Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs

Abstract

Although xylitol causes hypoglycemia in dogs, hepatic failure after ingestion has not previously been reported. Because an increasing number of consumer products contain xylitol, clinicians should be aware that ingestion of xylitol can have serious, life-threatening effects.

Acute Hepatic Failure in a Dog after Xylitol Ingestion

“…The dog in this case ingested a massive dose of 45 g/kg, almost 100 times the dose where hepatic necrosis is possible and three times the highest dose where hepatic necrosis has been previously successfully treated and reported, yet fatal in two others [3]. Early clinical Testing performed on Abaxis VS2 analyzer −Denotes values were not obtained signs and laboratory values followed the expected scenario with vomiting and hypoglycemia occurring less than 1 hour after ingestion.…”

“…The LD 50 , used to assess a substance's acute toxicity, varies considerably from species to species. The LD 50 in mice is >20 g/kg [3]. While the LD 50 in dogs ingesting xylitol has not yet been established, a report in rabbits showed an LD 50 to be 4-6 g/kg [10].…”

“…Two previous reports described the onset of liver failure in dogs after ingestion [3,12]. One single case report [12] showed full recovery, while a second report showed three out of eight dogs likely recovering [3]. More recently, a retrospective report of 192 cases with xylitol toxicity showed no reports of hepatic failure as a sequela [4].…”

“…Elevations of serum hepatic enzyme concentrations may occur as early as a few hours after ingestion or be delayed by 24-48 h. Coagulopathies that develop in dogs with xylitol toxicosis are likely secondary to acute hepatic failure, disseminated intravascular coagulopathy, or both [8]. Two previous reports described the onset of liver failure in dogs after ingestion [3,12]. One single case report [12] showed full recovery, while a second report showed three out of eight dogs likely recovering [3].…”

“…It occurs naturally in many fruits and vegetables, such as strawberries, raspberries, plums, and lettuce [1], and is manufactured by extracting xylan (a polysaccharide found in hardwoods), hydrolyzing xylan to monosaccharide units (D-xylose), and then hydrogenating the D-xylose to produce xylitol [3]. A sucrose shortage during World War II caused an increased production and use of xylitol.…”