> Xlear Sinus Care Spray
> Xylear Nasal Spray (for adults and children)
> Xyliseptic Nasal Spray.
> Abilify Discmelt Orally Disintegrating Tablets (aripiprazole), an atypical antipsychotic
> Clonazepam Orally Disintegrating Tablets, benzodiazepine
> Emtriva oral solution (emtricitabine), HIV-1 reverse transcriptase inhibitor
> Mobic Oral Suspension (meloxicam), nonsteroidal anti-inflammatory
> Neurontin (gabapentin) Oral Solution
> Riomet (metformin) Oral Solution, antidiabetic agent
> Varibar barium sulfate products, liquids and puddings for swallowing studies
> Zegerid Powder for Oral Suspension (omeprazole), proton pump inhibitor.
Foods with xylitol as the primary sweetener (excluding gums and mints):
> Clemmy's Rich and Creamy ice cream products
> Dr. John's products (hard and soft candies, chocolates, drink mixes and so on)
> Jell-O sugar-free pudding snacks
> Nature's Hollow jams, syrup, ketchup, honey and so on
> SparX Candy
> Zipfizz energy drink-mix powders.
Toxic doses and treatment recommendations
The toxicity of xylitol is dose-dependent. The dose necessary to cause hypoglycemia in dogs is approximately 0.1 grams/kg,
while the amount needed to cause hepatic necrosis is approximately 0.5 grams/kg. Most chewing gums and breath mints typically
contain 0.22 to 1.0 gram of xylitol per piece of gum or per mint. Therefore only one piece of gum may result in hypoglycemia
in a 10-pound (4.5-kg) dog.
Hypoglycemia is typically evident within one to two hours of xylitol ingestion but in rare cases has been delayed as much
as 12 hours. Prompt decontamination via the induction of emesis in asymptomatic patients with euglycemia is essential to prevent
poisoning. Activated charcoal does not bind well to xylitol and is not typically necessary or recommended. Should hypoglycemia
develop, supplementation with intravenous dextrose is needed until the dog can self-regulate its blood glucose concentrations
(typically 12 to 48 hours).
For dogs exposed to hepatotoxic doses of xylitol, preemptive administration of dextrose (prior to the onset of hypoglycemia)
may be helpful. Additionally, close monitoring of hepatic enzymes is warranted as evidence of necrosis may be seen one to
two days following exposure. Should hepatic necrosis develop, IV fluids, dextrose, hepatoprotectants and monitoring of coagulation
profiles are needed.
The prognosis following xylitol exposure is excellent when the ingestion is caught early, decontamination is performed, and
blood glucose is monitored frequently. The prognosis becomes guarded if the dog has already begun to develop hepatic failure.
Dr. Ahna Brutlag is associate director of veterinary services for Pet Poison Helpline and SafetyCall International, PLLC.