From sugar-free chewing gum to toothpaste, sugar free peanut butter, sweets and cereals, these many products are perfectly safe for humans but because of different metabolisms can be deadly for your pet. Xylitol if ingested by pets causes a massive release of insulin from the pancreas. This, in turn, results in a dangerously low blood sugar level and symptoms such as weakness, trembling, seizures, collapse. At higher dosages, xylitol can cause massive liver destruction (known as necrosis) in which large numbers of liver cells die abruptly. This produces an acute health crisis and, in many cases, death. KNOW THE SIGNS Vomiting, weakness or lethargy, depression, unstable on feet, trembling or tremoring, seizures, a racing heart rate, jaundiced gums, black-tarry stool, diarrhoea and bruising. Immediately after eating, vomiting may occur. Hypoglycaemia (low blood sugar) develops within 30 to 60 minutes, resulting in lethargy and weakness. These signs may quickly develop into walking problems, collapse, and seizures. Within hours skin and intestinal haemorrhaging may occur and may mean a very poor outcome. NEXT STEPS What to do… If you think your dog was accidentally poisoned by a sugar-free product, stay calm, read the ingredients to see if the product contained xylitol. The general rule is that if xylitol is listed in the first 3-5 ingredients (typically in order of the amount that they appear in the food or product), it is going to be poisonous. (remember it’s only Xylitol that is poisonous NOT other sweeteners) With xylitol poisoning, it is very important to calculate whether a toxic dose has been ingested. In dogs, doses > 0.1 g/kg are considered toxic and result in sudden problems. Higher doses (> 0.5 g/kg) of xylitol have been linked with acute hepatic necrosis. Many sugar free candies and chewing gum contain various amounts of xylitol ranging, on average, from 2 mg/piece to 1.0 grams/piece. Unfortunately, not all sources are disclosed by the company (e.g., how many grams of xylitol may be in each piece of gum) so sometimes it’s hard to calculate a toxic dose. If, unfortunately your dog did eat a poisonous dose of xylitol, treatment includes the following: If blood sugar when tested by a vet is normal and ingestion was recent (within a few hours), your vet may induce vomiting. If your dog is hypoglycemic, a stat bolus of intravenous (IV) dextrose (i.e., sugar) is a must, followed by hospitalization. Treatment will include IV fluids with sugar supplementation (e.g., dextrose) for a minimum of 12-18 hours. If your dog is able to maintain his blood sugar as the dextrose supplementation is weaned down over time, then your dog can go home! If your veterinarian induced vomiting in your dog, make sure they skip the charcoal – no need for your veterinarian to give activated charcoal (i.e., a black liquid product that binds up some poisons). Charcoal does not reliably bind to xylitol, so it’s not necessary with xylitol poisoning. If a toxic dose was ingested and not vomited back up, your veterinarian will recommend hospitalizing your dog for IV fluids, dextrose supplementation, and symptomatic supportive care. Careful monitoring of blood work (including the liver enzymes, electrolytes and blood sugar) is very important and should be undertaken by the vet. If your dog ate a dose approaching the liver-toxic amount of xylitol, the use of liver protectants (e.g., SAMe, milk thistle, n-acetylcysteine) is warranted. Most dogs are sent home on liver protectants for several weeks, while rechecking liver enzymes frequently at your vet to be on the safe side. Don’t hesitate…. When in doubt, if you think your dog has eaten xylitol, contact your vet right away for life-saving care. They can help calculate and determine whether or not the amount of xylitol eaten was poisonous or not. Remember, with any pet poisoning, the sooner you recognize the problem and seek the vets attention, the less expensive and less dangerous it is to your pet! THE UNFORTUNATE FACTS… The prognosis for dogs with hypoglycaemia is good with immediate and proper treatment, while the prognosis for dogs that have developed liver toxicity is poor. Large ingestions of xylitol (a relatively small amount of the product) that are not caught immediately can unfortunately result in liver failure and death despite aggressive supportive care. This can occur in less than 36 hours in dogs that are otherwise young and healthy. Remember to always make sure you keep these products and foods (don’t forget the drinks) out of the reach of your pets.