Overview 

Xylitol is a commonly-used sugar substitute that can be toxic to dogs.  

This ingredient is often found in sugar-free chewing gums, candies, toothpaste and more. The amount of xylitol in these products can vary, but even the ingestion of a small amount of xylitol can cause severely low blood sugar, seizures or liver injury.  

If you see or suspect ingestion of xylitol-containing products, contact your veterinarian, the Pet Poison Helpline or ASPCA Poison Control immediately. 

Cause 

Xylitol is a type of sugar alcohol commonly used as a sugar substitute. Xylitol is found in various products ranging from sugar-free foods like gum, candy, peanut butter and baked goods, but it can also be found in non-food products like toothpaste, medications, lotions, shaving cream and more. The exact amount of xylitol in products varies wildly and can even vary between flavors of the same brand.  

When dogs ingest xylitol, it is rapidly absorbed, and even a small amount can cause an exaggerated insulin release. Insulin is a hormone normally secreted to regulate the amount of sugar in the bloodstream.  

However, this large release of insulin is 3-7 times the amount of insulin that would normally be needed to metabolize regular sugar. This causes very low blood sugar (hypoglycemia) to develop within 30-60 minutes after ingestion of xylitol. Xylitol can also cause damage to the liver from larger ingestions, which can be more serious or even fatal in some circumstances.  

Diagnosis 

If you know or suspect your dog consumed a xylitol-containing product, make sure to bring the packaging with you to help your veterinarian approximate how much xylitol was consumed.  

There is no specific test that can detect xylitol after ingestion. A diagnosis is made based on the history of exposure, clinical signs and specific blood work parameters, such as your dog’s blood sugar and liver enzyme levels.  

Clinical signs 

The clinical signs will depend on the amount of xylitol ingested, but they often start within 30-60 minutes after ingestion. These include: 

• Lethargy 

• Disorientation 

• Incoordination or stumbling   

• Tremors  

• Vomiting  

• Seizures 

• Coma 

Treatment 

Since xylitol is rapidly absorbed after ingestion, your veterinarian likely will not induce vomiting unless the ingestion was less than 30 minutes prior and no signs of low blood sugar have started. 

The main treatment methods for xylitol toxicities involve stabilizing blood sugar and electrolyte levels, as well as managing liver injury with the following treatments: 

• Delivering dextrose (sugar) via IV  

• Additional IV fluids and electrolytes 

• Anti-nausea medications 

• Medications to protect the GI tract and liver 

Blood glucose and electrolyte levels are closely monitored during treatment, and dogs may be hospitalized for a minimum of 12-24 hours. Liver enzyme values are often rechecked three days after the initial exposure.  

Outcome 

Most dogs that are aggressively treated for hypoglycemia after ingestion of xylitol recover and have a good prognosis. Dogs that develop liver injury may have a more guarded prognosis.