title: Acute Hepatic Failure in a Dog after Xylitol Ingestion.
abstract: Xylitol is a five-carbon sugar alcohol produced from natural resources frequently used as a sugar substitute for humans. We report the development and successful treatment of acute hepatic failure and coagulopathy in a dog after xylitol ingestion. A 9-year-old 4.95 kg (10.9 lb) neutered male Chihuahua was evaluated at a veterinary clinic for vomiting after ingesting 224 g (45 g/kg, 20.5 g/lb) of granulated xylitol. Hypoglycemia developed within 1-2 h, elevated liver values, suggesting the development of acute hepatic failure, within 12 h and coagulopathy less than 24 h after ingestion. Treatment included maropitant, intravenous dextrose, phytonadione, metronidazole, and fresh frozen plasma. N-acetylcysteine (NAC) and S-adensoyl-L-methionine (SAMe) provided hepatic detoxification and support. The dog survived and liver values returned to normal within 1 month post ingestion. No adverse effects to hepatic function have been identified 2 years after acute xylitol toxicity. This paper is one of the few reports of successful management of a dog with hypoglycemia, hepatic failure, and coagulopathy caused by xylitol toxicity. To date, this is the highest published xylitol dose survived by a dog, as well as the only reported case that documents laboratory changes throughout the course of toxicity and includes normal hepatic indices for 7 months following xylitol toxicity. The rapidly expanding use of xylitol in a variety of products intended for human consumption has led to a rise in xylitol toxicity cases reported in dogs, and clinicians should be aware that more dogs may potentially be exposed and develop similar manifestations.
authors.affiliation: Pet Poison Helpline, 3600 American Blvd W #725, Bloomington, MN, 55431, USA. rschmid@petpoisonhelpline.com.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Schmid
authors.affiliation: Pet Poison Helpline, 3600 American Blvd W #725, Bloomington, MN, 55431, USA.
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Hovda
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000818:Animals; D017849:Animals, Inbred Strains; D000931:Antidotes / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000503:physiopathology / Q000628:therapy / Q000662:veterinary*; D003131:Combined Modality Therapy / Q000662:veterinary; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control / Q000662:veterinary; D004285:Dogs; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control / Q000662:veterinary; D017114:Liver Failure, Acute / Q000209:etiology / Q000517:prevention & control / Q000662:veterinary*; D008297:Male; D012436:S-Adenosylmethionine / Q000627:therapeutic use; D013549:Sweetening Agents / Q000737:chemistry / Q000506:poisoning*; D016896:Treatment Outcome; D014993:Xylitol / Q000037:antagonists & inhibitors / Q000506:poisoning*
chemical_list: D000931:Antidotes; D015415:Biomarkers; D013549:Sweetening Agents; D012436:S-Adenosylmethionine; D014993:Xylitol; D000111:Acetylcysteine
keywords: Dog; Hepatic failure; Hypoglycemia; N-acetylcysteine; Xylitol