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Urgent Food Poisoning Alert for All Dog Owners

Image result for dog and xylitol

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Recently a 3-year-old Pug named Bruce in Overland Park, Kansas discovered a tin of sugar-free Mentos and helped himself.  Within a half-hour, Bruce was lethargic. Fortunately, his owner connected the dots between the Mentos and Bruce’s rapidly deteriorating condition.

After calling the veterinarian’s office, as he picked Bruce up to rush him out to the car, the dog went limp.  Once at the vet’s office, he had a seizure.  The mints Bruce had eaten contained xylitol, a sweetener that is highly toxic to dogs.  It’s a sugar alcohol extracted from corn and corn fiber, birch, raspberries and plums.

Xylitol is used to sweeten a wide range of products, including sugar-free gum and mints, nicotine gum, chewable vitamins, certain prescription drugs, dental hygiene products and baked goods.

Xylitol can also be purchased in granulated form as a sugar replacement to sweeten beverages, cereals and other foods.

Fortunately for Bruce, the veterinary staff quickly treated him with glucose water and monitored him closely.  He survived the initial crisis, but they don’t know yet if there has been permanent damage to his liver.

The Number of Products Containing Xylitol Is Exploding

Xylitol poisoning in dogs is reaching epidemic proportions according to some sources. The sweetener is being used in an ever growing list of products because it’s as sweet as sucrose, but with only two-thirds the calories of sugar.

It’s less expensive than other sugar substitutes, tastes better and causes little if any insulin release in humans.

Just a few years ago, xylitol could be found in less than a hundred products in the U.S., primarily limited to sugar-free gums, candy and foods.  Today it can be found in a wide range of health and beauty products, food products, over-the-counter drugs and supplements and prescription medications.

Until fairly recently, xylitol was found primarily in products not normally given to dogs. Poisonings were usually the result of dogs like Bruce sampling human foods, candy or gum on the sly.

However, xylitol is now being found in certain peanut and nut butters.  As most dog guardians know, our pets love these creamy butters.  Many people use a dab of peanut or nut butter to hide pills or supplements they give to their dog, or they fill a Kong with the gooey stuff as a special treat.

Peanut and Nut Butters Containing Xylitol

Dr. Jason Nicholas, who runs Preventive Vet, has compiled a list of nut butters containing xylitol:1

Go Nuts, Co. Almond Butter

Almond Butter – Chocolate Almond Butter

Peanut Butter – Dark Chocolate Mint

Peanut Butter – Natural Chocolate Flavor

Peanut Butter – Natural Flavor

Peanut Butter – Organic Maple Flavor

Krush Nutrition Nutty By Nature Peanut Butter Brownie Batter

Nutty By Nature Peanut Butter Cookie Dough

Nutty By Nature Peanut Butter Snickerdoodle Cookie

Nutty By Nature Peanut Butter Thick & Creamy

Nuts ‘N More® Almond Spread – Almond Butter

High Protein + Almond Spread – Almond Butter

High Protein + Almond Spread – Chocolate Almond

High Protein + Almond Spread – Cinnamon Raisin

High Protein + Peanut Spread – Chocolate Peanut

High Protein + Peanut Spread – Peanut Butter Flavor

High Protein + Peanut Spread – Pumpkin Spice

High Protein + Peanut Spread – Toffee Crunch

Peanut & Protein Spread – Sesame Cranbutter

Peanut Spread – Peanut Butter Flavor

Peanut Spread – Toffee Crunch

P28 Foods High Protein Spread – Almond Butter

High Protein Spread – Banana Raisin

High Protein Spread – Peanut Spread

High Protein Spread – Signature Blend

Protein Plus PB Hank’s Protein Plus – Almond Butter

Hank’s Protein Plus – Banana

Hank’s Protein Plus – Caramel Pretzel

Hank’s Protein Plus – Chocolate Chip

Hank’s Protein Plus – Coconut

Hank’s Protein Plus – Honey Maple

Hank’s Protein Plus – Plain

Hank’s Protein Plus – Snickerdoodle

These are specialty nut butters sold primarily in nutrition stores and online, but the fact that xylitol is now being used in these products is a heads-up for dog parents everywhere of the importance of reading ingredient labels.  It’s probably just a matter of time before more mainstream peanut and nut butters also contain xylitol.  As Dr. Ahna Brutlag, associate director of veterinary services for Pet Poison Helpline explains the seriousness of the situation:

“First, dogs fed straight peanut butter as a treat or fed treats baked with xylitol-containing peanut butter may certainly be at risk for harm.

