On presentation, additional vomiting was induced using apomorphine. The dog produced at least 4 bouts of vomitus that contained visible tablets, both whole and partially dissolved. Based on the condition of the tablets, it was not possible to accurately quantify the amount of product produced.
Because of the risk for severe hypoglycemia and hepatic necrosis, the following therapies were immediately instituted:
- Plasmalyte (IV) with 2.5% dextrose (15-30 mL/hr). Dextrose administration, even in states of euglycemia, may be helpful if hepatotoxic doses of xylitol were ingested.
- Acetylcysteine (140 mg/kg IV loading dose, followed by 70 mg/kg IV q6h at 7 doses) can help restore or maintain glutathione concentrations in the liver.
- Denosyl (225 mg PO q24h; denosyl.com) contains SAMe (S-Adenosylmethionine), which, along with helping to restore glutathione concentrations in the liver, provides support for transmethylation, transsulfation, and aminopropylation pathways.
- Marin Plus Chew for Dogs (1 chew PO q24h; marinplusliver.com) contains silymarin, Vitamin E, and other ingredients that aid in hepatoprotection. Silymarin is thought to act as an antioxidant and free radical scavenger by inhibiting lipid peroxidase and -glucuronidase.
Daily glucose curves checked glucose every 2 to 4 hours, and the dextrose dose was increased to 5% PRN to maintain euglycemia. Because of the dogs significant increase in ALT and concurrent increase in aPTT on the second day of hospitalization, the following treatments were initiated:
- Vitamin K1 (5 mg/kg SC q24h)
- Pantoprazole (1.6 mg/kg IV q24h)
- Two fresh frozen plasma transfusions (125 mL/kg over 3 and 4 hours, respectively)
- Plasma transfusions are typically reserved for cases in which the PT/aPTT exceeds 1.5 times normal values and/or clinical evidence of a coagulopathy is present. In the authors opinion, they were not yet indicated in this case.
Overall, Piper tolerated hospitalization well with bright response and good appetite. Except for one episode of liquid diarrhea with frank blood (ie, hematochezia) on the third day of hospitalization, no major physical abnormalities were appreciated.
Piper was discharged 4 days postingestion with Vitamin K1 (25 mg PO q24h for 10 days), Denosyl (225 mg PO q24h for 60 days), Marin Plus Chews (1 chew [based on body weight dosing] PO q24h for 60 days), and omeprazole (20 mg PO q24h for 14 days).