Xylitol (sugar-free gum) Toxicity

Xylitol Toxicity

By Dr. Karen Burgess

What is xylitol?
Xylitol, a naturally occurring sugar, is found in corn, plums, berries, lettuce, oats, mushrooms, and various trees. Once manufactured, the white powder produced is very similar to sugar in its appearance and taste. Containing a third of the calories of traditional sugar, xylitol is preferential for diabetic humans. Once processed, xylitol is a white powder that looks and tastes similar to sugar and has been proven to actually decrease cavity formation in humans. All of these positives for humans has increased the popularity of xylitol in the marketplace over the last several years.

What products contain xylitol?
The most common and easily accessible xylitol containing products include Ice Breakers, Orbit, Stride and Trident chewing gums. Other sources include diabetic candies, baking additives, Jell-O sugar free pudding, children’s vitamins, nasal sprays, and over the counter medications such as children’s Allegra.

What problems does xylitol cause in dogs?
Severe and sudden drops in blood sugar, liver failure, seizures, and death can all occur from xylitol ingestion in dogs. In humans xylitol does not cause release of insulin. However in dogs, it is a potent stimulator of insulin release from the pancreas which leads to a rapid and severe drop in blood sugar levels. This low blood sugar level (hypoglycemia) can quickly become a life threatening situation. High doses of ingestion can also lead to liver failure for yet unknown reasons, often 2-3 days after ingestion. Pets that experience this condition do not always show signs of low blood sugar initially making follow up monitoring very important.

How much xylitol does it take to cause problems?
The toxicity concerns begin at 50 mg/pound of dog. While different brands contain diiferent amounts of xylitol, the typical range is 300 to 1500 mg/piece of gum. This means a 20lb dog can experience toxicity after ingesting just one piece of gum containing 1000 mg. As one can imagine, the scenario is even worse for smaller dogs. Liver failure becomes a concern at a dose of approximately 2000 mg/pound.

Signs of xylitol toxicity
Common signs of hypoglycemia, which may develop in as few as 15 minutes, include vomiting, walking as if drunk/weakness, depression, tremors/seizures, and coma.

What to do if your pet ingests xylitol
Contact your veterinarian, animal emergency hospital, or animal poison control immediately. Do not induce vomiting unless under the direction of a veterinarian as this may worsen developing hypoglycemia. If clinical signs are apparent hospitalization, laboratory work, and treatment for low blood sugar will likely be indicated for a minimum of 24 hours. Follow up laboratory work will help determine whether damage has also occurred to the liver. Prognosis is good if caught early before symptoms develop or with only mild signs. Pets that develop coma or liver failure carry a poor prognosis for survival.

• Ice Breakers: 1-1.5g/piece
• Orbit: 9.2mg/piece or none at all
• Orbit Strawberry mint: 317mg/piece
• Stride: 185mg/piece
• Trident (regular): 0.22g/piece
• Trident (Xtracare): 0.28g/piece

Pyrethrin Toxicity

Pyrethrins, Permethrins, and Pyrethroids

By Dr. Karen Burgess

What are pyrethrins?
Pyrethrins are a natural insect repellent and insecticide that tends to break down readily and are derived from the flower of the mum (Chrysanthemum cinerariaefolium). Over the years pyrethrins have started replacing the more toxic organophosphate products. Pyrethroids (including permethrin) are synthetic versions of pyrethrins and tend to break down slower in the environment. The primary action of pyrethrins is on an insect’s nerve center causing almost instantaneous paralysis. Some insects have developed resistance to natural pyrethrins over the years, thus leading to development of the longer acting pyrethroids. In some cases additional potentially toxic components (ex. organophosphates) are added to pyrethroids to enhance their efficacy.

What products contain pyrethrins?
Pyrethrins are commonly found in yard treatments, foggers, and dog or cat flea products (shampoos, powders, topical spot ons).

How much pyrethrin exposure is a problem?
For cats or fish, any pyrethrin exposure is a concern. Remember to keep your dog out of water that may have fish until any topical flea product has completely dried (or 48 hours to be safe). Products containing pyrethrins have varying percentages of concentration. If exposure or toxicity is a concern, please contact your veterinarian or animal poison control immediately.

What problems and symptoms do pyrethrins cause?
Symptoms of toxic exposure start shortly after exposure and include drooling/excessive salivation, vomiting, agitation, and gagging. Some dogs have a skin type of reaction to pyrethrins that may look like excessive itchiness (feeling of pins and needles), restlessness, or whimpering/crying. Severe exposure may progress to seizures, severe depression/coma, and death. Cats experience similar but often more severe signs and should be considered an immediate and potentially life threatening emergency. Often the first sign cat owners notice is trembling or excessive shaking.

What to do if you feel your pet has been exposed to toxic amounts of pyrethrins
Contact your veterinarian, animal emergency hospital, or animal poison control immediately. If your cat has been exposed to pyrethrins toxicity can be life threatening. Hospitalization, decontamination (removing product from skin or stomach), muscle relaxants, and supportive care are indicated until no further symptoms are noted. Prevent exposure by reading product labels carefully (make sure safe to use on cats, correct formula for your pet’s weight) and not allowing cats access to dogs treated with pyrethrins for at least 24 hours.

