D-Limonene / Xylitol

Question 1

What is D-limonene used for in animals?

Answer 1

control of flea, ticks, and lice

Usually a 5% solution

Question 2

What is D-limonene?

Answer 2

Citrus oil extract from citrus peels

Question 3

What percentage of D-limonene can essential oils have compared to what is used in animal flea products?

Answer 3

Essential oils can be up to 95% concentration vs only 5%

Question 4

What animals are most sensitive to D-limonene?

Answer 4

Cats

but dogs and cats are susceptible

Question 5

What is the most common exposure/route of absorption of D-limonene?

Answer 5

Absorbed readily through the skin (reaches peak plasma levels in about 10 mins)

Question 6

What is the MOA of D-limonene?

Answer 6

Unknown - may be central and peripheral vasodilation due to a neuronal mechanism

Question 7

What clinical signs are associated with D-limonene toxicosis?

Answer 7

Ataxia, weakness, recumbency, paralysis, CNS depression, hypothermia, and hypotension (**hypotension can be severe in cats)

Less common - skin irritation/reaction

Question 8

What lesions are noted in patients with D-limonene toxicosis?

Answer 8

No specific lesions (unless there is a skin reaction)

**may note LEMON SCENT

Question 9

What treatment is reccommended for patients with D-limonene toxicosis?

Answer 9

Decontaminate with a bath - make sure to keep the patient warm

Supportive care for clinical signs - patients usually recover within a day

Question 10

What products can xylitol be found in?

Answer 10

It is a sugar alcohol that can be found in “sugar free” items like gum, some peanut butter, and other diet food products

There is no FDA regulation to have this on the label - so it’s hard to know all or what products contain it

Question 11

What animals are most sensitive and susceptible to xylitol?

Answer 11

Dogs (some other animals have a response - but not the fatal hypoglycemia that we see in dogs)

Question 12

Is xylitol absorbed fast or slow?

Answer 12

Slowly from the GI tract

Question 13

What is the toxicity of xylitol in dogs?

Answer 13

moderately toxic (200 - 400mg/kg) - hypoglycemia

1 piece of sugar free gum may have 1-2 grams

Larger doses - 1.6g - 2g/kg can cause hepatic failure in dogs

Question 14

What is the MOA of xylitol toxicosis in dogs?

Answer 14

Potent promoter of insulin release - resulting in hypoglycemia and hypokalemia

Large doses - liver failure, GI hemorrhage, and DIC

Question 15

T/F: Some dogs may have a subclinical hypoglycemic phase and present in liver failure due to xylitol toxicosis

Answer 15

TRUE

Less common, but it can happen

Question 16

What is the typical onset of clinical signs in a dog with xylitol tox?

Answer 16

30-60 mins up to a few hours depending on the amount

CS: weakness, ataxia, collapse, sz, vomiting/dhr, intestinal hem, icterus

Question 17

Large amounts of xylitol can cause signs of liver damage and DIC within ____ hours of ingestion

Answer 17

48 hrs

Question 18

What lesions are associated with xylitol tox?

Answer 18

Not specific for hypoglycemic dz

Liver failure: Petechial, ecchymotic or GI hemorrhages, hepatic necrosis or atrophy

Question 19

What is the first liver enzyme that you would see elevation in due to xylitol toxicosis?

Answer 19

ALT

Usually noted after 48 hours:
Other lab work - hypoglycemia and hyperkalemia
prolonged clotting times, thrombocytopenia, hyperphosphatemia

Question 20

T/F: When you suspect xylitol tox in a dog - you should start decontamination with toxiban (activated charcoal) right away

Answer 20

False - not effective

decontaminate via emesis

Question 21

What treatment can be done for xylitol tox dogs?

Answer 21

Supportive care - Supplemental dextrose in IVF, oral feeding of sugar containing meals

Symptomatic: antiemetics, antibiotics if signs of liver failure, antacids and GI protectants

Question 22

What is the prognosis of xylitol toxicosis in dogs?

Answer 22

Generally pretty good for hypoglycemic patients if treated quickly

patients with signs of liver failure have guarded prognosis