Second, a dog that nabs the entire jar of xylitol-containing peanut butter and happily gorges on his or her treasure without anyone knowing could quickly become extremely ill. If this occurred during the day while the owners were not home, it’s possible the dog could die before people returned.”2

You should be aware of any product in your home containing xylitol, and especially anything you might consider offering to your dog.

Xylitol-Related Dog Poisonings More Than Doubled in 7 Years

Each year as the number of products containing xylitol expands, sadly, so do the cases of poisoning in dogs.  In 2007, the first year the ASPCA Animal Poison Control Center (ASPCA-APCC) started tracking cases of xylitol toxicity in dogs, the Center received 1,764 calls.  In 2014, they handled 3,727 xylitol calls.3

That’s over a 200 percent increase in just 7 years, and includes only the cases called into the ASPCA-APCC.  There are other animal poison control centers that receive calls, as well as unreported cases of xylitol-related illnesses and deaths.

The Toxicity of Xylitol Depends on the Species and Dose

Although xylitol is safe for humans, the sweetener’s effect varies by species.  In people, rhesus monkeys, rats and horses, xylitol causes little to no insulin release.  However, it has the oppositeeffect on dogs, ferrets, rabbits, cows, goats and baboons.  Its effect on cats is unknown.

Humans absorb xylitol slowly, and the sweetener when ingested orally is absorbed at from 50 to 95 percent.  However, in dogs, xylitol is rapidly and fully absorbed within about 30 minutes.  Just a small amount of xylitol can cause a dangerous insulin surge and a rapid drop in blood sugar.

The toxicity of xylitol in dogs is dose-dependent.  The dose required to trigger hypoglycemia (low blood glucose) is approximately 0.1 grams/kg, while the amount needed to cause liver failure is about 0.5 grams/kg.  Most gum and breath mints typically contain .22 to 1.0 gram of xylitol per piece of gum or mint.

This means just a single piece of gum or one mint may cause hypoglycemia in a 10-pound dog.  For more detailed information and graphics on how much xylitol is dangerous to different sized dogs, as well as a comparison of xylitol versus chocolate toxicity in dogs, take a look at this Preventive Vet page.

Determining the Amount of Xylitol in a Product

Currently, product manufacturers aren’t required to list the quantity of xylitol on package labels, and while some companies will reveal the amount in their products, many are reluctant to do so.

In some cases, you might be able to use the placement of xylitol on an ingredient list to estimate how much is in the product.  In the U.S., ingredient lists for foods must be organized in descending order based on weight.  The ingredient weighing the most is at the top of the list.

In most chewing gum ingredient lists, xylitol appears in fourth or fifth place, making it clinically insignificant.  But if it appears as one of the first three ingredients, extreme caution should be taken.  In fact, I recommend dog guardians avoid or very carefully secure any product that contains any amount of xylitol, no matter how small.

When it comes to medications and dietary supplements, U.S. regulations do not require manufacturers to list xylitol by name on package labels.  This is because the sweetener is often categorized as an “inactive” or “other” ingredient, and such ingredients don’t have to be listed in order by the amount contained in the product.

To confuse matters further, when xylitol is named in these products, it is often part of an alphabetized list, which could lead pet owners to assume — perhaps in error — that there is a very small amount in the product.  That’s why it’s best, in my opinion, to either avoid or very carefully store any product that contains xylitol in any amount.  Dr. Nicholas has compiled a fairly comprehensive list of products containing xylitol here.

Symptoms of Xylitol Poisoning and Required Treatment

Symptoms of xylitol intoxication in dogs include vomiting, weakness, lethargy, loss of coordination, seizures and collapse.  Hypoglycemia is usually evident within an hour or two after a dog ingests xylitol, but symptoms are occasionally delayed for several hours.

Treatment depends on how quickly it is given.  Vomiting is induced in cases where the xylitol has just been ingested.  Once a dog develops hypoglycemia, IV dextrose must be administered until the animal can self-regulate his blood glucose concentrations, which typically takes from 12 to 48 hours.

