Xylitol Poisoning in Dogs: Signs, Risks, and Prevention

Xylitol is a sugar alcohol used as a sweetener in sugar-free products such as gum, candy, mints, peanut butter, and baked goods¹. It is also found in nonfood items like toothpaste, mouthwash, medications, vitamins, sunscreens, and cosmetics¹².

In most mammals, xylitol has no notable effect on insulin levels, but in dogs it triggers a rapid release of insulin that can cause profound hypoglycemia (low blood sugar)¹. According to Cornell University veterinarians, this insulin release is 3 to 7 times the amount normally needed to metabolize regular sugar². The mechanism for liver injury is less clear but may involve ATP depletion or reactive oxygen species produced during xylitol metabolism¹.

Dogs are the only domestic species in which xylitol toxicosis has been reported; cats are not at risk for hypoglycemia or liver injury from xylitol¹.

The amount of xylitol in products varies widely, even between flavors of the same brand². Veterinary sources identify two main risk levels:

• Small amounts can cause hypoglycemia¹⁵.
• Larger amounts may cause severe liver injury or failure¹.

To put this in perspective, Veterinary Partner notes that the hypoglycemic dose is approximately 0.075 to 0.1 grams per kilogram of body weight⁵. Chewing gum pieces have highly variable xylitol content: most flavors of Orbit gum contain about 0.009 grams per piece, but their strawberry mint flavor has over 0.3 grams per piece⁵. A small dog can be poisoned by a single stick of gum depending on the product and the dog's size⁵.

Because xylitol content varies so much, it is important to bring the product packaging to your veterinarian so the amount ingested can be estimated²⁵.

Symptoms of hypoglycemia can develop within 30 minutes of ingestion or may be delayed up to 12 to 18 hours if the xylitol is in a product that slows absorption¹. The ASPCA notes that symptoms can appear in as little as 30 minutes but may take up to 12 hours³.

Clinical signs of hypoglycemia include¹²⁴:

• Vomiting
• Weakness or lethargy
• Ataxia (incoordination or stumbling)
• Tremors
• Seizures
• Coma

Signs of liver injury may not appear until 24 to 48 hours after ingestion, although increases in liver enzymes are often detectable within 4 to 12 hours¹. The ASPCA notes that liver injury symptoms may not be seen for two or three days³. Signs of liver damage include¹³:

• Lethargy
• Vomiting
• Decreased appetite
• Jaundice (yellowing of the skin or gums)
• Coagulopathy (bleeding disorders)

Not all dogs that develop liver injury show hypoglycemia first; this may be due to a rebound increase in blood glucose¹.

Xylitol is found in a wide range of products. The ASPCA lists these common sources³:

Food items:

• Sugar-free gum and candy
• Peanut butter (some brands)
• Baked goods
• Drink powders
• Pudding
• Pancake syrup
• Ketchup and barbecue sauce

Nonfood items:

• Toothpaste and dental floss
• Mouthwash and breath fresheners
• Medications and vitamins (especially liquid formulations and chewables)
• Sunscreen
• Cosmetics and lip balm
• Baby wipes
• Deodorants

The Merck Veterinary Manual adds that xylitol is also present in sugar-free syrups and elixirs used as medicinal bases, such as liquid gabapentin formulations¹. Pet Poison Helpline notes that xylitol is found in sleep aids and shaving cream⁴.

If a product is labeled "sugar-free," check the ingredient list for xylitol¹.

If you suspect your dog has ingested a xylitol-containing product, act quickly:

1. Contact your veterinarian or an emergency clinic immediately. The ASPCA Animal Poison Control Center (888-426-4435) and Pet Poison Helpline (855-764-7661) are available 24/7²³⁴.
2. Bring the product packaging. This helps your veterinarian estimate how much xylitol was consumed²⁵.
3. Do not induce vomiting unless instructed. Because xylitol is rapidly absorbed and hypoglycemia can develop quickly, vomiting should only be attempted under veterinary supervision and only if the dog is still clinically normal¹. Cornell veterinarians note that vomiting is typically not induced if more than 30 minutes have passed or if signs of low blood sugar have already started².
4. Do not give activated charcoal. Activated charcoal does not appreciably bind xylitol and is not recommended¹.

Treatment involves stabilizing blood sugar and electrolyte levels². Veterinary care typically includes¹²:

• IV dextrose to correct hypoglycemia
• IV fluids and electrolytes
• Anti-nausea medications
• Medications to protect the GI tract and liver
• Monitoring of blood glucose every 1 to 2 hours for at least 12 hours
• Liver enzyme testing every 24 hours for at least 72 hours

Dogs may need to be hospitalized for a minimum of 12 to 24 hours². Hypoglycemia may persist for 24 hours or more, so treatment should continue until normal blood glucose can be maintained without supplemental dextrose¹.

The prognosis for uncomplicated hypoglycemia is good if prompt treatment is initiated¹. Cornell states that most dogs aggressively treated for hypoglycemia recover and have a good prognosis².

However, dogs that develop liver injury face a more guarded outlook. Mild increases in liver enzyme activity usually resolve within a few days¹. Severe increases or signs of liver insufficiency suggest a more serious prognosis; in one study, 62.5% of dogs with clinical signs of liver injury died or were euthanized despite aggressive veterinary intervention¹.

Veterinary Partner notes that patients that develop hepatic necrosis usually do not survive⁵. Elevated blood phosphorus levels often indicate a poor outcome⁵.

Prevention is the best protection. The ASPCA recommends³:

• Check ingredient labels. When purchasing a new item, look for xylitol in the ingredient list. If you have a pet prone to getting into things, consider avoiding products with xylitol³.
• Keep products out of reach. Store xylitol-containing items in safe locations³.
• Keep purses and backpacks off the floor. These are common ways dogs access gum, candy, or medications³.
• Take medications in a closed room. This prevents dogs from accessing dropped pills³.

If a product is labeled "sugar-free," check whether xylitol is listed before bringing it into your home¹.