Sugar-Free Gum is NOT for Dogs

History

Skye is a 6 month old intact male Australian Shepherd who presented for ingesting a ½ pack of sugar free gum which contained xylitol. He was then transferred to IVS from the referring veterinarian for continued care and monitoring of his blood levels post-emesis which produced gum.

Physical Exam & Diagnostic Findings

Upon presentation to IVS, Skye had pink mucous membrane and capillary refill time of less than 2 seconds. He had normal bilateral respiratory effort and normal heart sounds without murmurs or arrhythmias. His abdomen palpated as soft and non painful, no peripheral lymph nodes were enlarged, and appeared ambulatory and neurologically sound. No abnormalities were noted with his integument, eyes, ears, or mouth. His body condition score was appropriate with a score of 5/9. Skye was bright, alert, and responsive and had a low pain score. His temperature was slightly elevated at 102.7°F.

At the referring veterinarian, his blood glucose was 34 mg/dL, while normal glucose for a healthy dog is 80-120 mg/dL. Therefore, Skye was hypoglycemic. A comprehensive panel with electrolytes and a complete blood count was run upon presentation at IVS which showed an elevated glucose of 170. Other abnormalities on the bloodwork included a mild anemia with a hematocrit of 34% (normal: 37-62), mild hypokalemia with potassium levels of 3 mmol/L (normal: 3.5-5.5), and an elevated liver leakage enzyme with an ALT of 140 U/L (normal: 8-75).

During his hospitalization, his blood glucose levels were rechecked every 2 hours until he reached a stable level, rechecked his liver enzymes 24 hours after intake, and his electrolyte levels checked every 8 hours. Each electrolyte blood recheck showed that potassium has returned to the normal reference interval. His blood glucose levels and ALT levels are indicated in the tables below.

Blood Glucose (mg/dL)
(6/26-6/27)
10AM: 170
12PM: 88
2PM: 106
4PM: 97
6PM: 104
8PM: 106
10PM: 117
4AM: 100
9PM: 97

ALT (U/L)
6/26, 10AM: 140
6/27, 10AM: 91
6/28, 10AM: 81

Aside from his initial spike of blood glucose upon intake, which could be due to excitement and stress, his glucose levels eventually normalized and remained within the reference interval for the remainder of his hospitalization. His liver leakage enzyme, ALT, started high but progressively lowered despite not returning to normal prior to discharge, but with continued at-home medication, it was hopeful for his liver level to enter the normal interval. It was recommended for Skye to redo blood work at his regular vet two weeks later to check his liver values.

Xylitol Toxicity & Pathogenesis

Skye was dealing with xylitol toxicity due to the sugar free gum he ate. Xylitol is a natural sugar-alcohol used commonly for a sugar substitute in gum, mints, dental paste, and baked goods. Toxicity due to xylitol ingestion is manifested in two clinical ways: hypoglycemia, if dosed >0.1 g/kg, and hepatic necrosis, if dosed >0.5 g/kg. Hypoglycemia occurs due to the direct stimulation of insulin secretion of the pancreas, and the mechanism of hepatic necrosis is unknown but since the liver is the primary organ for metabolism, it is believed to be due to the production of reactive oxygen species while xylitol is being metabolized. After orally ingested, xylitol is rapidly absorbed and hypoglycemia can be seen within 10-15 minutes but with peak plasma levels within 30-60 minutes.

This can affect any breed and age of dog, and history usually involves discovering chewed up gum packages, witnessing the ingestion, or an acute onset of weakness, lethargy, vomiting, and seizures. Vomiting is typically the initial sign and clinical signs of hypoglycemia such as weakness, collapse, tremors, or ataxia can occur shortly after ingestion while hepatopathy usually occurs 9-12 hours post ingestion.

Treatment

Skye received 0.2 ml of Apomorphine IV at the referring veterinarian an hour and 15 minutes after ingestion of the gum to induce emesis and gum was present in the vomitus. Upon arrival at IVS, Skye’s owners agreed to an extensive hospitalization plan in order to normalize his glucose and liver values.

An IV catheter was placed in Skye’s cephalic vein so he could receive medications and fluids. He received 1.5mL of Cerenia IV upon intake to prevent nausea and vomiting and received this once a day during his stay. He was placed on a constant fluid rate of 70ml/kg/day of PhyLyte and also received a constant rate of 2.5% dextrose to balance his glucose levels. He was also prescribed Denamarin 225mg once a day orally for liver support. He was also started on N-acetylcysteine to treat the toxicity and to hopefully correct his liver values. He received an initial IV dose of 140mg/kg then a dose of 70mg/kg IV every 6 hours for 7 doses. Additionally, since he’s a puppy and is active, he was prescribed 50 mg of Trazodone orally for mild sedation when needed to keep him calm while hospitalized.

This treatment plan continued for the duration of his hospital stay while his bloodwork was regularly rechecked. Skye remained stable and was discharged after 48 hours. The only medication he was instructed to continue receiving was Denamarin 225 mg once a day but mouth, and was strongly recommended to recheck his liver values in 2 weeks. He was allowed to continue his normal activity levels and continue eating his regular diet.

Thankfully, the owner noticed the sugar free gum ingestion and acted straight away by bringing Skye to the veterinarian. Due to the owner’s vigilance and the knowledge and tools the veterinarians had, Skye was able to properly recover from this toxin.

Sources

• Hovda, Lynn R., et al. Blackwell’s Five-Minute Veterinary Consult Clinical Companion. Small Animal Toxicology. 2nd ed., Wiley Blackwell, 2016.
• Shell, Linda G., et al. “Xylitol Toxicosis (Canine).” VIN, 27 July 2023, www.vin.com/members/cms/project/defaultadv1.aspx?pid=607&id=4954062.
• Hayes, Cristine. “Xylitol Toxicosis in Dogs - Toxicology.” Merck Veterinary Manual, Merck, June 2025, www.merckvetmanual.com/toxicology/food-hazards/xylitol-toxicosis-in-dogs.