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Piles of White: Xylitol Poisonings


A dog in a big pile of white, powdered xylitol.

Xylitol is funny stuff. It's sweet. It's fine for cats. It's great for people and helps our teeth and blood sugar. But it's deadly for dogs and it can be found all around the house in: gum, toothpaste, diabetic friendly sweets, and as bags of powder for all your baking needs.


In most species, xylitol stays where it belongs in the body: the long tube from the mouth to the butt that we call the gastrointestinal tract (GI tract). In dogs, it goes out of the GI tract and into the bloodstream where it wreaks havoc by dangerously dropping the blood sugar (no blood sugar = no life) and attacking the liver (you can't live long or well without one). There's no antidote but there's lots we can do to minimize the risks and the damage.


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


What do you recommend?

A woman calling poison control after her dog ate xylitol.

For anything you didn't bake yourself, I really recommend calling ASPCA Poison Control at: 888.426.4435. They're the ones who know how much xylitol is in whatever your dog ate (the toothpaste and gum companies won't tell me no matter how nice I ask). Without knowing how much xylitol is in what your dog ate and your dog's weight, it's impossible to do the math and know if we need to be worried (or not).


Yes, the ASPCA is going to charge you a fee ($95 as of this writing). Yes, there are some cheaper options out there. But you get what you pay for... at least that's my clinical experience on toxicities.


Sadly, the ASPCA isn't allowed to tell you what to do during this call. The licensing boards won't let any of us give recommendations without an examination first. I think it's dumb, but it's still the law (and it's hard enough keeping these licenses without breaking any rules). What the toxicologists will do is all the math and recommend you see a veterinarian for an examination so we can give you the ASPCA's answers in a way that won't cause anyone legal problems.


Toxicologists with the ASPCA went on for many more years of training on poisonings compared to us regular veterinarians. They're true experts here (and have access to information that no one else does)... but I wouldn't recommend you try to get them to do surgery on your dog or clean their teeth. Specialists usually aren't so good outside of their specialty (even if they insist they are).


What is the textbook approach?

A dog reading a textbook to treat a poisoning the right way.

If you haven't already, we have you call the toxicologist. They give you a case number (please write it down and bring it with you). Then we call the toxicologist to get their recommendations after. They will want our examination findings and the most recent weight first.


If your dog has any symptoms (stumbling like drunk, seizures, unresponsive, bleeding) or we find anything weird on blood work, we're going to ask if your dog got into anything that could cause similar signs and symptoms to a xylitol poisoning (medications). In rare cases, we find a disease that isn't a poisoning at all but causes low blood sugar and/or liver problems like a xylitol poisoning (like cancer and big infections).


Blood work should likely be done at an emergency facility and not your regular veterinarians for two reasons: 1) we're going to get the results back quickly (most family vets send the blood work to a lab) and 2) we can check for bleeding problems and most family vets can't (they don't have the equipment or right blood tubes).


What we check is:

  1. A Complete Blood Count: this looks to see if the immune system is cranky, if your dog is anemic (has lost blood), if your dog's body is trying to do something about the anemia if they have anemia, and if they have enough platelets to plug up normal leaks that happen around the body (platelets are the body's corks).

  2. A Chemistry to check the blood sugar level (low is bad), liver levels (high is bad), and protein levels (low is bad). Some of these may be pre-existing problems that you just didn't know about yet (they aren't causing any obvious symptoms) and have nothing to do with xylitol. More important than these initial numbers is how they change over the next day or two (do they get better, worse, or stay the same).

  3. A Coagulation Panel that checks to see if your dog can make scabs and stop inappropriate bleeding on their own. This is the test that your family vet probably can't do.


Sadly, there is no specific test for xylitol... only testing and asking you how much your dog ate.


Depending on what the xylitol is in, it's quite quickly absorbed into the dog's body. Most of the time, the toxicologist tells me to not bother trying to make the dog vomit. The risk (pneumonia) outweighs the reward (getting enough xylitol back to make a difference).


