Xylitol, a sweetener which causes hypoglycemia and liver damage in dogs, is showing up in some very unexpected places. It is frequently used as a sugar substitute in chewing gum, breath mints, and dental products like toothpaste and mouth wash. It is also sold in bulk as a substitute for table sugar, which means even homemade bread, muffins, and cupcakes can cause a problem if made with xylitol.
It can be helpful to use the location of xylitol within an ingredient list to estimate the quantity in the product. In the USA all food must list their ingredients in descending order by weight. For most chewing gums the amount of xylitol is often clinically insignificant if it is listed as the 4th or 5th ingredient. If it is listed as one of the first three ingredients, extreme caution should be taken.
For drugs and dietary supplements, the regulations regarding the order of ingredients is considerably different. In this case, xylitol is often considered an “inactive ingredient” or “other ingredient” – such ingredients are not required to be listed in order of predominence. Often they are listed in alphabetical order instead.
Novel Sources of Xylitol:
Over the counter medications
– Axia3 ProDigestive Antacid (flavored chewable tablets)
– Children’s Allegra Oral Suspension
– Fleet Children’s Pedia-Lax Liquid Stool Softener
– Umcka Cold and Flu chewable tablets (homeopathic product)
Dietary supplements and vitamins
– KAL Colostrum Chewable, Vanilla Cream’
– KAL Dinosaurs Children’s Vitamins and Minerals (chewable tablets)
– Kidz Digest Chewable Berry from Transformation Enzyme
– L’il Critters Fiber Gummy Bears
– Mega D3 Dots with 5,000 IU of Vitamin D3 per “dot” (dissolvable tablet)
– Suntheanine L-Theanine chewable tablets by Stree-Relax
– Vitamin Code Kids by Garden of Live (chewable multivitamins)
– Webber Natural Super Sleep Soft Melts (dissolvable tablets)
Nasal products
– Xlear Sinus Care Spray
– Xylear Nasal Spray (for adults and children)
– Xyliseptic Nasal Spray
Prescription drugs
– Abilify (aripiprazole) Discmelt Orally Disintegrating Tablets
– Clonazepam (benzodiazepine) Orally Disintegrating Tablets
– EMTRIVA (emtricitabine) oral solution
– Mobic (meloxicam) oral suspension
– Neurontin (metformin) Oral Solution
– Riomet (metformin) Oral Solution
– Varibar barium sulfate products
– Zegerid Powder (omeprazole) for Oral Suspension
Foods with xylitol as the primary sweetener (excluding gums and mints)
– Clemmy’s Rich and Creamy ice cream products
– Dr. John’s products (hard and soft candies, chocolates, drink mixes, etc)
– Jell-O sugar free pudding snacks
– Nature’s Hollow jams, syrup, ketchup, honey, etc
– SparX Candy
– Zipfizz energy drink mix powders
The toxicity of xylitol is dose dependent. The dose necessary to cause hypoglycemia in dogs is approximately 0.1 grams/kg or 0.05grams/lb, while amount needed to cause liver damage is approximately 0.5 grams/kg or 0.22 grams/lb. Most chewing gums and breath mints typically contain 0.22 – 1.0 grams of xylitol per piece of gum or per mint. Therefore, only one piece of gum may result in hypoglycemia in a 10 pound (4.5kg) dog. Hypoglycemia is typically evident within 1-2 hours of xylitol ingestion but, in rare cases, has been delayed by as much as 12 hours. Prompt and appropriate gastric decontamination is essential to prevent poisoning. Activated charcoal does not bind well to xylitol and is not recommended. Should hypoglycemia, supplementation with intravenous dextrose is needed until the dog can self regulate its blood glucose concentrations (typically 12-48 hours). Close monitoring of liver enzymes is warranted as evidence of liver damage may be seen in 1-2 days following exposure. The prognosis following xylitol exposures is excellent when the ingestion is caught early, decontamination is preformed, and blood glucose id monitored frequently.