Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 72 SEPTEMBER/OCTOBER 2018 2. ANTIHYPERGLYCEMICS Description: This heading encompasses all oral antihyperglycemic medications and insulin injections. The most common oral antihyperglycemic medications for which the Animal Poison Control Center receives calls are the sulfonylureas (e.g., glipizide and glyburide). 2 The hypoglycemia caused by insulin injections is dose-dependent. Clinical signs: Aside from hypoglycemia, the clinical signs vary according to the agent. Margin of safety: Variable. The margin of safety for sulfonylureas and insulin injections is narrow. For others, such as metformin or acarbose, the margin is much wider. Mechanism for hypoglycemia: The mechanisms vary according to the drug. Sulfonylureas, for example, affect potassium channels on pancreatic β cells, thereby causing release of insulin. 13 Treatment Tips ■ Hypoglycemia with sulfonylurea exposures can be profound, and any exposure is a concern. The hypoglycemic effects can persist for well over 24 hours 2 and after large overdoses may last 72 hours. 13 ■ Oral exposure to insulin does not cause hypoglycemia. The insulin is digested in the stomach and is inactivated. 1. XYLITOL Description: This sugar alcohol is used as a sweetening agent in many foods, candies, mints, chewing gums, and supplements. It is also used as a cooling agent in nasal sprays, diapers, baby wipes, sunscreen, toothpaste, and mouthwashes. 21 Although there are many other sugar alcohols, xylitol is the only sugar alcohol that poses a concern for animal safety. Clinical signs: Ingestion of xylitol can cause vomiting, depression, diarrhea, hypoglycemia, increased liver enzymes, ataxia, tremors, and seizures. Other signs include liver failure, hepatic encephalopathy, and coagulopathy. Liver failure has been seen within 12 hours 22 but can be delayed up to 72 hours. 23 Margin of safety: Narrow. Ingestion of 100 mg/kg or more can cause hypoglycemia. Mechanism for hypoglycemia: Direct and indirect. Xylitol-induced hypoglycemia can be profound and results from insulin release. 22 However, in some animals, liver injury can occur without the hypoglycemic phase. Hypoglycemia can result from liver failure rather than insulin release. 23 Treatment Tip Xylitol is poorly absorbed by activated charcoal, 24 and charcoal use for xylitol toxicity is not indicated. CONCLUSION This list of toxicologic causes of hypoglycemia in the dog can be a useful tool for the small animal veterinarian. Reviewing these substances with the client may prove to be a practical way to determine the cause of hypoglycemia. Although this list of hypoglycemic substances is not comprehensive, it covers the 10 most common toxicologic causes of hypoglycemia in the dog as reported to the ASPCA Animal Poison Control Center. More information can be found by calling the ASPCA Animal Poison Control Center at 1-888-426- 4435 and visiting the ASPCApro website ( aspcapro. org ) for helpful printouts, articles, and newsletters. References 1. Plumb DC. Plumb's Veterinary Drug Handbook. 8 th ed. Stockholm, S weden: PharmaVet, Inc.; 2015:106-107. 2. American Society for the Prevention of Cruelty to Animals, Animal Poison Control, Urbana, IL. Antox Database. Unpublished data 2001-2016. 3. Li C, Liu C, Nissim I, et al. Regulation of glucagon secretion in normal and diabetic human islets by gammahydroxybutyrate and glycine. J Biol Chem 2013;288:3938-3951. 4. Wismer T. Baclofen overdose in dogs. Vet Med 2004;May:406-410. 5. Richardson JA, Welch SL, Gwaltney-Brant SM, et al. Metaldehyde toxicosis in dogs. Compendium 2003;25:376-380. 6. Mubarak AS, Yiquen T. Hypoglycemic property of cocoa products: potential underlying mechanisms. Int Curr Pharm J 2015;4:362-366. 7. L ee JA. Sago palm toxicosis in dogs. Clinician's Brief 2017;March:51-54. 8. Fatourechi L, DelGiudice LA, Sookhoo N. Sago palm toxicosis in dogs. Compendium 2013;April:E1-E7. Ingestion of xylitol can cause vomiting, depression, diarrhea, hypoglycemia, increased liver enzymes, ataxia, tremors, and seizures.

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