The sugar substitute xylitol is not toxic to humans, but when ingested by dogs, can cause a sudden release of insulin, which may cause seizures and result in brain damage. Liver failure is another potential result.

Prior to a recently-published article on xylitol toxicity co-authored by Dr. Amy Koenigshof, the prevalence of these complications had not been documented. The article, published in the Journal of Veterinary Emergency and Critical Care, summarizes the features, clinical signs, treatment, and outcome in dogs known to have ingested xylitol.

Last year, the ASPCA received 3,727 calls about xylitol, according to an article in the Wall Street Journal. At least 11 of those involved fatalities. As with any medical events, many cases go unreported. The Wall Street Journal article, which quoted Koenigshof, spurred a number of articles on this threat to dog health.

Koenigshof and her co-authors examined records of 192 dogs known or suspected to have eaten products containing xylitol. Of the 192 cases, 122 dogs (+63%) were hospitalized for supportive care and 30 dogs (+15%) became hypoglycemic at some point during evaluation at a veterinary teaching hospital. No dog suffered liver failure.

The two most common treatments for xylitol toxicity apomorphine, used to induce vomiting, and intravenous fluids.

All dogs in this study survived, suggesting an excellent prognosis for dogs receiving veterinary care after ingesting lower doses of xylitol that do not develop liver failure.