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Poisonings

Xylitol Toxicity:
Xylitol is a sugar alcohol used widely in human foods. It has the same sweetness as sugar but 40% of the calories of sucrose (sugar). It also has antimicrobial, low glycemic index, anti carcinogenic properties.

Where is Xylitol found? Xylitol is used in a wide variety of products- sugar free foods (candy, gum, jelly, peanut butter, baked goods, drink powders, condiments, syrup, baking mixes, nut butter, protein mixes, protein bars), toothpaste, oral hygiene rinses, medications, medication based (elixers, syrups), vitamins, supplements, cosmetics, deodorants, sunscreen, and hair care products.

Why is Xylitol a problem in dogs but not humans? Xylitol does not cause insulin release in humans and horses and very little insulin release in cats. However in dogs, it stimulants an exaggerated insulin release 3-7 times that comparable to the same amount of dextrose. High dosages result in acute liver failure.

Xylitol powder used for baking has 190 g xylitol per cup. In products it can be hard to tell how much xylitol is in the product, as not always listed, as it is often proprietary information. If xylitol is the only sugar alcohol in the product then the mg of sugar alcohol is the same as how much xylitol is in the product. One brand of gum has 9 mg xylitol per piece for all types, but one flavor has 700mg xylitol per piece. A dosage of 75-100mg/kg can cause life threatening hypoglycemia which can last over 24 hours. A dosage of over 500mg/kg can cause acute liver failure

Symptoms: Life threatening low blood sugar (hypoglycemia) and seizures due to low blood sugar is the primary symptoms of xylitol toxicity in dogs. Liver enzyme elevations can occur as early as 4-6 hours post ingestion and peak at 20-40 hours post ingestion. With liver failure hyperbilirubinemia (jaundice), hypokalemia (low potassium), hyperphosphatemia (high phosphorus), and internal bleeding can occur. Hypoalbuminemia (low protein in blood) can occur from bleeding.

Treatment: Xylitol is absorbed rapidly into the blood stream. Vomiting is recommended only if it has not been longer than 60 minutes post ingestion (and may not be effective if vomiting is induced after 30 minutes post ingestion).

Due to the risk of hypoglycemic seizures (seizures due to low blood sugar), vomiting is best done in the veterinary setting. Hydrogen peroxide can be given at 5-10ml and if given with some food is more effective.

Life threatening hypoglycemia (low blood sugar) is treated with IV dextrose. Administration of liver protectants may be beneficial. Treatment of the symptoms is done using IV fluids, injectable anti nausea medications, monitoring and correcting labwork for abnormalities such as hypokalemia (low potassium), high phosphorous, and high bilirubin. Vitamin B12 is often administered if liver disease or clotting abnormalities are present.

Chocolate Toxicity:

The toxic principles in chocolate are theobromine and caffeine, which are methylxanthines. Methylxanthines are rapidly absorbed orally, metabolized via the liver and excreted in the bile and urine. They undergo hepatic recirculation, which means they are excreted into the gut from the bile, reabsorbed from the intestine, metabolized by the liver, excreted into the bile again, reabsorbed from the intestines again, and so on. They also are reabsorbed from the bladder wall into the blood stream once excreted into the urine.

Signs: Methylxanthines stimulate the cardiovascular and central nervous systems. In dogs clinical signs occur within 6-12 hours of ingestion. Usually symptoms begin with polydispia (increased drinking), vomiting, diarrhea, bloating, restlessness, hyperactivity, progressing to ataxia (walking like drunk), tremors, seizures, then heart effects such as PVCs (arrhythmias), tachycardia (increased heart rate), tachypnea (increased breathing rate), high blood pressure, high body temperature, and coma. Pancreatitis can also occur due to the high fat and sugar content in chocolate.

Treatment: Treatment includes induction of vomiting. Vomiting can be helpful even if done hours after ingestion, as chocolate can become a firm lump in the stomach. Activated charcoal every 4-6 hours for 3 dosages is used to bind all the chocolate in the intestines. Monitoring and correcting of serum sodium levels is important, as activated charcoal can cause high sodium levels. It is important to monitor heart rate and rhythm, blood oxygen levels, and pancreatic enzymes. Treatment of symptoms with medications is performed as needed to regulate body temperature, seizures, tremors, cardiac arrhythmias, and oxygen support. A urinary catheter to prevent reabsorption through the urine may be helpful as well.

Grape and Raisin Toxicity:

Grapes and raisins (also Sultanas which are light brown seedless grapes dried and Zante currants which are dried grapes as well) cause kidney failure in dogs. There are no reports of toxicity from grape juice or grape seeds or extracts. Toxicity has only been shown in dogs. The toxic principle has not been found. Toxicity has been found from as low as 0.7oz/kg grapes and 0.11oz/kg raisins. Recent evidence shows that even smaller amounts may cause toxicity in dogs.

Signs: Grape and raisin toxicity causes kidney damage in dogs. The Creatinine kidney value rises shortly after exposure, but it may take longer for the BUN kidney value to rise. Elevations in other labwork values that may occur are calcium, phosphorus, ALT & ALP liver enzymes, amylase pancreas enzyme, and increased or decreased potassium. Later in the toxicosis, anemia and decreased platelets may occur. Decreases in platelets may cause bleeding to occur.

