Ingestion of toxic substances is a common reason for emergency room visits for dogs. One of the best ways for pet owners to prevent pet health emergencies is to be knowledgeable about common toxins in and around the home. Emergency veterinarian Dr. Christine Klippen discusses some of the most common toxins for dogs in part one of this two part episode.
Welcome Back, Dr. Klippen
[00:01:04] Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Today is the first in a series of episodes on different types of toxins that your animal might be exposed to. I’m joined today by Dr. Christine Klippen, who was a guest on the ‘Feline Lower Urinary Tract Disease and Urinary Obstruction’ episode, previously. So I’m very thankful that she offered to come back and do more episodes with me, and share some more of her incredible knowledge in an emergency room setting with all of you out there. She’s going to be talking, over the next few episodes, about common household toxins that can affect your dog and your cat. We had such a great discussion about the dog toxins that we decided to break up the episode into 2 parts, because the episode is so jam packed with really good information. I didn’t want to overwhelm people in just one episode, so it’s a really exciting episode that we’ve split up into two. Without any further ado, please enjoy Part 1/2 of dog toxins. Dr. Klippen, thank you so much for joining us again.
[00:02:07] Dr Klippen: Thank you so much.
[00:02:09] Dr. Lancellotti: Can you tell our listeners a little bit about your background and why you are so familiar with different types of toxins that their pets might come in contact with?
[00:02:18] Dr Klippen: I am an emergency doctor, so unfortunately toxin ingestion is probably one of the ‘number 1’ things that come in through my emergency room. I have been an emergency doctor for about 12 years. I graduated from Colorado State in 2009 and I currently practice in a very large-volume Primary Care Hospital in Washington, DC.
[00:02:41]Dr. Lancellotti: Excellent. You have a lot of these cases under your belt and very familiar with toxins and what they can do to our pets, so I’m very happy that you’ll be sharing all of that knowledge with pet owners today. Tell us a little bit about why it’s important for pet owners to be aware of these toxins and what they might do to their animal.
[00:03:01]Dr Klippen: A lot of us will think of the time when our dog got into the Halloween candy stash, made a big mess, probably had vomiting and diarrhea, and everyone laughed about it. And yes, a good majority of the toxins that our pets will get into may not necessarily have significant consequences, especially if caught early, but there are those that can have significant consequences and there are no warning signs on some of these things for our pets. So unfortunately, I have seen pretty devastating consequences in not knowing what things that are around us could cause our pets harm.
A Memorable March
[00:03:48]Dr. Lancellotti: Tell me a little bit about something that may have been preventable- something that you’ve seen in your emergency room.
[00:03:55] Dr Klippen: A couple of years ago, here in Washington DC, we had the Million Women March, where hundreds of thousands of people came down to the Washington Mall to march.
[00:04:08] Dr. Lancellotti: My mom went to that, actually.
[00:04:10] Dr Klippen: Yeah. It was a pretty spectacular sort of thing to be around (I worked that night) and the communities in the DC area opened up their homes to have people come in from around the city. And I remember a case where a dog got into a bag of medications that someone brought with them, and didn’t really think much of it. The pills were in one of those little pill sorters, in a plastic baggie in the person’s luggage, and the dog ingested such a large quantity of Ibuprofen that it presented to me in a coma. It was so terrifying for the pet and the pet owner. You know? I felt for them. Thankfully, that dog made a full recovery and left the hospital within 2 days, which was mind-blowing.
[00:05:04] Dr. Lancellotti: That’s amazing. What a miraculous recovery and well done to you and to all of the staff who, I’m sure, worked incredibly hard to give that dog a chance.
Today, we’re going to talk about a number of different toxins that dogs might ingest from within the home. It is really a great idea to have the number of your emergency veterinarian, as well as the ASPCA Poison Control or Pet Poison Hotline programmed into your phone. Those numbers are incredibly valuable in an emergency situation. Your veterinarian might know some of the common toxins, but the professionals at Poison Control will have the most knowledge. Your vet may have you call poison control so that they can consult with them, and there is a fee associated with most veterinary-specific poison control hotlines. The human poison control hotlines, unfortunately, don’t have the same accurate information because they’re focused on toxins that affect people. Certainly, when I was working emergency as an intern, that ASPCA Poison Control hotline was on speed dial for me. They are incredibly knowledgeable, not just for pet owners, but for veterinarians as well, because they have so much research behind all the different toxins. They are definitely an invaluable resource.
