This story is about Reggie the miracle Puggle (Beagle, Pug cross) who has more lives than most cats. He is a lovely dog but has an uncanny tendency to get himself into trouble…mostly due to his insatiable desire to anything and everything! I will not get into all of other trouble Reggie has gotten himself into, as this article is about xylitol toxicity, but suffice it to say that despite his dedicated and wonderful family’s best efforts to keep bad things out of Reggie’s tummy, Reggie once again managed to steal a pack of gum out of a visiting friend’s purse. The purse was up high on a counter (the picture to the left is not Reggie but a pretty good likeness – can’t post a picture due to patient confidentiality) that a dog Reggie’s size should not be able to reach.
This gum like many other brands of gum, had 1.6 grams of xylitol in each cube. Reggie’s toxic dose per his body weight is 6 grams and he ate 30 cubes. Simple math tells us that Reggie consumed 8 times the toxic dose of this compound that is extremely toxic to dogs.
Xylitol is in a naturally occurring sweet compound that is commonly found in berries, corn, plums and other fruits. Commercially, it is extracted from corn and certain other vegetables and is used as a sweetener in many foods, oral care products, and medicines. It has increased in popularity because, although it sweetens as well as, if not better than, sugar, but it has 2/3 less calories per unit volume than sugar. Thus, xylitol is commonly found in sugar free chewing gums, candies, mints, toothpastes, cough syrups, pediatric medicinal suspensions, and is especially popular in low carbohydrate protein bars and shakes. It is listed commonly on the nutrition label as a class of sugar substitutes called sugar alcohols.
Xylitol is safe for use in humans and is widely considered a low glycemic index sweetener that is safe for diabetics. In the case of oral health, research supports that xylitol even reduces the buildup of plaque on the teeth. Aside from the occasional laxative effect it has on some people that may lead to mild GI discomfort or diarrhea, it by and large is considered quite safe for people.
The reason it is safe for people is that xylitol passes through the intestinal tract of humans without triggering the pancreas to release insulin. Quite oppositely in dogs, xylitol stimulates the pancreas to cause rapid release of insulin, the hormone responsible for signaling boy cells to take up blood glucose, leading to severe hypoglycemia, seizures, coma, and death if not treated quickly. Xylitol also causes liver failure in some patients, but the mechanism by which it damages the liver remains unknown.
In Reggie’s case, incredibly, he never experienced the most common and severe side effect of hypoglycemia. My hypothesis as to why this was the case is that one of the severe cases of disease that Reggie survived as a young dog was the most severe form of an inflammatory disease of the pancreas called pancreatitis. It took a combination of several days of intensive treatment, a collaboration of several veterinarians, and an extraordinary dedicated family to facilitate his survival against the odds over 5 years ago.
Interestingly, this bout of pancreatitis may have left Reggie’s pancreas functional enough for his metabolic needs to sustain a healthy life, but perhaps in some level of a compromised state the prevented his pancreas from rapidly releasing insulin. How ironic it would be if a previous bout with a life threatening illness earlier in his life may have facilitated Reggie’s survival this time around.
In any case, it is very fortunate that Reggie did not experience hypoglycemia as he did go into liver failure to the extent that he developed an inability to clot. The clotting mechanism of the body is a biochemical cascade that causes coagulation and stoppage of bleeding when it occurs. Coagulation factors are synthesized by the liver, so when the liver is in failure, it cannot produce enough coagulation factors to stop bleeding. Reggie was not only in a state where his liver could not perform its necessary detoxification functions, but he could have bled to death from a very small cut.
5 days of intensive care hospitalization later, Reggie the miracle pug was discharged on oral medication as an outpatient and back to the care of his family. In his re-check lab work this week, he had marked improvement in his liver values and clotting profile, and per his Mom, he was back to his naughty ways of trying to steal food again. I like his chances of continuing on to make a full recovery as long as his family can manage to keep him out of trouble.
I chose to write about Reggie not only because he is an incredibly loving and tough – albeit naughty – dog, but he has an uncanny will to live and iron physical constitution. His loving family is also an example of what vigilance and lack of hesitation to seek help can accomplish. Reggie’s Mom rushing him to my practice in a moment’s notice once she realized what had happened was a huge reason why he is in the mend now.
Most importantly, I did not want what Reggie and his family have gone through to happen to others, as the dangers of xylitol toxicity in dogs is largely unknown. Please join me in spreading awareness about the dangers of xylitol so that other dogs and families may be spared Reggie’s ordeal, for most dogs would not have been so lucky.
Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.