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Xylitol Toxicosis



AUTHOR: IRINA. MEADOWS



EDITOR: SAFDAR. KHAN



BASIC INFORMATION image



DEFINITION


Xylitol is a 5-carbon sugar alcohol used as a sweetener in gums, candies, confectionery/baked goods, and in some medications. Toxicosis is characterized by hypoglycemia leading to weakness, lethargy, disorientation, seizures, and ataxia usually within 12 hours after ingestion. Hepatotoxicity can occur in 12-48 hours in some dogs and may be idiosyncratic (individual susceptibility). Toxicosis has been fatal in some dogs.



SYNONYMS



• Xylite, Eutrit, Newtol, Xyliton

• Chemical names are 1,2,3,4,5-pentapentanol or 1,2,3,4,5-pentahydroxypentane.

• Many “sugar-free” products contain xylitol as a sweetener.


EPIDEMIOLOGY


SPECIES, AGE, SEX: Toxicosis has been documented in dogs only. No known age, sex, or breed predisposition.



RISK FACTORS



• Animals with preexisting liver disease may be at increased risk for hepatotoxicosis.

• Young animals may be more prone to developing hypoglycemia.


CLINICAL PRESENTATION


DISEASE FORMS/SUBTYPES: Xylitol toxicosis is an acute syndrome.



HISTORY, CHIEF COMPLAINT



• Evidence of chewed up package; gum or wrappers in the vomitus/stool

• Lethargy, vomiting, weakness, disorientation, ataxia, seizures, typically 30 minutes to 12 hours after ingestion.

• Some dogs develop both hypoglycemia and acute liver failure. Some dogs do not show evidence of hypoglycemia but may have signs of acute hepatic injury (see p. 503) in 12-48 hours.


PHYSICAL EXAM FINDINGS



• Nonspecific lethargy, vomiting, weakness

• With marked hypoglycemia: ataxia, disorientation, seizures

• Evidence of bleeding disorder is common: petechiae, ecchymoses, gastrointestinal hemorrhage, oozing from venipuncture sites.

• Vital signs usually within normal range (body temperature, respiratory rate and character, heart rate)


ETIOLOGY AND PATHOPHYSIOLOGY



• Toxicosis occurs acutely when dogs eat large amounts of xylitol-containing products.

• In humans, xylitol does not cause significant increase in insulin or blood glucose levels, but in dogs, xylitol causes a rapid and dose-dependent increase in blood insulin and concomitant decrease in blood glucose concentration.

• Mechanism of hepatotoxicosis in dogs may be necrosis of hepatocytes due to adenosine triphosphate (ATP) depletion, resulting in cell necrosis; or production of reactive oxygen species, resulting in damage to cell membranes and macromolecules.


DIAGNOSIS image



DIAGNOSTIC OVERVIEW


Diagnosis rests on any combination of history (observed or suspected ingestion), physical exam (signs consistent with hypoglycemia and/or liver failure), and results of routine laboratory testing (hypoglycemia +/− signs of acute liver injury +/− coagulopathy). No specific confirmatory test exists.

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on X

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