Toxin #1: Chocolate
Dr. Lancellotti: Let’s talk a little bit with Dr. Klippen today about the top 10 most common toxins for dogs. What do you think #1 is?
[00:06:28] Dr Klippen: Chocolate.
[00:06:30] Dr. Lancellotti: Oh yeah, absolutely.
[00:06:33] Dr Klippen: Chocolate is definitely year round, but we see it around some of the popular holidays. Halloween, of course. Christmas, Easter, Valentine’s day, etc. These are all the times that we may have more goodies in the home and dogs are notoriously getting into the kids’ stash, or even taking stuff off of the counter.
[00:06:58]Dr. Lancellotti: Sure. So why is chocolate toxic and what should pet owners know about chocolate and how it affects the dogs? What do you think they should do if they see their dog eat it?
[00:07:11] Dr Klippen: There are a couple active ingredients within chocolate that act as stimulants- so they act a little bit like caffeine. The darker the chocolate, the more potent it is, so the less the pet actually needs to eat. At lower doses, we can see dogs develop signs of vomiting and diarrhea. At higher doses, we will start to see excitability, maybe excessive panting, tremors, an elevated heart rate, and elevated blood pressure. And then at very high doses (and thankfully, I’ve only seen a few of these cases in my career), I’ve actually seen dogs have seizures as a result of getting into very dark chocolate, like Baker’s chocolate. Central nervous system signs, and even potentially coma and passing away are all possible results. Thankfully, I don’t happen to have seen that too often.
[00:08:05] Dr. Lancellotti: How long would you say it takes for the chocolate to start causing some of these signs?
[00:08:10] Dr Klippen: Most of the time with chocolate ingestion, we’ll typically start to see signs within about 4-6 hours and we still may recommend inducing vomiting, or trying to (what we consider) decontaminate a pet within 6-8 hours after ingestion to get everything out of their system. A lot of times, the way that we make our decisions, in regards to whether or not a pet needs to be seen, is based upon a calculated amount and the most up-to-date body weight on that pet.
[00:08:42]Dr. Lancellotti: Do you have a good rule of thumb for pet owners to follow if they’re worried about how much chocolate their animal has eaten?
[00:08:50] Dr Klippen: Yeah. So a rule of thumb is about one ounce of milk chocolate per pound of body weight. With dark chocolate (depending on cacao %), it’s a little bit closer to half an ounce per pound.
[00:09:07]Dr. Lancellotti: So if there’s any question as to how much chocolate to the animal has eaten, that’s a good rule to follow. But also, having that number for poison control (calling them and letting them know how much you think they’ve eaten, what you think the animal’s weight is, etc.) is going to be a great option for you, as far as you’re concerned with your pets.
Toxin #2: Marijuana
Dr. Lancellotti: Let’s talk a little bit about something that I’ve seen more and more in recent years- marijuana toxicity. Tell us a little bit about marijuana toxicity in dogs.
[00:09:39]Dr Klippen: As marijuana becomes legal in the jurisdictions around us, we are seeing more and more dogs getting into their owner’s supply. In fact, there was a statistic with ASPCA Poison Control and Pet Poison Hotline that they were seeing calls up over 200-300% from a number of years ago, so it’s a much more common problem than we’ve seen. It’s not a crime if your pet gets into it and honestly, as an emergency doctor, I just need folks to let me know ahead of time, just to make sure that it’s not something else that I need to be concerned about. But they’ll typically get into either the end of a joint or a rolled product, or even edibles. It seems like I’m seeing more and more dogs get into edible products, especially if they’ve been made into candies or cookies and that sort of thing.
[00:10:35] Dr. Lancellotti: Then, you also have to worry about chocolate toxicity if you’re dealing with brownies in that situation.
[00:10:40] Dr Klippen: Yes.
[00:10:41] Dr. Lancellotti: What are some things that the pet owner might see and how soon after ingesting marijuana might they start to see those signs?
[00:10:49] Dr Klippen: Signs usually will begin within about 2-4 hours, post-ingestion. Owners may notice dilated pupils. They may notice that an animal is starting to dribble urine. One of the things that I see, most commonly, are what looks like tremors of the head and the neck or they are walking not coordinated (almost like they’re drunk). Another really specific sign is generalized sensitivity to light, sound, and movement. Most dogs, in my experience, are usually better in 12-18 hours, post ingestion. Whereas with the edible products (because they’re more potent), I have seen some dogs that will have clinical signs last upwards of about 2 days.
