Xylitol Poisoning in Dogs

What is xylitol?

Xylitol is a naturally occurring substance that is widely used as a sugar substitute. Chemically, it is a sugar alcohol, and is found naturally in berries, plums, corn, oats, mushrooms, lettuce, trees, and some other fruits.

Commercially, most xylitol is extracted from corn fiber or birch trees. Although it has been used as a sugar substitute for decades, its popularity has increased dramatically in the last decade due to its low glycemic index and dental plaque fighting properties. Xylitol is used in reduced sugar, low sugar, and “no sugar added” foods. It may also be called wood sugar, birch sugar, and birch bark extract.

Where is xylitol found?

Xylitol can be found in oral care products, pharmaceuticals, and as a food additive. Product examples include sugar-free gum, candies, breath mints, baked goods, peanut butter, pudding snacks, and cough syrup; chewable or gummy vitamins, supplements or over-the-counter medications; mouthwash, and toothpaste. Xylitol can also be found in some over-the-counter nasal sprays, skin care products, laxatives, digestive aids, allergy medicines, dry mouth lozenges, and sleep supplements. Xylitol is also found in prescription human medications, especially those formulated as quick-dissolve tablets or liquids.

How safe is xylitol for dogs?

Xylitol is extremely toxic to dogs. Even small amounts of xylitol can cause hypoglycemia (low blood sugar), seizures, liver failure, or even death. Cats, ferrets, and horses do not appear to be at risk from ingestion of xylitol.

Why is xylitol toxic to dogs?

When dogs eat xylitol, it is quickly absorbed into the bloodstream, causing the pancreas to release insulin, resulting in a rapid increase in insulin levels in the blood. This rapid insulin increase causes a profound drop in blood sugar (hypoglycemia) as soon as 30 minutes to 2 hours after ingestion. If untreated, hypoglycemia can cause seizures and can be life-threatening. Ingestion of higher levels of xylitol leads to increased liver enzymes within 12 to 48 hours of ingestion, and liver failure within 24 to 48 hours. 

How much xylitol is poisonous to a dog?

The amount of a product that needs to be ingested before toxicity is expected varies by product. In general, lower doses of xylitol cause hypoglycemia, while higher doses cause liver failure.

The most common source of xylitol poisoning that Pet Poison Helpline gets calls about comes from sugar-free gum, although xylitol poisoning from other sources, such as supplements and baked goods, are on the rise.

What should I do if my dog eats something containing xylitol?

If you suspect that your dog has eaten a product containing xylitol, immediately contact your veterinarian or Pet Poison Helpline, a 24/7 animal poison control center, at 1-800-213-6680.

Do not induce vomiting or give anything orally to your dog unless your veterinarian directs you to do so. It is important to get treatment for your dog as quickly as possible. Some dogs may already be hypoglycemic, so inducing vomiting can worsen clinical signs.

What are the signs of xylitol poisoning?

Initial signs of xylitol poisoning are typically due to low blood sugar (hypoglycemia). Signs of low blood sugar may include:

• vomiting
• weakness
• lack of coordination or difficulty walking or standing
• weakness, sluggishness, or lethargy
• tremors
• seizures
• coma

Dogs that ingest enough xylitol to develop liver failure may or may not show signs of hypoglycemia first.

How is xylitol poisoning treated?

As with all poisoning cases, early intervention is key to successful treatment. Call your veterinarian or Pet Poison Helpline as soon as you realize your dog has consumed xylitol. Supportive therapy includes fluid support and medication to treat the dog’s clinical signs. For adequate treatment and observation, be prepared to have your dog stay in the hospital through the day with mild cases, and for a few days in more severe cases.

What is the prognosis for recovery from xylitol poisoning?

The prognosis is good for dogs that are treated before clinical signs develop, or for dogs that develop uncomplicated hypoglycemia that is quickly reversed with treatment. If liver failure develops, patients will need more prolonged treatment, but the prognosis should still be good with appropriate treatment.

How can I prevent this problem?

If you use products containing xylitol, make sure they are stored safely out of reach of all pets in the home, especially dogs. Do not share any food with your pets that may contain xylitol. When brushing your pets’ teeth, only use toothpaste intended for dogs, never one made for human use. Keep in mind there are some veterinary products that contain small amounts of xylitol (e.g., mouthwashes). At prescribed doses, these products should not result in xylitol poisoning; however, if ingested in large amounts, they can potentially result in poisoning.

Pet Poison Helpline, an animal poison control center based out of Minneapolis, MN, is available 24/7 for pet owners and veterinary professionals that require assistance treating a potentially poisoned pet. The staff provides treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals, and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helpline’s per-incident fee includes follow-up consultations for the duration of the poison case. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com