Retrospective evaluation of xylitol ingestion in dogs: 192 cases (2007–2012)

Abstract

The prognosis for dogs evaluated by a veterinarian that ingest lower doses of xylitol and do not develop liver failure is excellent. Dogs ingesting xylitol should be hospitalized and monitored for variations in BG, because BG drops in most dogs following presentation. Additional studies are needed in dogs ingesting higher doses of xylitol before correlations between dose and the development of clinical signs or liver failure can be established. Treatment and prognosis for these dogs warrants further investigation.

Acute Hepatic Failure in a Dog after Xylitol Ingestion

“…Xylitol is primarily metabolized in the liver (70-80 %) by oxidation to D-xylulose. D-xylulose is phosphorylated to an intermediate in the pentose phosphate pathway which is then converted to glyceraldehyde-6-phosphate or fructose-6-phosphate, ultimately forming glucose, glycogen, or lactate [4]. The majority of xylitol is converted to glucose, with a small amount being converted to lactate [4].…”

“…D-xylulose is phosphorylated to an intermediate in the pentose phosphate pathway which is then converted to glyceraldehyde-6-phosphate or fructose-6-phosphate, ultimately forming glucose, glycogen, or lactate [4]. The majority of xylitol is converted to glucose, with a small amount being converted to lactate [4]. The remainder of xylitol (20-30 %) is metabolized by lungs, kidneys, myocardium, fat stores, and erythrocytes, where they are then converted into carbon dioxide and water through carbohydrate metabolism [1].…”

“…In humans, xylitol causes little to no insulinotropic effects and ingesting >130 g/day results only in diarrhea [2], whereas in dogs, xylitol stimulates pancreatic insulin secretion leading to profound hypoglycemia [9]. Dogs develop a dosedependent increase in plasma insulin concentration after ingesting xylitol [4]. The insulin release is 2.5-7 times greater than that seen with the equivalent amount of ingested glucose [4].…”

“…The use of xylitol resurfaced in the 1970s when it was found not only to be an excellent sweetener, but also have numerous health benefits. Today, xylitol is also being produced using resources such as corncob remnants from ethanol plants [4].…”

“…Xylitol has been shown to be anticariogenic and has antimicrobial properties against common oral bacteria, which make it a popular addition to gums and candies [1,4]. It has a low glycemic index and requires few carbohydrates for metabolism, as seen with its lower calorific value, 2.4 kcal/g compared with 4.0 kcal/g for sucrose, making it an ideal sweetener for diabetics [5].…”