Stuporous State in a Dog Following Ingestion of Chewing Gum Containing Xylitol Without Documented Hypoglycemia

An adult dog presented for evaluation of a stuporous state following the ingestion of more than 50 xylitol-containing chewing gums (minimum xylitol dose ingested > 3 mg/kg). On admission, the patient was hyperglycemic (9.0 mmol/L [163 mg/dL]) with moderately increased liver parameters and a normal plasma ammonia concentration. Non-ambulatory status, absent menace response bilaterally, and absent gag reflex were noted. Hypoglycemia was never documented throughout hospitalization, although dextrose supplementation was provided when the blood glucose concentration was the lowest (4.2 mmol/L [75 mg/dL]). Within 15 h of supportive care, the dog's neurologic status acutely improved to bright and alert. The patient was discharged home 2 days later. This case describes a dog with severe neurological signs after ingestion of a large amount of gum containing a low dose of xylitol in the absence of documented hypoglycemia and represents the first report of a prolonged yet reversible alteration in mental status under these circumstances, suggesting that xylitol may be neurotoxic even at low doses.