Acute Hepatic Failure in a Dog after Xylitol Ingestion

J Med Toxicol. 2016 Jun;12(2):201-5. doi: 10.1007/s13181-015-0531-7.


Xylitol is a five-carbon sugar alcohol produced from natural resources frequently used as a sugar substitute for humans. We report the development and successful treatment of acute hepatic failure and coagulopathy in a dog after xylitol ingestion. A 9-year-old 4.95 kg (10.9 lb) neutered male Chihuahua was evaluated at a veterinary clinic for vomiting after ingesting 224 g (45 g/kg, 20.5 g/lb) of granulated xylitol. Hypoglycemia developed within 1-2 h, elevated liver values, suggesting the development of acute hepatic failure, within 12 h and coagulopathy less than 24 h after ingestion. Treatment included maropitant, intravenous dextrose, phytonadione, metronidazole, and fresh frozen plasma. N-acetylcysteine (NAC) and S-adensoyl-L-methionine (SAMe) provided hepatic detoxification and support. The dog survived and liver values returned to normal within 1 month post ingestion. No adverse effects to hepatic function have been identified 2 years after acute xylitol toxicity. This paper is one of the few reports of successful management of a dog with hypoglycemia, hepatic failure, and coagulopathy caused by xylitol toxicity. To date, this is the highest published xylitol dose survived by a dog, as well as the only reported case that documents laboratory changes throughout the course of toxicity and includes normal hepatic indices for 7 months following xylitol toxicity. The rapidly expanding use of xylitol in a variety of products intended for human consumption has led to a rise in xylitol toxicity cases reported in dogs, and clinicians should be aware that more dogs may potentially be exposed and develop similar manifestations.

Keywords: Dog; Hepatic failure; Hypoglycemia; N-acetylcysteine; Xylitol.

Publication types

  • Case Reports

MeSH terms

  • Acetylcysteine / therapeutic use
  • Animals
  • Animals, Inbred Strains
  • Antidotes / therapeutic use
  • Biomarkers / blood
  • Chemical and Drug Induced Liver Injury / blood
  • Chemical and Drug Induced Liver Injury / physiopathology
  • Chemical and Drug Induced Liver Injury / therapy
  • Chemical and Drug Induced Liver Injury / veterinary*
  • Combined Modality Therapy / veterinary
  • Disseminated Intravascular Coagulation / etiology
  • Disseminated Intravascular Coagulation / prevention & control
  • Disseminated Intravascular Coagulation / veterinary
  • Dogs
  • Hypoglycemia / etiology
  • Hypoglycemia / prevention & control
  • Hypoglycemia / veterinary
  • Liver Failure, Acute / etiology
  • Liver Failure, Acute / prevention & control
  • Liver Failure, Acute / veterinary*
  • Male
  • S-Adenosylmethionine / therapeutic use
  • Sweetening Agents / chemistry
  • Sweetening Agents / poisoning*
  • Treatment Outcome
  • Xylitol / antagonists & inhibitors
  • Xylitol / poisoning*


  • Antidotes
  • Biomarkers
  • Sweetening Agents
  • S-Adenosylmethionine
  • Xylitol
  • Acetylcysteine