Now we're going to put a catheter in your dog's vein so we can give an around-the-clock sugar drip to them that we adjust based on their blood sugar that we will be checking every few hours, 24 hours a day. The catheter also comes in handy if your dog has any seizures. Trying to give an injection to a seizing dog isn't easy without a catheter already in a vein.


Depending on the dose of xylitol or if your dog's liver is getting cranky (or melting) according to the blood work, we're going to give liver protectants: Denamarin and N-acetylcysteine. We give the first by mouth and the second as an injection to make sure it gets in there... another handy use for that catheter we put in earlier.


And if your dog has any bleeding problems or protein issues (both a result of liver problems), we may be doing a blood, plasma, or protein transfusion to buy your dog some time to turn things around. The liver has a pretty awesome ability to regenerate a lot of itself but that doesn't happen overnight. I've had a dog go home two weeks after a complete shutdown of the liver from a poisoning (but it did cost them enough to buy a car with all we had to do).

Then we wait and recheck the blood work at 24 and 48 hours. Depending on how much xylitol your dog ate, the trends of the blood work (better, worse, or the same), and what the toxicologists tells us (your fee you paid them lets us call them back for follow-up advice if needed), you may get to go home with nothing to do or worry about or there may be more to do. In the simplest case, that will be continuing liver protectant medications (pills) for the next few months with some rechecks of the liver values with your family veterinarian. In the less than ideal case, your dog stays with us for a while to treat bleeding problems or to take over the job of the liver for a while. Sadly, in the worst case, we may need to make some tough decisions about your dog's future if the poisoning is bad and things aren't going well (but this is rare).


What would I do if it were my dog?

A veterinarian on a hike with his dog in the mountains.

I'd call the toxicologists. Honestly.


The results of getting the math wrong and delaying treatment could be death. Death is bad. And the chances of getting the math right by guessing how much xylitol is in your sugar-free gum's secret sauce is very small (very small).


If the toxicologist says not to worry about it, I don't. All toxins are dose dependent and if my dog didn't eat enough to cause a problem, it's not a big deal.


But if the toxicologist recommends treatment, I'd spend the money. The only time to treat this kind of poisoning and prevent permanent damage (or death) is now. If we wait for symptoms of low blood sugar (like seizures) or liver damage (like bleeding), we have to treat these problems in addition to the xylitol poisoning. That's less fun and even more expensive.


At a minimum, doing a continuous sugar infusion while keeping an eye on my dog's blood sugar every few hours would be a good idea. Xylitol is quickly absorbed so making the dog vomit usually isn't useful and just risks causing pneumonia. Pneumonia is a big deal. So I won't try to make my dog vomit with this poison unless the toxicologist tells me to.


If I were somewhere I couldn't hospitalize my dog or get medical supplies (long hikes are my thing), I'd see if anyone had some real sugar. Karo syrup, honey, or a simple syrup (also useful for making lemonade, rock candy, and cocktails) are good choices..


Then I'd keep my dog on a sugar high around the clock for the next 48 hours by starting them off on a teaspoon (5mL) of Karo syrup or simple syrup per 10 pounds of body weight every few hours in addition to their regular food. I'd back off if my dog starts peeing more than normal since this likely means the sugar is getting through the kidneys. Where sugar goes, water (pee) follows. And sugar isn't the healthiest thing to run through the kidneys or have hanging out in pee (unless you want a urinary tract infection and some kidney injury).


If someone happened to have a blood glucose monitor, I'd check the blood sugar every few hours for the next 2 to 3 days. AlphaTRAKs are the go-to for portable devices for dogs and cats and more accurate than your diabetic aunt's monitor. And Freestyle Libres only work in well hydrated dogs and have some known over and underestimation problems on sugar numbers in dogs so they're more complicated than set it and forget it.


I want the blood sugar above 100 and less than 300 (that's when the sugar starts going through the kidneys). Some spikes up into the 500+ range aren't usually such a big deal though.


