Canis ISSN: 2398-2942

Xylitol toxicity

Synonym(s): Food additive E967 toxicity

Contributor(s): Alexander Campbell, Rosalind Dalefield

Introduction

  • A 5-carbon sugar alcohol.
  • Used as an artificial sweetener in sugar-free chewing gums and confectionery, and as a sugar substitute in baking.
  • An excipient in many human and some veterinary medicines.
  • Used in some drinking water additives for animals to decrease dental plaque and calculus formation.
  • Signs: xylitol is a potent stimulator of insulin release in dogs.
  • Onset often within one hour; can be delayed.
  • Hypoglycemia and/or hepatotoxicty.
  • Hepatotoxicity may present as coagulopathy.
  • Diagnosis: history, clinical signs.
  • Treatment: supportive care.
  • Hypoglycemia should be managed conventionally.
  • Hepatoprotectant therapy may be used, although it has not been demonstrated to be beneficial in this toxicosis.

Pathogenesis

Etiology

  • Xylitol is a potent stimulator of insulin release in dogs.
  • Whether administered orally or intravenously xylitol will cause dose-dependent increases in insulin concentrations in dogs.

Pathophysiology

  • Doses in excess of 50 mg/kg may cause hypoglycemia.
  • Hepatotoxicity is associated with doses in excess of 0.5 g/kg (500 mg/kg).
  • Cases with fatal outcomes are reported at doses in excess of 1.4 g/kg; isolated fatal cases are reported at lower dosings.
  • Dogs absorb xylitol more rapidly than humans.
  • Xylitol is a potent stimulator of insulin release in dogs.
  • Mechanism of hepatic damage remains unclear.

Timecourse

  • Xylitol taken orally is absorbed very rapidly in the dog, with peak plasma concentrations occurring at about 30 min after ingestion.
  • Onset of signs related to hypoglycemia may be present within 30-60 mins of ingestion.
  • Hepatoxic effects usually occur 9-72 hours post ingestion, and may occur in dogs that have not shown signs of hypoglycemia.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Campbell A, Bates N (2010) Xylitol toxicity in dogs. Vet Rec 167 (3), 108 PubMed.
  • Xia Z, He Y, Yu J (2009) Experimental acute toxicity xylitol in dogs. Vet Pharmacol Therap 32 (5), 465-469 PubMed.
  • Thomas H & Boag A (2008) What is your diagnosis? Hypoglycaemia. J Sm Anim Pract 49 (1), 47-49 PubMed.
  • Todd J M, Powell L L (2007) Xylitol intoxication associated with fulminant hepatic failure in a dog. J Vet Emerg Crit Care 17 (3), 286-289 VetMedResource.
  • Clarke D E (2006) Drinking water additive decreases plaque and calculus accumulation in cats. J Vet Dent 23 (2), 79-82 PubMed.
  • Dunayer E K (2006) New findings on the effects of xylitol ingestion in dogs. Vet Med 101 (12), 791-797 ASPCApro.
  • Dunayer E K, Gwaltney-Brant S M (2006) Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. J Am Vet Med Assoc 229 (7), 1113-1117 PubMed.
  • Cope R B (2004) A screening study of xylitol binding in vitro to activated charcoal. Vet Hum Toxicol 46 (6), 336-337 PubMed.
  • Dunayer E K (2004) Hypoglycemia following canine ingestion of xylitol-containing gum. Vet Hum Toxicol 46 (2), 87-88 PubMed.
  • Foss T S (2004) Xylitol: "Sweet" temptation for dogs. Vet Tech 25 (11), 773-775 ResearchGate.
  • Asano T, Greenberg B Z, Wittmers R V et al (1977) Xylitol, a partial homologue of alpha-D-glucopyranose: potent stimulator of insulin release in dogs. Endocrinology 100 (2), 339-45 PubMed.
  • Woods H A, Krebs H A (1973) Xylitol metabolism in the isolated perfused rat liver. Biochem J 134 (2), 437-443 PubMed.
  • Kuzuya T, Kanazawa Y, Hayashi M et al (1971) Species difference in plasma insulin responses to intravenous xylitol in man and several mammals. Endocrino Japan 18 (4), 309-320 PubMed.
  • Kuzuya T, Kanazawa Y, Kosaka K (1969) Stimulation of insulin secretion by xylitol in dogs. Endocrinology 84 (2), 200-207 PubMed.
  • Kuzuya T, Kanazawa Y (1969) Studies on the mechanism of xylitol-induced insulin secretion in dogs. Effect of its infusion into the pancreatic artery, and the inhibition by epinephrine and diazoxide of xylitol-induced hyperinsulinaemia. Diabetologia (4), 248-257 PubMed.
  • Hirata Y, Fujisawa M, Sato H et al (1966) Blood glucose and plasma insulin responses to xylitol administrated intravenously in dogs. Biochem Biophys Res Commun 24 (3), 471-475 PubMed.

Other sources of information

  • Dunayer E K (2008) Personal communication.
  • Thrall M A, Baker D C, Campbell T W, DeNicola D, Fettman M J, Lassen E D, Rebar A, Weiser G (2004)Veterinary Hematology and Clinical Chemistry.Philadelphia, Lippincott Williams & Wilkins.

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