[00:11:39] Dr. Lancellotti: Do you have specific dogs where you might be a little bit more concerned that they’ve ingested marijuana?
[00:11:46] Dr Klippen: Yeah. I’m usually concerned about the very small and the very big. The very small patients, I’m always concerned, may not be able to regulate their body temperatures, their blood pressure, and their blood glucose, because it is a depressant which will slow things down. And then I’m also concerned about those really big dogs, because if you have a big dog who may have difficulty walking, I’m concerned about the threat of injury (falling down the stairs, for example), or even not having an owner be able to physically pick up a large dog to get them to the hospital if necessary.
[00:12:27] Dr. Lancellotti: Sure. What are some other things that you might be concerned about if you’re seeing these clinical signs, but maybe the owner hasn’t seen the dog ingest marijuana?
[00:12:37]Dr Klippen: Because the marijuana ingestion is not always witnessed, it can mimic some other concerning conditions. Things like low blood sugar or even potentially neurologic concerns (seizure disorders or central nervous system diseases), can mimic marijuana ingestion. So, I think that’s one of the reasons why it is so important that if there is the potential for an exposure, it’s much easier for people to let me know that upfront, because I may tailor my recommendations for monitoring for these particular patients.
[00:13:15]Dr. Lancellotti: Yeah. We don’t care what you do in your free time. We just want to be here to help the pet.
Toxin #3: Over the counter pain relievers
Dr. Lancellotti: How about some of the over the counter medications that people, very commonly, have in the house? Which ones do you get specifically concerned about?
[00:13:29] Dr Klippen: The ones that I see most frequently are Ibuprofen and some of the class of drugs we consider non-steroidal anti-inflammatory, like Naproxen, as well as acetaminophen or Tylenol. Sometimes, these ingestions can be accidental. All of us have dropped pills on the floor. It happens. Usually, there’s an animal right beneath your feet that thinks it’s crumbs or something. Sometimes, I will have well-intentioned folks not realizing that there are very specific differences in dogs and cats compared to people, giving these medications to pets. Those are the two major groups that I see with the over the counter medications.
[00:14:17]Dr. Lancellotti: What are some things that might happen if an animal (either) accidentally ingests these particular medications or the owner gives it, thinking that it could potentially help with pain? What are you worried about with those animals?
[00:14:31]Dr Klippen: A lot of it is very dose dependent, so we will try to calculate how much an animal had been exposed to compared to their body weight. At lower doses, we can see things like GI upset, GI ulceration, vomiting, and potentially diarrhea. I have seen some dogs develop serious enough stomach ulcers that they can cause perforation of stomach. But where I start to get even more concerned, is when we start to reach the kidney toxic doses. These medications (nonsteroidals) can actually cause kidney failure in patients. And they don’t happen right away. It can take a couple of days for them to have those effects, so if it’s something that’s witnessed, it’s better for us to intervene early rather than to wait and see what happens.
[00:15:26]Dr. Lancellotti: Sure. Definitely following through with your family veterinarian or with the emergency veterinarian that you’ve worked with to monitor those kidney values would be very important as well. What about acetaminophen? Because that’s a little bit different than Ibuprofen and Naproxen.
[00:15:42] Dr Klippen: The Tylenol acetaminophen does work a little bit differently. When we see dogs get into toxic amounts of acetaminophen, they’ll typically start to develop signs within 1-4 hours after ingestion. Some people will notice that a pet will start to act very lethargic or very depressed. They may develop an elevated respiratory rate, so they may start breathing harder. One of the things that we see, very commonly, is that they do start to have changes in the color of their mucus membrane. If you were to roll down their eyelid and look at the pink portion of the eye, or you’d roll up their lips to look at their gums (which should normally be nice and pink, like your fingernail beds), you would start to see almost a blue to a purple color. What’s happening is the acetaminophen is interrupting the ability of the red blood cell to carry oxygen to the tissues of the body. So, while it works a little bit differently, it can still have pretty profound consequences.
[00:16:50]Dr. Lancellotti: Tell me a little bit about how that would be treated.
