Xylitol ingestion in dogs causes rapid hypoglycemia and potential hepatic failure; what is an immediate treatment?

• A. Induce vomiting and administer activated charcoal.
• B. IV dextrose administration to correct hypoglycemia.
• C. Administer insulin to counter hyperglycemia.
• D. Administer IV fluids without dextrose.

Answer: (B)

Xylitol in dogs triggers a rapid release of insulin, causing dangerous hypoglycemia that can progress quickly to seizures, coma, or death. The immediate priority is to correct the low blood glucose fast, so giving intravenous dextrose to raise the blood sugar is the best first step. A dextrose bolus (for example, 0.5–1 g/kg of 50% dextrose IV) can rapidly restore glucose levels, and then a dextrose-containing IV fluid is usually continued to maintain euglycemia for several hours as the body processes the xylitol and to prevent a rebound drop. Monitoring blood glucose closely guides ongoing treatment.

Other options don’t address the urgent need to raise glucose. Inducing vomiting or giving activated charcoal may not be effective quickly enough because xylitol is rapidly absorbed. Administering insulin would worsen hypoglycemia. Providing IV fluids alone without dextrose will not correct the low blood sugar and could allow the condition to worsen. After stabilization, monitoring for potential hepatic injury and providing supportive care complete the management.