Xylitol intoxication associated with fulminant hepatic failure in a dog

Abstract

Objective: To describe a case of xylitol intoxication causing fulminant hepatic failure in a dog. Case summary: A 2.5‐year‐old castrated male English Springer Spaniel weighing 26 kg, was presented after ingestion of half of a loaf of bread containing the sweetener xylitol. Toxic effects of the xylitol in this dog included vomiting, mild hypoglycemia and fulminant hepatic failure. Clinical management of acute hepatic failure and subsequent coagulopathy with supportive care and fresh frozen plasma is described. The dog was discharged 3 days after admission after a full clinical recovery. New or unique information provided: This paper describes the clinical consequence and successful treatment of fulminant hepatic failure in a dog following ingestion of xylitol.

Safety assessment of potential food ingredients in canine hepatocytes

“…(continued) inter-dog variability with aflatoxin B1 than seen with APAP. In contrast to these toxic responses, xylitol, reported to cause in vivo hepatic damage in dogs (Todd and Powell, 2007), was the least toxic substance not showing a decrease in viability (Fig. 1C).…”

“…Additionally, xylitol, a very popular sweetener used in candy, baked food, and medical products was assessed. This sweetener has been reported to result in severe hypoglycemia and liver failure in dogs with liver enzyme elevations that is reversible after a few days (Todd and Powell, 2007). Therefore, xylitol was exposed to canine hepatocytes to determine its potential direct toxicity.…”

Acute Hepatic Failure in a Dog after Xylitol Ingestion

“…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].…”

“…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].…”

“…There is no antidote for xylitol toxicosis, and general treatment guidelines include decreasing absorption, treating emesis, stabilizing blood glucose, protecting the liver, addressing coagulopathies, and providing further care as needed. Due to low binding properties, activated charcoal is not typically used [12]. Monitoring blood glucose closely and providing dextrose supplementation when needed is critical in the early stages of management for xylitol toxicosis.…”