[00:16:54]Dr Klippen: Again, we may still try to decontaminate them, make them vomit, or maybe follow up with doses of a medication called Activated Charcoal to help bind anything that’s still remaining in the GI tract. There are some medications that we can give, within a hospital setting, to try to help with some of that oxidative stress. And vitamin C. There’s some other ones that are usually recommended by poison control with some pretty close monitoring. I have had some pets need to have blood transfusions as a result of getting into acetaminophen, and some of them have been hospitalized for several days. So it really depends upon both, the point at which we get them in the emergency room, and what sort of effects are already being seen?
[00:17:45] Dr. Lancellotti: That’s a great reminder- as soon as you notice that the animal has eaten something, getting on the phone with Poison Control and getting them to your emergency veterinarian is a really good way to minimize the severity of this potential toxin.
Toxin #4: Grapes and Raisins
[00:18:00]Dr. Lancellotti: I want to move on to toxin #4, which is something that my husband and I are absolutely terrified about in our house. We have two small children and they love grapes and raisins. And in our household, grapes and raisins are an out-of-the-house food. If we are going on a hike somewhere, or if we are taking a long car ride, we will cut up our grapes and raisins and bring them out of the house, because we are terrified of our three dogs getting exposed to grapes or raisins. I know a lot of owners are not as familiar that this is a toxin to be worried about, so tell us a little bit about grape and raisin toxicity.
[00:18:42]Dr Klippen: Grape and raisin toxicity, we would actually consider almost a “newer” concern over the last 15 years. I remember I spent some time (when I was in veterinary school at ASPCA Poison Control) working with the toxicologists while I was still in school and learned that grapes and raisins were poisonous. And I remember, as a kid, feeding my dog grapes and raisins and I never knew that it was a concern. The specialists at Poison Control started to realize that there was a common thread and started to rack up numbers of cases of dogs developing kidney failure with ingestions. They weren’t sure what about grapes and raisins was toxic, because they’re not toxic to a lot of other species. They weren’t sure if it was the flesh, the skin or the juice. And the challenge with this is that we didn’t know if it was dose-related (10 grapes would make you more likely to see signs), or if it was something called idiosyncratic. And idiosyncratic means that it’s an unpredictable sort of reaction, so now we treat all grapes and raisins as potentially serious ingestions.
[00:20:09] Dr. Lancellotti: Because you don’t know who’s going to react to even the smallest amount…
[00:20:12]Dr Klippen: Correct. If we are going to start to see clinical signs of grape and raisin ingestion, we’ll typically see it about 24-48 hours after ingestion. Pet owners may notice things like vomiting, not eating, lethargy, dehydration, as well as maybe an increased thirst and increased urinations. So now, our standard of care at our hospital is that for any sort of grape and raisin, we are still trying to recommend that pet owners come in and be seen on the emergency service.
[00:20:47]Dr. Lancellotti: And I know that there have been some recent developments, as far as a better understanding of grape and reason toxicity. Can you tell me a little bit about that?
[00:20:57] Dr Klippen: Sure. This is super exciting news because it’s data that’s come out probably like February 2021. It’s still very recent, but several of the toxicologists at ASPCA Poison Control have started to determine that there may be a specific ingredient called tartaric acid, which can be the key to toxicity. Wine makers have understood this for years because that is where some of the science in wine making comes into play. What they have found is that different grapes have different amounts of this tartaric acid, and that also may be an influence in why some dogs develop signs and some dogs can eat pounds and pounds of grapes and never have a problem. The research is coming out and it’s super exciting from an emergency perspective, so that you’re not having to panic and eat grapes outside of your house with your kiddos, with a feeling like, “Oh my God, they’re going to drop one and I have to rush to the emergency room.” So this is really exciting news.
[00:22:09]Dr. Lancellotti: That is really exciting. I was thrilled when I saw that there was some more information coming out. We’ll definitely keep a close eye on what’s coming out of the ASPCA Poison Control, as far as the research with grapes. I’m really excited about that.
Toxin #5: Xylitol
[00:22:22]Dr. Lancellotti: Let’s talk a little bit about xylitol, because I know this is something that is a lot more readily available now. So tell us a little bit about what xylitol is and what pet owners should know.
