Xylitol is a low calorie sugar substitute that has gained popularity since its first FDA-approved appearance in the early 1960s. It contains about two thirds the calories of regular sugar and has good properties for human health, with the initial marketing for diabetics. Today, you can probably imagine the amount of “low calorie” items that have been introduced to store shelves with xylitol listed in the ingredients. A few of the common items include sugar-free chewing gum, cookies, chocolate bars, peanut butter, pudding, mints, or a powdery substance for baking. In addition, due to the numerous health benefits, xylitol can also be found in items such as cough syrups, nasal sprays, chewable vitamins, sleep supplements, mouthwash, toothpaste, skin care products and some medications. Although there are health benefits for people, that is not the case when it comes to our four-legged, furry friends.
Clinical signs of xylitol poisoning in dogs can be seen with very small ingestions, even just 1 piece of gum could be harmful depending on the xylitol content and size of the dog. Early signs include vomiting, followed by a dose-dependent drop in blood sugar (hypoglycemia). Hypoglycemia leads to lethargy, weakness, incoordination, tremors, or seizures, that can progress to a coma. Larger doses are associated with acute liver failure due to xylitol being mostly metabolized by the liver. Clinical signs such as persistent vomiting, jaundice (yellowing of the skin or mucous membranes), or clotting issues may onset anywhere from 24-48 hours post-ingestion.
With any potential ingestion, it is important to read product labels carefully looking specifically for xylitol in the ingredient list. There are many sugar-free products that do not contain xylitol, but rather other sugar alcohols, such as sorbitol, that do not have the same concerns. If xylitol is a listed ingredient, clinical signs may develop rapidly, and it is crucial to initiate treatment as soon as possible. Treatment is symptomatic and supportive, usually involving stabilizing blood sugar levels, administering liver protectants, and monitoring bloodwork.
Recovery depends on how quickly treatment is initiated. Most dogs do well after blood sugar levels are restored, even some dogs that developed liver issues have made a full recovery. However, the longer symptoms persist without treatment, the worse the prognosis. If you suspect your dog has ingested a xylitol containing product, please contact your veterinarian or Pet Poison Helpline immediately. Do not give anything at home to induce vomiting unless specifically directed to do so by your veterinarian, as vomiting can worsen clinical signs.
Prevention is ultimately the best way to avoid an accidental exposure. If you use any of the products listed above, check the label for xylitol. Keep these products stored out of reach from dogs and do not share any foods containing it with your dog. Only use toothpaste designed for dogs when brushing their teeth and never keep your dogs’ medications close to any medications or supplements that you might have.
It is also important to mention that dogs are by far the largest population with reported xylitol poisoning, but it is not limited to them. We can see the same effect in goats and cattle, although it is rare due to the unlikelihood of exposure. Cats are not expected to have the same concerns as dogs and there are no reported cases in cats to date.
Always contact your veterinarian or Pet Poison Helpline at 1-800-213-6680 if your dog ingests any xylitol containing product to determine if therapy may be needed.
Katelin Hoch, Pet Poison Hotline DVM student extern, Kansas State University, Class of 2024
Samantha Koch, CVT, Veterinary Information Specialist, Pet Poison Helpline