Plant Toxicity

Common Plant Toxicity Concerns

By Dr. Karen Burgess

Holly
Toxic to pets and often found in holiday arrangements, holly contains methylxanthines similar to chocolate. The leaves are somewhat prickly which may discourage ingestion. Holly can be both irritating to the mouth and cause severe vomiting and diarrhea. Typically pets do not ingest enough of the plant to cause serious symptoms. Both Holly leaves and berries are toxic.

Mistletoe
Unlike the poinsettia plant, mistletoe can cause significant symptoms in pets including GI upset, neurologic signs (lethargy, seizures, coma), and difficulty breathing. The amount of mistletoe that would cause toxic signs is not well understood. Fortunately, most pets do not ingest enough to cause serious consequences.

Lilies
Sudden and severe kidney failure in cats is associated with ingestion of very small amounts (ex. couple of bites, exposure to pollen) of this extremely common plant. Vomiting is the most common initial symptom. This will often resolve initially. Within 1 to 3 days complete and irreversible kidney failure can develop. If treatment is started within 18 hours of ingestion (including hospitalization and aggressive fluid therapy for a minimum of 48 hours), prognosis may improve. Lilies are not toxic to dogs.

Tulips/Hyacinths
Tulip and Hyacinth bulb toxic components are concentrated in the bulb. Ingestion of bulbs can cause GI signs including anorexia, vomiting, and diarrhea. In more severe cases nervous system signs can develop.

Tomatoes
Tomato plants (leaves, fruits, and roots) contain a chemical called solanine which acts to naturally protect plants from pests and fungus. Found in highest concentration in young or green fruit, solanine can cause a range of signs from gastrointestinal upset to more serious neurological signs. Fortunately absorption is poor orally and therefore intervention is rarely necessary. Potatoes also contain solanine and can cause similar signs.

Chrysanthemums
Although containing potentially toxic pyrethrins, mums are considered minimally toxic in pets causing primarily gastrointestinal upset.

OTC Drug Toxicity

Over The Counter Drug Toxicity

By Dr. Karen Burgess

Aspirin
Aspirin falls into a category of drugs called non-steroidal antiinflammatories or NSAID for short. There are many NSAIDS available for pets and humans and as a class they are effective pain relievers and blockers of inflammation.

Depending on the chemical makeup of a particular NSAID there can be varying degrees of negative side effects. After ingestion of aspirin, salicylate is the potentially toxic metabolite produced in the body. The most common side effects seen with Aspirin include stomach wall bleeding (ulcers), slower clotting times (tendency to bleed), and kidney damage. While the pain relieving benefits tend to be brief (8 to 12 hours), toxic effects tend to last much longer (7-10 days). In one study it was shown that all dogs given aspirin at an appropriate dose had visible gastric bleeding. While many think that enteric coated or buffered aspirin are a safer option, the coating allows variable absorption and in humans are associated with increased risk of gastrointestinal bleeding. Aspirin is rarely recommended for pain relief in human medicine anymore as there are safer options available. The primary way aspirin is now used for people is at low doses (think baby aspirin for an adult) to “thin blood” or help prevent clot formation.

Unfortunately for the unknowing pet owner, aspirin is readily available in the pet care aisle and even labeled for pet use. Many assume because marketed in this way that this is a safe option when in fact it can be a very dangerous choice. Current acceptable dosing for aspirin is also the dose which can cause stomach ulcers. Additionally, after even one dose of aspirin no other NSAIDs or steroids should be used for 7 days. This means that much needed effective and safe pain relief may not be an option for your veterinarian to prescribe after aspirin use.

For cats aspirin is particularly dangerous. Ingestion of even one aspirin would likely be fatal. The metabolism of aspirin is much slower in cats making a daily dose of baby aspirin extremely dangerous.

Signs of toxicity from aspirin including vomiting (with or without blood), diarrhea, loss of appetite, bloody or black stool, excessive bruising, bone marrow suppression, weakness/depression, or death.

Baby aspirin contains 81 mg aspirin, regular strength 325 mg, and extra strength 500 mg. What many may not realize is that Pepto-Bismol products may contain 262 mg salicylate per TBSP or 300 mg salicylate per tablet. Check all labels carefully before giving a medication to your pet as aspirin is a common add on ingredient in over the counter products.

Ibuprofen
Ibuprofen is an NSAID that decreases inflammation, reduces fever, and provides pain relief. Toxicity concerns are similar to Aspirin (gastric ulceration, clotting issues). Similar to aspirin, there is a dose recommendation for dogs, but this is typically discouraged due to potential negative side effects. Cats are less tolerant of ibuprofen than dogs.

Tylenol/Acetaminophen
Acetaminophen provides both pain and fever relief but does not affect inflammation or clotting like NSAIDs. While the safe dose range is narrow, in many dogs acetaminophen products may be a safer option to assist with pain. Cats lack the ability to break down acetaminophen in the liver and even one dose of acetaminophen may be fatal (10 mg/kg). Toxic dose in dogs are typically seen at doses exceeding 100 mg/kg.

Symptoms of toxicity may be more likely to develop in smaller dogs or those with underlying liver disease. Lethargy, swollen face, blue gums, shortness of breath, and yellow tinged skin are all possible signs. Hospitalization and intensive treatment may be necessary with more serious exposure.