I'd also hold off on trying to give more sugar by mouth if my dog is too out of it to swallow (this isn't good) and I'd switch to giving sugar by butt (it's gross but it works). I'd just squirt it up there with a catheter tipped syringe, a turkey baster, or a condiment squeeze bottle or something.


If my dog starts stumbling around like they are drunk, passes out, has seizures, has weird bruises or breathing problems, or does other weird and scary stuff, things probably aren't going so well and it's time to find somewhere to run some blood work or get ready for things to get worse (sometimes much worse).


I'd start some Denamarin in a size appropriate for my dog. I'll follow the directions on the label and give the Denamarin for the next two weeks. This medication helps protect the liver from injury but should be kept out of reach because if your dog eats the whole bottle at once... you have another toxicity to deal with. I've treated more than one Denamarin toxicities. Dogs eat stuff they shouldn't. It's kind of their thing.


I may also consider some over-the-counter N-Acetylcysteine if there aren't any veterinary clinics open or my hippy hiking buddy happens to be well stocked on anti-oxidants. This medication also helps protect the liver as a free-radical scavenger. I'd give 1 (one) 600mg capsule per 10 pounds for the first dose and then 1 (one) 600mg capsule per 20 pounds every 6 hours for 7 doses (48 hours, 2 days worth of anti-oxidants).


If my dog seems fine in 3 or 4 days, all's likely just fine. While this is how things usually go, it isn't how things always go (xylitol, like all toxins, are dose dependent... the more you eat, the worse it is). Even with textbook treatment and endless funds, we can't save 100% of these animals. The more corners we cut to save on costs (or because we are 3 days walk to the nearest trailhead), the bigger the risks are.


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

A dog with a first aid kit in the snow.

Gloves: I don't like getting sticky with all that honey, simple syrup, and drops of blood from the blood sugar checks.


AlphaTRAK and test strips: A great, portable, blood glucose monitor validated for dogs. It's not totally accurate (the paperwork says so), but it's the best you can do for a dog in a handheld. There are plenty of videos on how to use one. Above 100 and under 300 is good for this poisoning.


Sugar: Something to keep that blood sugar up. It's also useful for wounds and making treats for the kids (young and old). Honey and Karo Syrup are good too. Start with around a teaspoon (5mL) per 10 pounds and adjust according to the blood sugar reading or peeing.


Syringes: Catheter tipped syringes work well.


Lubrication: In case we need to give some sugar by the butt route because the dog is too out of it to swallow. Petroleum jelly (Vaseline) will work fine too.


Denamarin: The liver protectant that showed the world what alternative medicine that is proven to work becomes... medicine. Follow the directions on the bottle and keep your dog from eating the whole bottle at once by storing it up high somewhere. Denamarin poisonings aren't good.


N-Acetylcysteine: It's a free-radical scavenging, anti-oxidant, liver protectant. Just make sure there aren't other problematic ingredients in the over-the-counter stuff (like xylitol!). The dose is 1 (one) 600mg capsule per 10 pounds for the first dose followed by 1 (one) 600mg capsule per 20 pounds every 6 hours for 7 doses.


What to expect after treatment?

A happy woman enjoying time with her dog after the veterinarian successfully treated a xylitol poisoning.

If everything is fine after stopping the sugar solution and stays fine (your dog is acting normally) in 3 or 4 days, everything's likely good and there is nothing more to do.


But if your dog shows any signs of worry (acting drunk, passing out, bruising/breathing problems, or anything else that worries you), try to get to an emergency veterinarian to check some blood work so you know what you're up against. Treating this kind of poisoning early and by the book is the best option. Sadly, the textbook doesn't pay the bill and people aren't always somewhere with textbook things to treat animals.


You may also have your dog's pee checked in a week or two for a urinary tract infection. All that sugar in the pee makes a wonderful home for bacteria. The signs? They pee more, it hurts when they pee, there is some blood in the pee, they are licking "down there" more. Depending on the type of bacteria, your dog may also get bladder stones. But we'll save that (and checking for a UTI at home with test strips) for another time.

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