Xylitol poisoning in dogs in less than a minute with VETbytes

Would you know how to handle a case of xylitol toxicity? Get straight to the point of care with VETbytes’ treatment action plan. Read the ‘Key Points’ checklist in under a minute before the client arrives and know that you are up-to-date and ready for action!

Xylitol poisoning in dogs

  • Ingestion can cause hypoglycaemia, hepatic failure or both
  • Dogs that ingest > 0.05–0.1 g/kg are at risk for developing hypoglycaemia
    This usually occurs 30–60 minutes after ingestion
  • Dogs that ingest > 0.5 g/kg are at risk for developing hepatotoxicosis and acute hepatic failure. This usually occurs 1–3 days after ingestion
  • Can estimate that 1 cup of xylitol contains 190g and 1 piece of gum contains 0.3-1g of xylitol
  • Emesis is indicated unless the animal is showing signs of hypoglycaemia or has ingested 100% xylitol products more than 30 minutes prior to presentation as clinical signs may develop during decontamination, risking aspiration
  • Charcoal is NOT recommended as xylitol is readily absorbed from the gastrointestinal tract and binds poorly to charcoal
  • Administer dextrose to hypoglycaemic patients at a dose of 0.25–0.5 g/kg 50% dextrose i/v over 10 minutes (0.5–1 ml/kg 50% dextrose)
  • Hepatoprotectants are indicated in patients that have ingested hepatotoxic doses, e.g. SAMe, Silybin or N-acetylcysteine. There is however no strong clinical evidence to prove their efficacy
  • Additional treatments may include management of coagulation defects and gastroprotectants although evidence is scarce that hepatic disease is a direct cause of gastroduodenal ulceration and erosion
Don’t be caught out!
  • Dogs may present with acute hepatic failure without having shown initial signs of hypoglycaemia
  • Asymptomatic dogs with known ingestion of xylitol should be hospitalised for at least 72 hours in case of delayed-onset hypoglycaemia which may be seen when gum is ingested, or in case of development of hepatic failure without hypoglycaemia
Prognosis is good for dogs that develop uncomplicated hypoglycaemia but poor to guarded for those that develop hepatic failure.

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Heatstroke – VETbytes’ do’s and don’ts of treating dogs

Summer is the time of year when we are most likely to be presented with a case of heatstroke. Are you up to date with the do’s and don’ts of active cooling? Use VETbytes to quickly access the information you need to make the right clinical decisions.

Cooling before presentation to the vet is associated with improved survival

  • Advise the owner to begin cooling immediately using either wet towels to wipe/wet the patient or a hose with cool water
  • Recommend that the owners keep the windows open in the car on the way to the surgery

Recommended methods for cooling:

  • Running water – hose, shower
  • Fan (care not to apply near the head and apply lubricant to the eyes to protect the corneas)
  • Place on a cool surface
  • Spray alcohol onto the extremities
  • Cold packs on large vessels (e.g. axilla, groin, jugular)
  • Massaging while active cooling
  • Flow by oxygen
  • Room temperature enema (severe hyperthermia)

Do not:

  • Immerse in water or ice bath
  • Leave wet towels over the patient
  • Use ice-cold water (will result in vasocontriction and discomfort)
  • Place in a small cage
  • Use antipyretics, e.g. NSAIDs as may have multi-organ dysfunction

Monitoring:

  • Monitor the temperature every 10 minutes
  • Avoid hypothermia, stop cooling when temperature 39.5°C

Don’t forget that early therapeutic renal support is crucial in heatstroke treatment as AKI is often only observed hours after thermal injury

Subscribe for a free trial to see the complete clinical guide to heatstroke management.

Special offers for BSAVA members. BSAVA members receive exclusive discounts and access to VETbytes. To find out more, click here.

Emergency Guide for Treating Feline Urethral Obstruction

Treating feline urethral obstruction can challenge the most experienced vet. You have an unstable patient who will die if left untreated. You need to make critical decisions about investigation and treatment for a successful outcome. Your clients and patients are depending on it.

VETbytes is your new clinical companion. On desktop, tablet or phone, its evidence-based concise clinical summaries will support you every step of the way. Available at the point-of-care, when and where you need it, VETbytes has the answers to help you treat these cases with confidence.

Formulate a diagnostic and treatment plan

Formulate a diagnostic and treatment plan with our Keep It Simple Summaries:
  • Step 1 – I/V fluids to manage cardiovascular compromise
  • Step 2 – Manage hyperkalaemia if still present
  • Step 3 – GA or sedate to relieve obstruction +/- place indwelling catheter
  • Step 4 – Analgesia, muscle relaxants, supportive care
  • Step 5 – Manage any post-obstruction diuresis
  • Step 6 – Address the underlying cause

Find urgent answers to critical-care questions with VETbytes:

What about cystocentesis?

  • Controversial, however recent evidence concluded that it is a low-risk procedure in this population of patients
  • May aid catheterisation, reduce discomfort and improve GFR
  • Potential risk of bladder tear/rupture
  • Indicated for those cases in which urethral catheterisation cannot be performed or that are very unstable and need sedation/GA
  • To reduce risk, use a flexible collection system and enter the ventral aspect of the bladder wall and angle caudally 45 degrees
  • Repeated cystocentesis is discouraged

What about cystocentesis?

What about I/V fluids? Will I rupture the bladder?

  • It is vital to achieve cardiovascular stability before general anaesthesia or sedation
  • Due to reduced renal blood flow and decreased GFR, urine production will be minimal so concerns about bladder rupture at this stage are misguided
  • However, relief of the obstruction should follow immediately after cardiovascular stability has been achieved

What about I/V fluids? Will I rupture the bladder?
Which catheter do I choose?

  • A rigid catheter, e.g. Standard (Jackson-type) tomcat catheter (polypropylene) can be used to relieve the obstruction if unsuccessful with softer catheters, but these are not suitable to be left in situ
  • A polytetrafluoroethylene open-ended catheter or a 20–22 G over-the-needle catheter (with stylet removed) may be more useful for distal obstructions
  • Larger catheters may cause more irritation or trauma, smaller catheters may get luminal obstruction and the patient may be able to urinate around the catheter
  • Use 3.5 Fr or 5 Fr

Which catheter do I choose?
Should I leave an indwelling catheter?

  • Indicated if severe azotaemia, severe bladder distension, cystic calculi or grossly abnormal urine
  • Indwelling catheters need to be soft (e.g. polyurathane), atraumatic and long enough to reach the bladder in large cats and should be attached to a sterile collection system
  • Optimal duration not determined so suggestion is to remove when urine looks clear, metabolic derangement and POD have resolved

Should I leave an indwelling catheter?
Additional features:

  • Coccygeal blocks – a step by step guide (easy when you know how!)
  • Quick reference data section e.g. retrograde positive contrast urethrogram
  • Drug calculators for speed of dose calculation for every drug on the site

Additional features:

Start your free 30-day free trial now to access the latest emergency medical advice, follow clinical best practice, reduce stress, contribute to your annual CPD targets and much more!

Special offers for BSAVA members. BSAVA members receive exclusive discounts and access to VETbytes. To find out more, click here.