In dogs who ingest enough xylitol to cause liver toxicity, liver enzymes must be closely monitored, as evidence of hepatic necrosis can show up one to two days after ingestion. Should the liver begin to fail, the dog will require IV fluids, dextrose, hepatoprotectants (substances to help support and repair the liver), and regular monitoring of blood clotting activity.

When xylitol exposure is caught early in a dog and treated effectively, the prognosis for a full recovery is excellent.  The prognosis for dogs that develop hepatic failure is less optimistic.

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Xylitol Dangers

Xylitol is popping up in unexpected places these days, from coffee to baby wipes to nasal sprays.

In fact, the ASPCA Animal Poison Control Center reports finding yet another product containing xylitol on a regular basis, so it’s more important than ever to keep a close eye on ingredient lists of household products.

(Xylitol is also found some workout clothing, but it does not pose a toxic risk to dogs, so it was not included in the list.)

Here’s a handy list of products that may contain xylitol, and check out this nifty infographic.  Share them on social media, with visitors, or post them somewhere conspicuous!

More Xylitol Information

Emergence of xylitol as a known hazard for pets:
This peer-reviewed article (PDF) expains how the sugar substitute was discovered to also produce acute, possibly life-threatening liver disease and coagulopathy.

Test your treatment strategy:
This hypothetical case study shows the effects and treatment options for a dog who ingested xylitol.

Cough drop toxicity: 
Xylitol is increasingly found as an ingredient in cough drops.

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A Menu for Food Safety

By Victoria Heuer

The 4th of July is such a great day.  It means cook-outs, picnics, and all around revelry as we celebrate our nation’s independence.  And if it falls close the weekend, the parties can go on for days.  We are all for including our pets in the family activities, but there are safeguards that must be taken to ensure their safety.  After all, we don’t want the holiday to be spoiled by disaster.

Some of the most typical disasters to occur during the holidays are related to foods.  Plan your backyard (or indoor) holiday party while keeping in mind that pets are wily little things that will scarf down as much as food as they can before they are caught. Here are some of the most hazardous foods to keep out of reach.

Ribs and Other Meats on the Bone

Throwing leftover bones to the dog may seem natural.  Dogs love bones, right? However, bones can be very dangerous for pets.  They might choke on them, or suffer a grave injury if the bone should splinter and become lodged in, or even puncture the digestive tract.  Have a pet-proof covered container ready for tossed bones.

 

Chicken

The Association for Pet Obesity Prevention (APOP) recently warned pet owners not to feed their pets chicken wings due to the risk of intestinal obstruction, or worse.  Whether wing bones or other bones from chicken pieces, the bones are highly likely to splinter, and because of their small size they are easily swallowed with little or no chewing.

Hot Dogs

Hot dogs can actually be a great treat for pets, but only if they are cut up into bite size pieces and carefully fed one at a time to the pet.  Dogs especially can get very excited and swallow a hot dog whole, without chewing.  Also to keep in mind, hot dogs are a high fat, high calorie food.  Ration them wisely to your pets and make it clear to guests not to share their “dogs” with the dogs.

Corn on the Cob

Corn on the cob is not directly poisonous, all by itself, but based on its shape and size it can easily form a painful and dangerous blockage within your dog’s intestines, requiring an expensive intestinal surgery to remove it.

Hamburger and Steak

Another food that is not “toxic,” per se, fatty meats like hamburgers and steaks can result in severe pancreatitis (inflammation of the pancreas), which can result in vomitingdiarrhea, abdominal pain, and even organ failure.

 

Chips and Dip

One of the more popular summer dips, guacamole, is also one of the most dangerous for pets.  The three main ingredients are all dangerous in their own right: avocado, garlic and onion.  Onions and garlic can cause gastrointestinal issues, elevated heart rate, and red blood cell damage.  Avocado toxicity, meanwhile, can lead to vomitingdiarrhea, and lack of stool production.

 

Fruit Salad

Most fruits are safe for pets.  In fact, some frozen pieces of watermelon would be a welcome treat to a dog on a hot day.  But there is one fruit that is common to nearly all fruit salads: grapes.  Although the reason for grapes’ (and raisins’) toxic effects on dogs is little understood, these fruits are well known for causing kidney failure.  In pets who already have certain health problems, signs of grape poisoning may be more dramatic.

