Science Digest: What is the incidence and risk factors associated with the development of a hepatopathy in dogs with xylitol ingestion?
8 December 2025
Ingestion of xylitol by dogs causes a dose-dependent increase in plasma insulin concentration, which may result in hypoglycemia, hepatotoxicity and hepatic failure. However, there appears to be an inconsistency between xylitol dose and the development of hepatotoxicity, and clinical signs of intoxication are often vague and can be challenging to differentiate from other conditions.1 A new study has identified early indicators after xylitol ingestion that may help clinicians identify dogs that may develop hepatopathy.1
The study, published in the Journal of Veterinary Emergency and Critical Care, evaluated the association between patient history, clinical signs, decontamination methods, and initial point-of-care diagnostics and the development of hepatotoxicity in dogs with xylitol ingestion.1
Records of 95 dogs at a university veterinary teaching hospital and a private practice hospital in the USA were retrospectively reviewed. Signalment, time of ingestion, dose and source of xylitol ingested, clinical signs at presentation, and decontamination methods, along with point-of-care diagnostics, were recorded.
Half of the dogs (50%) developed a hepatopathy, characterised by an increased alanine aminotransferase within 24 hours of ingestion, and no dog developed evidence of hepatic failure. The dose of xylitol ingested (which averaged 0.8 g/kg) was not significantly associated with the development of hepatopathy. There was no association between the source of xylitol and the development of a hepatopathy, and the most common sources of xylitol ingestion were chewing gum and baked goods.
The majority of dogs (65%) had no clinical signs before presentation. The most common clinical sign was vomiting, followed by seizures, ataxia, weakness, and lethargy. Dogs that had clinical signs prior to presentation were 1.95 times more likely to develop a hepatopathy than those without clinical signs.
Emesis was induced in 77% of dogs, and dogs that had emesis induced were less likely to develop a hepatopathy than those that didn’t. A single dose of activated charcoal was given to four dogs, and these dogs were less likely to develop a hepatopathy than those that didn’t receive activated charcoal.
Hypokalemia on presentation was associated with the development of a hepatopathy. The blood glucose at the time of presentation, presenting total plasma protein, presenting lactate concentration, and potassium concentration 24 hours after presentation were not associated with the development of a hepatopathy.
Limitations of the study are its retrospective design, meaning there was no standardisation of treatments; most dogs were only followed up until 48 hours after xylitol ingestion so there is the possibility that later-onset hepatopathy (after 48 hours) may have been missed; and in cases with co-ingestions of substances (in 12 dogs in the study), this may have affected the results.
Take home message
Dogs that had clinical signs prior to presentation or were hypokalemic on presentation were more likely to develop a hepatopathy. Dogs that had emesis induction and administration of activated charcoal were less likely to develop a hepatopathy. Hypoglycemia on presentation and the dose of xylitol ingested were not significantly associated with the development of hepatopathy. These findings can guide clinicians in their treatment and monitoring recommendations for patients with xylitol ingestion.
Reference
1Lovell T, Peterson K, Kundu D, Mochel JP & Walton RAL (2025) Retrospective Evaluation of the Incidence and Risk Factors Associated with the Development of a Hepatopathy in Xylitol Ingestion: 95 Dogs (2018–2022). Journal of Veterinary Emergency and Critical Care. https://doi.org/10.1111/vec.70041
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