Happy (almost) Easter! This weekโs posts are going to be themed around toxins commonly seen around the Easter holiday. Todayโs path rounds are on ๐ฑ๐ฒ๐ฅ๐ข๐ญ๐จ๐ฅ ๐ญ๐จ๐ฑ๐ข๐๐ข๐ญ๐ฒ!
๐๐ก๐๐ญ ๐ข๐ฌ ๐ข๐ญ?
๐๐ฒ๐ฅ๐ข๐ญ๐จ๐ฅ is an artificial sweetener found in candies, peanut butters, baked goods and gum. It can also be found in other products like chewable vitamins, some medications, toothpastes, etc.
๐๐ก๐จ ๐ ๐๐ญ๐ฌ ๐ข๐ญ?
Dogs seem uniquely susceptible to xylitol toxicity!
๐๐ก๐๐ญ ๐๐๐ฎ๐ฌ๐๐ฌ ๐ข๐ญ?
Xylitol causes release of large amounts of ๐ข๐ง๐ฌ๐ฎ๐ฅ๐ข๐ง, which is the major hormone that encourages ๐ ๐ฅ๐ฎ๐๐จ๐ฌ๐ (sugar) in the bloodstream to enter cells. With large amounts of insulin floating around, more glucose than normal is pushed into the cells, resulting in ๐ก๐ฒ๐ฉ๐จ๐ ๐ฅ๐ฒ๐๐๐ฆ๐ข๐ (low blood sugar). Xylitol can also cause severe ๐ก๐๐ฉ๐๐ญ๐ข๐ ๐ง๐๐๐ซ๐จ๐ฌ๐ข๐ฌ (cell death in the liver), however the mechanism of this is unknown.
๐๐ก๐ฒ ๐ข๐ฌ ๐ญ๐ก๐ข๐ฌ ๐ ๐ฉ๐ซ๐จ๐๐ฅ๐๐ฆ?
Hypoglycemia can cause ๐๐ญ๐๐ฑ๐ข๐ (irregular, wobbly gait), seizures, and even a coma. This is due to the nervous systemโs requirement for glucose to produce energy, whereas other types of cells can use proteins or fats if glucose is limited. Without enough glucose in the blood, the nervous system quickly develops issues!
The hepatic necrosis caused by xylitol can lead to ๐ข๐๐ญ๐๐ซ๐ฎ๐ฌ (yellowing of the skin), vomiting and ๐๐จ๐๐ ๐ฎ๐ฅ๐จ๐ฉ๐๐ญ๐ก๐ฒ (inadequate blood clotting). The liver is responsible for producing most of the clotting proteins in the blood, so when it fails, it stops producing these proteins. Affected animals may be at risk of excessive bleeding or even spontaneous bleeding.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐๐ข๐๐ ๐ง๐จ๐ฌ๐๐?
Diagnosis is typically made through a history of xylitol ingestion, combined with findings of hypoglycemia or liver injury on bloodwork.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐ญ๐ซ๐๐๐ญ๐๐?
Patients with hypoglycemia are typically given supplemental glucose until they are able to maintain their blood glucose concentration on their own. If liver disease or coagulopathy develops, these will need to be treated as well, usually though administration of ๐ฉ๐ซ๐จ-๐๐จ๐๐ ๐ฎ๐ฅ๐๐ง๐ญ๐ฌ (encourage blood clotting) and ๐ก๐๐ฉ๐๐ญ๐จ๐ฉ๐ซ๐จ๐ญ๐๐๐ญ๐๐ง๐ญ๐ฌ (protect against liver damage).
๐๐ก๐จ๐ญ๐จ๐ฌ
1-2) Examples of icterus in the ear and gums from a dog with hepatic necrosis.
3) The abdomen of a dog with hepatic necrosis showing multiple small, spontaneous hemorrhages called ๐๐๐๐ก๐ฒ๐ฆ๐จ๐ฌ๐๐ฌ.
4) The liver of that dog! The darker patches are likely areas of hemorrhage, interspersed with sad, dying liver cells.
5-6) What that liver might look like on histology! The darker red areas have hemorrhage overlying dead liver cells, while the more pink areas are liver cells that are still alive.
๐๐จ๐ฎ๐ซ๐๐๐ฌ
Gwaltney-Brant SM. Xylitol toxicosis in dogs. Merck Veterinary Manual 2021.
Photos 1-4 ยฉ University of Calgary Diagnostic Services Unit.
Photos 5-6 ยฉ Noahโs Arkive contributor Miller licensed under CC BY-SA 4.0.
