Stealth xylitol poisonings on the rise

“We’ve seen a massive jump in the number of xylitol calls that we’re getting,” said Ahna Brutlag, DVM, MS, DABT, DABVT, of the Pet Poison Helpline: they’ve doubled over the last five years. “Calls about chocolate poisoning are still number one, but xylitol has moved into that number-two spot.”

Brutlag is the Pet Poison Helpline’s director of veterinary services and senior veterinary toxicologist.

A lower-calorie sugar substitute with a low glycemic index, xylitol’s been on veterinarians’ radar for years because of its toxicity to dogs. But lately, it’s getting trickier to spot. “We’re seeing it show up in all sorts of products,” Brutlag told NEWStat. “Products that aren’t even edible.”

Products like deodorant, face gels, hair care products, and baby wipes. Baby wipes? Yes, baby wipes.

“Xylitol produces a nice cooling sensation, so it can be really soothing on the skin,” Brutlag explained. It’s also a humectant, which means it can help maintain moisture in a product, which also helps explain the baby wipes. Brutlag can’t quite believe it herself: “Who would have thought that if a dog ate a baby wipe, we might have to think of xylitol as a potential risk factor, versus whatever else might be in the baby wipe?”

She said that’s why the Pet Poison Helpline is working to get the word on Xylitol out to veterinarians during Pet Poison Prevention Month: “They’d have no reason to be thinking of xylitol being in products other than food or medications, because that’s where they’re used to seeing it.”

Brutlag said low blood sugar is the number one tipoff that a dog who ate a baby wipe (or face gel, or deodorant) might have xylitol poisoning. “If that dog came into the hospital and emergency bloodwork shows he’s hypoglycemic, xylitol would be one of the first things you’d want to ask the pet owner about.”

Diagnosing xylitol poisoning can get even trickier than bringing up baby wipes.

Brutlag said the Helpline recently had a call from a pet owner whose dog—Pickles, a 12-year-old female mixed breed with diabetes—got into his cannabis-infused breath mints: “So we’ve got this dog who ate breath mints that had tetrahydrocannabinol (THC) in them, which is toxic to dogs. And they were sweetened with xylitol,” Brutlag says. “Now it’s a double-whammy of potential poisoning.”

Each mint contained 3 mg cannabinol, 2 mg THC, 1 mg melatonin, and an unlabeled amount of xylitol. Pickles ate 30 of them. “At the time of the owner’s call to us, he noted that Pickles was very sluggish and seemed easily startled,” Brutlag said. “Due to the dog’s signs, the amount of THC ingested, and the unknown amount of xylitol in the product, we advised Pickles be seen in the ER.” Helpline staff also contacted the mint manufacturer to find out how much xylitol the mints contained.

When Pickles arrived in the ER, Helpline staff spoke with the veterinarian on duty, who reported she was disoriented and ataxic but ambulatory. Her vitals were normal. “We discussed the expected clinical signs from the THC, melatonin, and xylitol, and provided treatment and lab testing recommendations,” Brutlag said. “They immediately drew blood to check blood glucose, liver enzymes, and other parameters. She was also administered a dose of activated charcoal.”

The call to the mint maker revealed that each mint contained around 700 mg of xylitol--which meant Pickles ingested a high enough dose to cause hepatic damage.

Brutlag said Pickles was hospitalized and her blood glucose and liver values were closely monitored for 24 hours, during which Helpline staff spoke with the treating veterinarian multiple times to help them assess her lab results and tailor her treatment regimen.

“Pickles actually experienced hyperglycemia, which is uncommon following xylitol ingestion in dogs,” Brutlag said. “We expect hypoglycemia secondary to release of insulin release due to xylitol—but attributed this to her underlying diabetes.” Pickles was started on hepatoprotectants.

Within 24 hours, her clinical signs resolved and she was discharged with instructions to continue having her liver values closely monitored by her regular veterinarian.

“Thankfully,” Brutlag added, “Pickles’ story ended on a happy note.”

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