Xylitol Toxicity

Laurie Anne Walden, DVM

Xylitol is a sugar substitute that is safe for humans but toxic to dogs. It is an ingredient in sugar-free gum and a variety of foods, especially products for people who have diabetes or need food with a low glycemic index. Xylitol is added to some oral care products because it slows the growth of bacteria that cause dental cavities.
 
Products that contain xylitol might or might not be labeled as being sugar free or low in sugar. Xylitol is found in products like these:

• Chewing gum
• Sugar-free candies and breath mints
• Cookies, cupcakes, muffins, pies, and other baked goods
• Low-sugar ice cream
• Some types of peanut butter and other nut butters (mostly small/specialty brands; check labels)
• Xylitol powder for baking
• Nutritional supplements
• Chewable vitamins
• Cough syrup
• Flavored medications
• Toothpaste and mouthwash

 
Effects in Dogs
Xylitol is safe for most animals, but dogs don’t metabolize xylitol the same way as other species. Compared with humans, dogs absorb more of the xylitol they ingest and process it more quickly. Xylitol causes dogs’ insulin levels to surge, resulting in rapid hypoglycemia (low blood sugar level).[1,2] Ingestion of larger amounts of xylitol can damage the liver and interfere with blood clotting.[3]
 
Symptoms of xylitol poisoning in dogs can appear as soon as 30 minutes after ingestion but might be delayed for several hours. These are some of the common symptoms:

• Vomiting
• Lethargy (decreased energy)
• Weakness
• Loss of appetite
• Diarrhea
• Loss of balance
• Stumbling
• Collapse
• Seizures

 
Other sugar substitutes and artificial sweeteners (sorbitol, aspartame, sucralose, and saccharin) should be safe for dogs.[2] Xylitol does not seem to be toxic to cats.[4]
 
What to Do
If your dog eats sugarless gum or another product that might contain xylitol, call a veterinary clinic or an animal poison control hotline right away. Keep the packaging if possible so the amount of xylitol your dog ingested can be estimated. Do not try to make your dog vomit. Induced (forced) vomiting can be dangerous for a dog whose blood glucose level is already dropping.[1]
 
Treatment usually involves hospitalization, intravenous medications to correct hypoglycemia, and continued monitoring of laboratory values. Dogs with liver involvement and more serious symptoms need more intensive treatment.
 
Dogs that ingest small amounts of xylitol and are treated promptly tend to recover well. The prognosis is poorer for dogs that develop liver damage and blood clotting problems.[2]
 
How to Keep Your Dog Safe
Keep candy, baked goods, and other products that might contain xylitol away from your dog (watch out for counter surfers!). If you keep gum or mints in your purse, don’t leave your purse where your dog can reach it. Don’t brush your dog’s teeth with toothpaste meant for humans. Read product labels to check for artificial sweeteners; sorbitol should be OK but xylitol is not.
 
References
1. DuHadway MR, Sharp CR, Meyers KE, Koenigshof AM. Retrospective evaluation of xylitol ingestion in dogs: 192 cases (2007-2012). J Vet Emerg Crit Care (San Antonio). 2015;25(5):646-654. doi:10.1111/vec.12350
2. Dunayer EK. New findings on the effects of xylitol ingestion in dogs. Vet Med. 2006;101(12):791-797.
3. Dunayer EK, Gwaltney-Brant SM. Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. J Am Vet Med Assoc. 2006;229(7):1113-1117. doi:10.2460/javma.229.7.1113
4. Jerzsele Á, Karancsi Z, Pászti-Gere E, et al. Effects of p.o. administered xylitol in cats. J Vet Pharmacol Ther. 2018;41(3):409-414. doi:10.1111/jvp.12479
 
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