Signs occur within hours of ingestion. Vomiting is the first sign in all cases. In addition, diarrhea, anorexia (not eating), lethargy, dehydration, abdominal pain, hypersalivation, and dehydration may occur within 24 hours. As the kidneys begin to fail, signs noticed 1-5 days later include polydipsia (increase drinking), polyuria (increased urination), ataxia (walking like drunk), weakness, edema (swelling), and trembling occur. As the kidneys shut down, the dog may urinate abnormally small amounts (oliguria), stop urinating altogether (anuria), and begin to have high blood pressure.

Treatment: Treatment includes vomiting, if the dog has not vomited yet. Activated charcoal followed by a repeat dosage 8-12 hours later will help bind the chocolate in the intestines. Further treatment includes IV fluids to treat kidney failure, medications to help vomiting and nausea, and nutritional support. In addition, monitoring and correcting of abnormalities in electrolytes is needed.

Marijuana Toxicity:

Of the reported cases of marijuana toxicity in animals, 96% of cases are in dogs, 3% are in cats, and 1% are in other species.

Signs: Symptoms begin with dilated pupils, incoordination, listlessness, stupor, decreased heart rate, and sometimes, urinary incontinence. Thirty percent of cases have GI signs, such as vomiting. In addition, decreased body temperature, decreased blood pressure, and injected conjunctiva (red eyes), may occur. Signs begin with 5min to 96hrs of ingestion, and most commonly 1-3hours of ingestion. Symptoms may last for 30min to 96hours. Because THC is stored within the fat, symptoms may last for days.

Treatment: Induction of vomiting is only helpful if accomplished within 30 min of ingestion, and if the pet is not showing symptoms yet. Activated charcoal every 8 hour for the first 24 hours can be administered to bind the marijuana in the gut. Patients with symptoms benefit from hospitalization to monitor and treatment with IV fluids. It is very important to closely monitor respiratory rate, heart rate, and body temperature and treat any abnormalities that occur. Agitated patients may need mild sedation. Patients that have lost consciousness need more intense monitoring.

Aspirin and Salicylate Toxicity:

Aspirin and NSAIDS are used to treat humans for inflammation, fever, clotting, and pain. Salicylates may be found in many human and veterinary aspirin products, topical analgesic ointments, sunscreen, GI Protectants (bismuth subsalicylate), over the counter acne treatments, tanning agents, wart removal products, and some food products (oil of wintergreen has 98% methyl salicylate).

Signs: Signs of acute overdose may take 1-4 days to occur and are due to GI bleeding. Signs include vomiting (+/- blood), diarrhea (+/- blood,) abdominal pain, lethargy, weakness, and pale gums. With larger exposures, hyperthermia (high body temperature), tachypnea (increased breathing rate), dehydration, seizures, coma, and non-cardiogenic pulmonary edema (fluid in the lungs) may occur. Prolonged clotting times, liver injury, and GI perforation (holes in the stomach or intestines) may occur. GI perforation can lead to a life threatening body-wide infection called septicemia. When liver damage occurs, there may be bleeding and jaundice. Seizures may also occur. Kidney damage may occur from low blood pressure and seizures.

Treatment: Induction of vomiting is helpful if it has been within 2 hours of ingestion and the pet is not having seizures, breathing difficulties or in a coma. Activated Charcoal to bind any aspirin in the gut is helpful and often repeated 8-12 hours later. Aspirin can be absorbed for over 24 hours after ingestion so vomiting and activated charcoal are important.

Gastrointestinal protectants are important such as Sucralfate, Misoprostol (cytotec), and acid reducers such as Famotidine (injectable pepcid) or omeprazole (prilosec). It is important to avoid GI medications that have salicylate, such as bismuth subsalicylate and OTC kaolin-pectin.

IV fluids will help remove aspirin from the blood stream and help maintain good urine flow. Seizures are treated with IV medications if they occur. If the pet is not breathing well enough or taking in enough oxygen, ventilation may need to be manually assisted. If there is bleeding, blood tranfusions are needed. Often pets have acid/base abnormalities which need to be treated with administration of bicarbonate. Vomiting often needs to be controlled with injectable anti-emetics.

Paintball Toxicosis:

It is not really known for sure what chemical in paintballs are toxic and how they cause problems in dogs. However, it may be an osmotic effect of drawing fluid into the intestine, which causes high sodium in the blood. Ingestion of 15 paintballs caused signs in a 41kg dog (90#).

Symptoms: Signs may occur as soon as 1 hour after ingestion and begin with vomiting, diarrhea, ataxia (walking like drunk), and tremors. Other signs include increased heart rate & body temperature, weakness, hyperactivity, polydipsia (increased drinking), blindness, depression, seizures, coma, and death.

Treatment: If ingestion was within the hour and there were no respiratory signs, heart signs, or seizures, vomiting is helpful. Activated charcoal is contraindicated (bad), as it pulls more water into the gut, causing a worsening of signs. If there are paintballs apparent on radiographs then gastric lavage is indicated (flushing the stomach with water to remove the paintballs while the pet is anesthetized). Warm water enemas stimulate removal through the GI tract. Monitoring and correcting electrolyte abnormalities is important with IV fluids. If seizures occur, treatment with IV medication is needed. It is very important to monitor and control the body temperature. Symptoms usually last for 24 hours.