Xylitol is a natural sweetener and sugar substitute that is toxic to dogs. Originally used in sugar-free candy, mints, and gum, xylitol is now found in an ever-increasing number of food and non-food products. At Animal Internal Medicine and Specialty Services, we care for an alarming number of dogs affected by xylitol toxicity whose owners are often uninformed about this dangerous ingredient, or unaware of its new and unusual hiding places.

To educate our clients about this harmful ingredient, we’ve prepared the following guide to xylitol toxicity.

What is xylitol and how does it harm dogs?

Xylitol may sound like something made in a laboratory, but this sugar alcohol, first derived from birch bark, is now inexpensively made from corn cob remnants from ethanol production. And while 40 percent lower in calories than sugar, xylitol is now used for its low-glycemic index, and anti-bacterial, anti-cavity, and moisture-retaining properties.

People can consume xylitol without a blood glucose spike, but in dogs, the sweetener triggers a fast and massive insulin release, causing severe hypoglycemia (i.e., low blood sugar). Xylitol’s effect is dose-dependent—high levels can damage the liver, leading to liver failure. 

Fortunately, in cats, xylitol ingestion does not trigger insulin release or hypoglycemia.

Where would my pet encounter xylitol?

While sugar-free gum remains the most common xylitol toxicity culprit, the sweetener is now appearing in everyday products, including:

  • Sugar-free foods — Candy, baked goods, peanut butter, pudding, syrups, ice cream, and energy bars
  • Medication and supplements —Sweetened syrups, nasal sprays, and melt-away or gummy preparations
  • Oral care products — Toothpaste and mouthwash
  • Personal hygiene products — Deodorant, hair care products, and cosmetics

Xylitol concentration in products can vary greatly, so never take a wait-and-see approach to find out if your dog has consumed a toxic amount. Immediately call Animal Internal Medicine and Specialty Services for guidance.

Do xylitol products carry a warning label about their risks to dogs?

Currently, the only way to know if a product possibly contains xylitol is to check the ingredients list, especially on sugar-free products. Look also for additional names for xylitol, such as birch sugar and sugar alcohol. To make matters more complicated, some products may not include xylitol—under any name—on their ingredients list. 

In an attempt to improve pet safety, the Paws Off Act of 2021 was introduced to the House of Representatives on September 14, 2021. The act proposes that food manufacturers be required to include a warning label on all xylitol products, stating their danger to dogs.

What are the xylitol toxicity signs in dogs?

Depending on the product and quantity consumed, dogs may react in 30 minutes, or as long as 12 to 18 hours after ingestion. When xylitol triggers the insulin release and the dog’s blood glucose plummets, they become excessively weak, depressed, and lethargic. Severely affected dogs may experience seizures, yellowed eyes and gums (i.e., icterus), bruising caused by low platelets, or coma. 

How is xylitol toxicity diagnosed in dogs?

The veterinary specialists at Animal Internal Medicine and Specialty Services will use your pet’s recent history and physical exam findings to diagnose xylitol toxicity. Bloodwork and ultrasound will be used adjunctively to assess liver function, and visualize any damage. Knowing the type, brand, and amount of product your pet ingested can accelerate your pet’s treatment, and improve their prognosis.

How is xylitol toxicity treated in dogs?

The first step in treating a dog with xylitol toxicity is to correct their hypoglycemia. Patients are given intravenous dextrose, a simple sugar, to raise their blood sugar, and return the body to a properly functioning state. If your dog is not showing toxic signs, and the ingestion was recent, vomiting may be induced, to eliminate xylitol from the stomach and upper small intestine. Unless we know that your dog has ingested a toxic xylitol amount, they are routinely hospitalized for 18 to 48 hours, for blood glucose checks, liver function monitoring, and dextrose injections, until their blood glucose stabilizes.

What is the prognosis for pets with xylitol toxicity?

Dogs whose liver is not injured or damaged recover well if they receive prompt treatment, and will have no long-term effects from their hypoglycemia. Unfortunately, the prognosis for dogs with liver injury or failure is more guarded. Liver failure is managed with supportive care and  protective medications, but the organ damage is permanent, and dogs with liver failure ultimately succumb to the disease.

How can I keep my pet safe from xylitol?

Unclear or inaccurate labeling, plus xylitol’s growing popularity, make protecting your dog a challenge. Reduce your dog’s risk for xylitol exposure by controlling the things you can, such as:

  • Hanging backpacks, purses, and bags from hooks, rather than leaving them on the floor or on furniture 
  • Checking the ingredients in your dog’s peanut butter
  • Emptying pockets of gum and mints before leaving clothes in the laundry
  • Purchasing xylitol-free gum
  • Reading labels before purchasing or sharing peanut butter with your dog
  • Keeping food in overhead cabinets, and keeping pantry doors closed
  • Feeding your pet only their food and pet treats—no human snacks
  • Storing all hygiene items out of reach, or in a closed cabinet

If you know or suspect your pet has ingested a product containing xylitol, immediately call Animal Internal Medicine and Specialty Services, whether or not they are exhibiting any signs. Describe to us what your pet ate, and the approximate quantity, so we can determine your next steps. If your dog is experiencing extreme weakness, seizures, or unconsciousness, bring them immediately to the hospital for emergency treatment.