 

Onions

As previously mentioned, onions can be highly toxic for cats and dogs.  We mention them again because it is common to find a bowl of chopped onions on the condiment table, on the ground as they fall out of hamburger and hotdog buns, and in most cold pasta and vegetable salads.  Although cats are more susceptible, dogs are also at risk if a large enough amount is consumed.  Onions can cause gastrointestinal issues, elevated heart rate, and red blood cell damage.  Even small amounts of onions are fatal to cats.

 

Desserts

Ice cream, cupcakes, cookies, brownies … no BBQ party is complete without dessert. And what is the most popular flavor? Chocolate, of course. Unfortunately, chocolate is also highly toxic to dogs, doubly so if it is “sugar-free”; that is, made with Xylitol. Both have fatal ingredients, so even small amounts should not be allowed.

Theobromine, the compound in chocolate that has the toxic effect, is most concentrated in dark chocolate and baking chocolate, the kind found in brownies and chocolate chip cookies.  Chocolate poisoning can cause heart arrhythmias, muscle tremors, and seizures.  Xylitol, used with sugar free foods as a sugar replacement, can have immediate and irreversible consequences.  Make sure that all of your guests know not to share their sweets, not matter how big those pleading puppy eyes get.

 

Fireworks

Finally, while not technically a food, we are very aware that dogs will chew on and swallow almost anything, so we would be remiss in our duties if we did not mention fireworks as an ingestion hazard. Fireworks contain hazardous chemicals like chlorates, potent oxidizing agents which are harmful to red blood cells and kidneys; soluble barium salts, which can cause a life-threatening drop in potassium; sulfur, which can convert to sulfate in the intestinal tract and act like an acid; and coloring agents, which can contain dangerous heavy metals.

Keep the fireworks in pet proof containers or high up on shelves until use, and then clean them up thoroughly after they have been set off to avoid curious nibbles.

 Now go and celebrate the holiday, safely!

 

 

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Very Important: Never Let Your Dog Get at Any Product Containing This

Toxic Pet Food

By Dr. Becker

Xylitol is a natural sugar alcohol extracted from certain fruits and vegetables.  Because of its sweet taste and plaque fighting benefits in humans, xylitol is a common sugar substitute found in a diverse assortment of products.  These include sugar-free gum, mints and other candy, baked goods, nicotine gum, chewable vitamins, certain prescription drugs, and dental hygiene products.  Nontoxic amounts are even included in some pet dental products.

Because xylitol has a low glycemic index, it’s also sold in bulk as a sugar substitute for baking and in-home use — which is why the Pet Poison Helpline has fielded calls from owners of dogs that became very sick after eating homemade bread, muffins and cupcakes made with xylitol.

Where Else Is Xylitol Found?

According to the Pet Poison Helpline (PPH), xylitol – which, as many pet owners know, is quite toxic for dogs, causing hypoglycemia and hepatic necrosis – is showing up in an ever-increasing number of surprising places.  New products on the market, including some nasal sprays, over-the-counter sleep aids, multivitamins, prescription sedatives, antacids, stool softeners, and smoking-cessation gums, contain “unexpectedly large amounts” of xylitol, according to Dr. Anna Brutlag of PPH.

Dogs who sample these products get a double dose of toxicity, first from the active ingredient in the product, and secondarily from the xylitol.  This potentially deadly combination can greatly complicate the symptoms, diagnosis, treatment, and prognosis for these animals.

According to Dr. Brutlag, the following “atypical” products contain xylitol.  Some may surprise you…

Over-the-counter medications:

  • Axia3 ProDigestive Antacid (flavored chewable tablets, propriety amount)
  • Children’s Allegra Oral Suspension
  • Fleet Pedia-Lax Liquid Stool Softener
  • Umcka Cold and Flu chewable tablets (homeopathic product)

Dietary supplements, vitamins:

  • KAL Colostrum Chewable, Vanilla Cream (chewable tablets)
  • KAL Dinosaurs Children’s Vitamins and Minerals (chewable tablets)
  • Kidz Digest Chewable Berry from Transformation Enzyme
  • L’il Critters Fiber Gummy Bears
  • Mega D3 Dots with 5,000 IU of Vitamin D3 per “dot” (dissolvable tablet)
  • Stress Relax’s Suntheanine L-Theanine chewable tablets
  • Vitamin Code Kids by Garden of Life (chewable multivitamins)
  • Super Sleep Soft Melts by Webber Natural (dissolvable tablets)

