose if my dog doesn't vomit on the first try. The downside of hydrogen peroxide? It causes the stomach to get angry resulting in ulcers.


I probably won't give my dog activated charcoal with (or without) sorbitol unless I can monitor salt levels. The risk of causing a salt poisoning is more than the benefit. Both activated charcoal (not the stuff you use in your grill) and sorbitol are available at Walmart and most pharmacies but I think it's too risky without knowing and rechecking salt levels. The seizures from a salt poisoning are hard to control (even in the hospital) and a bigger problem than most chocolate poisonings.


And even though it may work to bring the heart rate and blood pressure down, I probably won't give marijuana. I'd need to know exactly how much THC/CBD was in whatever I was giving (I'm not in Seattle any more) and there aren't readily available numbers on how much pot to give a dog to cause a mild, moderate, or severe poisoning (marijuana is still a DEA Schedule I substance in the US so research is limited and I'm not going to risk my DEA license by owning any... the DEA charges me too much money for my licenses). Maybe someone will do the research by giving small and increasing doses of marijuana to achieve the desired effect in a chocolate poisoning. Write your local vet school and see if anyone needs a research idea! For what it's worth, the peak effect of marijuana ingestion usually happens 30 to 90 minutes after a dog eats it.


There's not much over the counter (available at Walgreens or the gas station) that will work for vomiting in dogs. Vomiting also tends to get in the way of swallowing pills and keeping them down long enough to work. But there's always the butt. As I've written about previously, the colon is a useful organ when you can't give things by the mouth. Diphenhydramine (Benadryl) has some anti-vomiting properties. The dose in a dog is one or two 25mg tablets for every 25 pounds up to every 6 hours. For my Teacup Yorkie, pills are too big. I then use Children's Benadryl (12.5mg/5mL) and give around 1/4 to 1/2 teaspoon per 3 pounds... 1 to 2 mL per 2.5 pounds.


What's in my first aid kit (that I got at the store).



Gloves. Vomit is gross. What's in the vomit is gross. I’m wearing gloves. For everything.


Stethoscope (or just your hand): This is to get your dog's heart rate. A cheap stethoscope is likely fine. You should probably watch a Youtube video on how to count your dog's heart beat if you want to use one. I use a Littmann Cardiology IV. My wife uses a Littmann CORE Digital. I'm jealous of her nice things!


Hydrogen Peroxide (I make sure it's the 3% stuff and not 30% stuff... that may kill a dog): This should only be used for cleaning up blood and making a dog vomit if you need to. Using it to clean other things like cuts just delays healing. Stop using it for that. It doesn't do what you think it does.


Some syringes: to give the right amount of stuff. Catheter tip syringes work well for giving medications by the mouth and butt.


Scale: your bathroom scale will work fine if your dog is over 10 pounds and you can pick your dog up. Just subtract your weight from what the scale says. If your dog is under 10 pounds, use a baby scale or kitchen scale. If your dog is huge, swing by a veterinarian and ask them to weigh your dog. They really shouldn't need an exam for that. It's just a weight. Just don't ask them other stuff unless you're ready to pay an exam fee.


Diphenhydramine (Benadryl): 25mg tablets and/or 12.5mg/5mL liquid.


Some lubricant if you're going to give medications by butt.


What to expect after treatment?


A person cleaning the kitchen so their dog doesn't get into things... but the dog is on the counter.

Everything may be perfectly fine but there are some possible delayed problems:

  1. Diarrhea: after all that chocolate, stomach upset is a common problem. Diarrhea a day or two after eating the chocolate is somewhat common. It almost always goes away in a day or two without any treatment. If you see a spot or two of blood in the diarrhea, it's usually not a big deal as long as your dog is otherwise acting normally.

  2. Pancreatitis: the pancreas is an organ involved in digestion. When it gets cranky, your dog will usually have vomiting, diarrhea, and belly pain. In many cases of pancreatitis, some treatment is necessary.

  3. Black poop: if we gave activated charcoal, this probably isn't a big deal. If we didn't give charcoal, your dog may have a stomach ulcer that needs treatment.

  4. Blood sugar regulation problems: especially if they already have diabetes. But this usually isn't an ongoing problem.


Of the many valuable lessons our dogs teach us about companionship and enjoying the moment, they also teach us the value of staying tidy and keeping poisons (even chocolate) out of reach! Good dog helping us keep our home tidy!'

References:




Niedzwecki AH, Book BP, Lewis KM, Estep JS, Hagan J. Effects of oral 3% hydrogen peroxide used as an emetic on the gastroduodenal mucosa of healthy dogs. J Vet Emerg Crit Care (San Antonio). 2017 Mar;27(2):178-184. doi: 10.1111/vec.12558. Epub 2016 Dec 14. PMID: 27973761.


De Briyne N, Holmes D, Sandler I, Stiles E, Szymanski D, Moody S, Neumann S, Anadón A. Cannabis, Cannabidiol Oils and Tetrahydrocannabinol-What Do Veterinarians Need to Know? Animals (Basel). 2021 Mar 20;11(3):892. doi: 10.3390/ani11030892. PMID: 33804793; PMCID: PMC8003882.


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