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One of the Veterinary Poisons Information Service’s (VPIS) remits is toxicovigilance.
Xylitol, commonly used in sugar-free products, is a well-recognised toxic hazard to dogs, causing hypoglycaemia and liver failure. In February 2018, Mars Wrigley Confectionery UK launched a new range of Starburst Gums called Starburst Fruity Mixies, Starburst Strawberry Cubes and Starburst Red Berry Sticks. These products are described as a mix between a gum and a sweet, and the Fruity Mixies and Strawberry Cubes both contain a high concentration of xylitol (over 50 per cent).
The VPIS has been monitoring cases involving these products and have nine cases with complete follow-up. Eight cases involved Starburst Fruit Mixies (available in packs of 100 pieces) and one involved Starburst Strawberry Cubes (packs of 30 pieces).
In six cases involving the Fruit Mixies the dose ingested was estimated to range from 15 to 200 pieces of gum. The dogs ranged in weight from 5.0 to 36.7 kg (mean 21.7 kg). Only one dog was asymptomatic but was treated within an hour with emesis, activated charcoal, liver protectant and dextrose. Pieces of gum were present in the vomitus. The remaining eight dogs all developed clinical signs, including hypoglycaemia (n=7), elevated liver enzymes (n=5), vomiting (n=5), electrolyte imbalance (n=3) and seizures (n=2).
Of particular note is that onset of signs appears to be more rapid with these products compared to conventional chewing gum, which can be up to 12 hours after ingestion.
Animals are typically already symptomatic when the VPIS is contacted (usually within one to two hours after ingestion); this was true with all the symptomatic cases described above. All the dogs in this case series recovered within 24 to 96 hours of ingestion with treatment. We also have notes on 13 cases without follow-up and of these the clinical status at the time of the enquiry was reported in 10. Two dogs were reportedly asymptomatic and eight had clinical signs of vomiting (n=5), hypoglycaemia (n=3), convulsions (n=2), collapse (n=2) and elevated liver enzymes (n=1).
Animals require prompt and aggressive treatment but the prognosis is good
The formulation of these products as a mix of gum and sweet appears to affect the clinical picture of intoxication. Dogs that ingest Starburst Fruity Mixies or Strawberry Cubes are at risk of rapid onset hypoglycaemia (with subsequent collapse and seizures) and liver failure. These animals require prompt and aggressive treatment but the prognosis is good, although dogs that are reported later may not fare so well.
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