Hidden sources of pet toxins could mean trouble for patients

Xylitol, a sweetener that causes hypoglycemia and hepatic necrosis (liver failure) in dogs, appears in products you’d never suspect. Many products such as nasal sprays, sleep aids, multivitamins, prescription sedatives, antacids, stool softeners, smoking-cessation gums, and other products may contain unexpectedly large amounts of xylitol. Dogs that ingest these products face a double risk: not only may poisoning result from the active ingredient but also from the xylitol. This can result in a variety of serious and unanticipated clinical signs that complicate treatment and prognosis.

About Xylitol

Xylitol is a natural sugar alcohol normally found in small amounts in many fruits and vegetables. Because of its sweet taste and plaque-fighting properties, it is frequently used as a sugar substitute in chewing gum, breath mints and dental products like toothpaste and mouthwash. Nontoxic amounts are even found in some pet dental products. Due to its low glycemic index, it is also being sold in bulk to substitute for table sugar in baking and in-home use.

Interpreting the placement of xylitol in an ingredient list

In the United States, all foods must list their ingredients in descending order of predominance by weight. This means that the ingredient that weighs the most is listed first, and the ingredient that weighs the least is listed last.

Toxic doses and treatment recommendations

The dose necessary to cause hypoglycemia in dogs is approximately 0.1 grams/kg, while the amount needed to cause hepatic necrosis is approximately 0.5 grams/kg.

Most chewing gums and breath mints typically contain 0.22 to 1.0 grams of xylitol per piece of gum or per mint. Therefore only one piece of gum may result in hypoglycemia in a 10-pound (1.5-kg) dog.

When you’re in doubt of the xylitol quantity in a product it’s best to contact an animal poison control center for assistance.

Hypoglycemia is typically evident within one to two hours of ingestion, but in rare cases has been delayed as much as 12 hours.

Prompt decontamination via the induction of emesis in asymptomatic patients with euglycemia is essential to prevent poisoning. Activated charcoal does not bind well to xylitol and is not typically necessary or recommended. Should hypoglycemia develop, supplementation with intravenous dextrose is needed until the dog can self-regulate its blood glucose concentrations. Should hepatic necrosis develop, IV fluids, dextrose, hepatoprotectants, and monitoring of coagulation profiles are needed.

Product sources containing Xylitol:

Over-the-counter medications:

• Axia3 ProDigestive Antacid
• Children’s Allegra Oral Suspension
• Fleet pedia-lax Liquid Stool Softener
• Umcka Cold and Flu chewable tablets

Dietary Supplements, vitamins

• KAL Colostrum Chewable, Vanilla Crem
• KAL Dinosaurs Children’s Vitamins and Minerals
• Kidz Digest Chewable Berry
• L’il Critters Fiber Gummy Bears
• Mega D3 dots
• Stress Relax’ Suntheanine L-Theanine
• Vitamin Code Kids
• Super Sleep Soft Melts

Nasal Products:

• Xlear Sinus Care Spray and Nasal Spray
• Xylisetic Nasal Spray.

Prescription Drugs

• Abilify Discmenlt
• Clonazepam
• Emtriva
• Mobic Oral Suspension (meloxicam)
• Neurontin (gabapentin)
• Riomet (metformin)
• Varibar barium sulfate products
• Zegerid Powder (omeprazole)

In foods as a primary sweetener:

• Clemmy’s Rich and Creamu ice cream
• Dr. John’s products
• Jell-O sugar-free pudding snacks
• Nature’s Hollow jams, syrup, ketchup, honey, etc.
• SparX Candy
• Zipfizz energy drink-mix powder.

Source: dvm360.com/toolkit, April 2014 By Ahna Brutlag, DVM, MS