Nasal products:

  • Xlear Sinus Care Spray
  • Xylear Nasal Spray (for adults and children)
  • Xyliseptic Nasal Spray

Prescription drugs:

  • Abilify Discmelt Orally Disinteg­rating Tablets (aripiprazole)
  • 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

Toxicity of Xylitol Is Species- and Dose-Dependent

While xylitol is safe for human consumption, the same can’t be said for pets.  In 2011, the FDA released a consumer alert on the dangers of xylitol ingestion in certain animals.  The sweetener’s effect varies by species.  In people, rhesus monkeys, rats, and horses, intravenous (IV) xylitol causes little to no insulin release.  However, it has the opposite effect on baboons, cows, goats, rabbits, dogs, and ferrets. Its effect on cats is unknown.

Humans absorb xylitol slowly, and the sweetener when ingested orally is absorbed at from about 50 to 95 percent.  However, in dogs, xylitol is rapidly and completely absorbed within about 30 minutes.  Just a small amount of xylitol can cause a dangerous insulin surge and a rapid drop in blood sugar.

The toxicity of xylitol in dogs is dose-dependent.  The dose required to trigger hypoglycemia (low blood glucose) is approximately 0.1 grams/kg, while the amount needed to cause hepatic necrosis (liver failure) is approximately 0.5 grams/kg.  As a point of reference, most chewing gums and breath mints typically contain .22 to 1.0 gram of xylitol per piece of gum or per mint.  This means just a single piece of gum or one mint may cause hypoglycemia in a 10-pound dog.

Determining the Amount of Xylitol in a Product

Product manufacturers aren’t required to list the quantity of xylitol on package labels, and while some companies will reveal the amount in their products, many are reluctant to do so.  Incredibly, some have even asked veterinarians to sign a confidentiality agreement before divulging how much of the sweetener is in a particular product.

Fortunately, the Pet Poison Helpline has been working to get this information from manufacturers, and has been relatively successful.  So if you need to know the amount of xylitol contained in a specific product, the Helpline suggests you call them first at 1-800-213-6680.

In some cases, you might be able to use the placement of xylitol on an ingredient list to estimate how much is in the product.  In the U.S., ingredient lists for foods must be organized in descending order based on weight.  The ingredient that weighs the most is at the top of the list.  According to Dr. Brutlag, in most chewing gum ingredient lists, xylitol appears in fourth or fifth place, making it clinically insignificant.  She says if it appears as one of the first three ingredients, however, extreme caution should be taken.

I’ll go a step further and recommend that dog guardians avoid or very carefully secure any product that contains any amount of xylitol, no matter how small.

When it comes to medications and dietary supplements, U.S. regulations do not require manufacturers to list xylitol by name on package labels.  This is because the sweetener is often categorized as an “inactive” or “other” ingredient, and such ingredients don’t have to be listed in order by the amount contained in the product.  To confuse matters further, when xylitol is named in these products, it is often part of an alphabetized list, which could lead pet owners to assume – perhaps in error – that there is a very small amount in the product.

So I’ll repeat my recommendation to dog owners to either avoid or very carefully store any product that contains xylitol in any amount.

Symptoms of Xylitol Poisoning and Required Treatment

Symptoms of xylitol intoxication in dogs include vomiting, weakness, lethargy, loss of coordination, seizures, and collapse.

Hypoglycemia is usually evident within an hour or two after a dog ingests xylitol, but symptoms are occasionally delayed for several hours.  Treatment depends on how quickly it is given.  Vomiting is induced in cases where the xylitol has just been ingested.  Once a dog develops hypoglycemia, IV dextrose must be administered until the animal can self-regulate his blood glucose concentrations, which typically takes from 12 to 48 hours.

In dogs who ingest enough xylitol to cause liver toxicity, liver enzymes must be closely monitored, as evidence of hepatic necrosis can show up one to two days after ingestion.  Should the liver begin to fail, the dog will require IV fluids, dextrose, hepatoprotectants (substances to help support and repair the liver), and regular monitoring of blood clotting activity.

When xylitol exposure is caught early in a dog and treated effectively, the prognosis for a full recovery is excellent.  The prognosis for dogs that develop hepatic failure is less optimistic.

——- Source

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