[00:22:35] Dr Klippen: Xylitol is a naturally occurring substance that’s usually used as a sugar substitute. It can be made into a white powder and it looks and tastes like sugar. Previously, we used to see it in a lot of diabetic cooking and baking. So you can find xylitol sugar that you can bake with, you would find it in (what would be considered) sugar-free treats, sugar-free candies, which are geared towards the diabetic population. But the reason why it’s become a little bit more sneaky is that it is being approved much more frequently in, not only the sugar-free gum and breath mints, but in some of supplements. I will sometimes take Melatonin at night to help me sleep and xylitol is actually one of the first ingredients in that supplement. We’re also starting to see xylitol pop up in other sorts of products, things like peanut butter, which I know a lot of pet owners will use to give treats and/or pills. It’s being found in a lot more products then it did 15-20 years ago, so dogs are becoming exposed to it a lot more commonly.
[00:23:48]Dr. Lancellotti: What happens if a dog eats something that has xylitol like a pack of sugar-free gum, or the owner accidentally gets this xylitol peanut butter? What is going on in the dog’s body that makes it unable to process this?
[00:24:05] Dr Klippen: In both humans and dogs, the way that our blood sugar is normally regulated is the release of insulin by the pancreas. When we have a release of insulin by the pancreas, it causes the sugar within our bloodstream to be able to go into cells, and then the cells use that sugar for metabolism and the things that do on a day-to-day basis. Xylitol, in people, does not overstimulate the pancreas, so that’s why when we eat xylitol-containing products, we don’t experience those fluctuations in our blood sugar. But if dogs eat something that contains Xylitol, not only is the xylitol quickly absorbed into the bloodstream, it causes the pancreas to release a huge amount of insulin. Then, what happens is that the normal blood sugar in the bloodstream will go rushing into cells, but if you don’t have a diabetic patient, those blood sugars can plummet so quickly that these pets can now become hypoglycemic (decreased blood sugar).
[00:25:13] Dr. Lancellotti: So if the animal becomes hypoglycemic, what types of things are their bodies going to experience?
[00:25:26]Dr Klippen: Symptoms can happen pretty quickly. I have seen some patients develop signs within 15-30 minutes of eating, and what signs of hypoglycemia in a dog may look like, are things like vomiting, weakness, they may look a little bit drunk or have difficulty standing, or they may just be very sleepy or very lethargic. And again, tremors. I’ve even seen some of these patients present for seizure-like activity.
[00:25:56]Dr. Lancellotti: What happens if the dog has eaten xylitol? What would you recommend that the pet owner do? How is this going to be addressed in the hospital?
[00:26:04]Dr Klippen: Normally, the first thing that I’ll have my technical staff do is check a blood sugar, because depending upon the amount that they got into, I may still want to induce vomiting, but I don’t want to induce vomiting in a pet that’s already showing clinical signs. If I have a pet that’s already showing clinical signs, these are the ones that I’m likely going to admit for a period of time, so that I can provide them that glucose and that sugar support through intravenous fluids to help control their blood sugar until it works its way out of their system.
[00:26:42]Perfect. Join me again next week for Part 2/2, when we continue our discussion about household toxins for dogs with Dr. Christine Klippen. Make sure you’re subscribed to the podcast so you don’t miss an episode. I’ll see you on your next visit with Your Vet Wants You To Know.
References:
Brutlag, Ahna, and Holly Hommerding. “Toxicology of Marijuana, Synthetic Cannabinoids, and Cannabidiol in Dogs and Cats.” Veterinary Clinics of North America: Small Animal Practice, vol. 48, no. 6, Nov. 2018, pp. 1087–1102.
McLean, Mary Kay, and Safdar A. Khan. “Toxicology of Frequently Encountered Nonsteroidal Anti-Inflammatory Drugs in Dogs and Cats: An Update.” Vet Clin North Amer: Small Animal Practice, vol. 48, no. 6, Nov. 2018, p. 969–+.
Murphy, Lisa A., and Eric K. Dunayer. “Xylitol Toxicosis in Dogs An Update.” Vet Clin North Amer: Small Animal Practice, vol. 48, no. 6, Nov. 2018, p. 985–+.
Noble, Peter-John M., et al. “Heightened Risk of Canine Chocolate Exposure at Christmas and Easter.” The Veterinary Record, vol. 181, no. 25, Dec. 2017, p. 684.
Wegenast, Colette, et al. “Unique Sensitivity of Dogs to Tartaric Acid and Implications for Toxicity of Grapes.” Journal of the American Veterinary Medical Association, vol. 258, no. 7, Apr. 2021, pp. 706–707.
