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 4.95kg (10.9lb) neutered male Chihuahua was evaluated at a veterinary clinic for vomiting after ingesting 224g (45g/kg, 20.5g/lb) of granulated xylitol. Hypoglycemia developed within 1-2h, elevated liver values, suggesting the development of acute hepatic failure, within 12h and coagulopathy less than 24h 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 1month post ingestion. No adverse effects to hepatic function have been identified 2years 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 7months 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.