#FurbabyFridays: Pets and #Chocolate Can Be a Deadly Combination

Hello and welcome back to Furbaby Fridays with Dr. Tammy. This week we are counting down to Easter and I thought today would be a great time to remind folks about the dangers of chocolate. Yesterday, one of my clients came in because one or both of her dogs ate dark chocolate truffles—enough to make them both seriously ill. Their visit reinforced the need to take time out to discuss the dangers of chocolate for our fur babies.

 This tasty treat comes in all shapes and sizes and formulations whether in cocoa products like candies, cakes , cookies and brownies, but also in cocoa beans and mulches.  The most accidental exposures of pets to chocolate of course occur more around the holidays and Easter is a big one.

Because dogs tend to be the pets that tend to eat just about anything, we don't usually see cats with this toxicity, but there are a few of those pesky felines who pretend they are dogs and ingest some odd things. So to be safe, keep chocolate away from all fur babies.  This includes some cocoa bean hull mulches. Not only do the mulches smell like chocolate Pop Tarts, they are readily available for pet for some pets because of their use in gardens and landscapes. Of course the makers of the mulches will say there has only been one documented death from the ingestion of these kind of mulches, this does not mean that animals are not sick from them. In fact, even Hershey one of the makers of these mulches admit that 50% of dogs who ingest their mulch can get sick from it.  Here's an article by snopes.com that talks a bit more about it.

What makes chocolate toxic to animals?

Methylxanthines are the culprits here, specifically theobromine and caffeine. That's right. There are TWO toxic components in chocolate and each will vary in concentration depending on the type of product. The rule of thumb is the darker the chocolate the higher the amounts of both of these compounds. White chocolate has 0.25mg theobromine per ounce and 0.85mg of caffeine per ounce. In contrast, dry cocoa powder has 737mg theobromine and 70mg of caffeine per ounce.  Now what does that mean? 

Animals can show mild signs after only ingesting 20mg/kg of either theobromine or caffeine. Severe signs are seen at 40mg/kg and seizures at 60mg/kg. So if you have a 20 pound dog (roughly 10 kg) it would have to eat 400 mg of the toxins to start showing some signs.  So only 1/3 of an ounce of the dry cocoa powder can be dangerous and only one ounce of the cocoa bean hulls in the mulches could do it as well. Less than 1 ounce of milk chocolate per pound of body weight is potentially lethal for dogs. Milk chocolate is nearly 100 times as toxic as white chocolate. Baker's chocolate is SIX TIMES more toxic than milk chocolate. 

A lot of figures, I know but I wanted you to see the comparisons. If your dog decides he likes your dark chocolate candy bar you've been saving in your purse, you very well may have an emergency on your hands. 

 For an article about chocolate intoxication and a chart that includes the amounts of the types of chocolates and caffeine sources click HERE. It's a page on the ASPCA website with articles aimed more for veterinarians. The article is a PDF that will download to your computer if you click on the link.

It's not only the actual amount of chocolate we have to worry about when our pets ingest these kinds of foods. More often than not, the ingestion takes the form of eating candy in wrappers. Those can be just as bad leading to obstructions in the stomach and bowel loops. Even if the mulches are of the variety that have been treated to remove the theobromine, the debris itself could cause an obstruction if enough is eaten.  

What are the clinical signs to look for?

Usually withing six to twelve hours of ingestion you will see the first clinical signs. These include polydipsia (drinking a lot of water), vomiting, diarrhea, bloating and restlessness. If enough of the chocolate has been ingested, the signs can progress to an animal that ends up extremely agitated/hyperactive, urinating a lot, tremors or even seizures.  Other symptoms include high heart rates, arrhythmias, elevated body temperatures, coma and even death.  It's the arrhythmias that can cause death in these patients so it's imperative that you seek immediate veterinary care if your pet gets a hold of any kind of chocolate. It's better to be safe than regret it later.

How is chocolate intoxication treated?

As soon the pet arrives, the veterinary staff will be in motion. Stabilization first involves decontamination of the stomach by inducing vomiting. This will be done only if the patient is stable enough for it to happen. If your dog is seizuring, the induction of vomit will NOT occur. Instead the seizures will be brought under control first. Once more stable then decontamination will occur using stomach tubes to remove as much of the chocolate that remains and to administer activated charcoal without sorbitol. (In the paint ball toxicosis article you will recall that sorbitol is one compound that can cause issues all on it's own. 

If it's been within a two hour period of ingesting the chocolate, emesis (vomiting) will be induced. Trust me, some of the dogs that have come into my clinic after eating chocolate have amazed me with the sheer amount of the stuff in their stomachs. One patient at a box of mint cookies covered in dark chocolate. My treatment room reeked of minty chocolate for hours after that pooch tossed his cookies...pun intended. ;)  

Intravenous fluids, close monitoring of vital signs to make sure elevations of temperature and heart rates don't occur. If the signs do progress, then medications are administered to control seizures and arrhythmias. Usually our patients present early enough that just 12 hours of IV fluids, and monitoring are all that's needed after the decontamination. Activated charcoal is sometimes split into three different doses in order to continue to absorb any chocolate that got into the intestinal tract.  The patients that have the longest recovery are those who are treated after the bad symptoms have already started or they've ingested chocolate that contains other "ingredients" such as marijuana, laxatives, "magic" mushrooms and other recreational drugs. 

So do yourself and your pets a huge favor and lock up all products containing chocolate and caffeine. Even if it's white chocolate containing very little toxin per ounce, it's best to just keep it out of reach. Don't leave any candies out in dishes, Christmas stockings, wrapped under the Christmas tree, in Easter baskets accessible to pets, boxed chocolates on Valentine's Day, or baked goods out where your pets have access.  I know that all seems like common sense, but you'd be surprised by the number of folks who say "my dog never jumps up on the counter. Why would I put the chocolate away?"  Here's another good one, "It's a dog. They don't eat chocolate."  

This is where I usually hear Bill Engvall's "Here's Your Sign" routine.  LOL

#FurbabyFridays: Chocolate Toxicity

Hello and welcome back to my weekly installment of Furbaby Fridays with Dr. Tammy. This week we are counting down to Easter and I thought today would be a great time to remind folks about the dangers of chocolate. This tasty treat comes in all shapes and sizes and formulations whether in cocoa products like candies, cakes , cookies and brownies, but also in cocoa beans and mulches.  The most accidental exposures of pets to chocolate of course occur more around the holidays and Easter is a big one.

Because dogs tend to be the pets that tend to eat just about anything, we don't usually see cats with this toxicity, but there are a few of those pesky felines who pretend they are dogs and ingest some odd things. So to be safe, keep chocolate away from all fur babies.  This includes some cocoa bean hull mulches. Not only do the mulches smell like chocolate Pop Tarts, they are readily available for pet for some pets because of their use in gardens and landscapes. Of course the makers of the mulches will say there has only been one documented death from the ingestion of these kind of mulches, this does not mean that animals are not sick from them. In fact, even Hershey one of the makers of these mulches admit that 50% of dogs who ingest their mulch can get sick from it.  Here's an article by snopes.com that talks a bit more about it.

What makes chocolate toxic to animals?

Methylxanthines are the culprits here, specifically theobromine and caffeine. That's right. There are TWO toxic components in chocolate and each will vary in concentration depending on the type of product. The rule of thumb is the darker the chocolate the higher the amounts of both of these compounds. White chocolate has 0.25mg theobromine per ounce and 0.85mg of caffeine per ounce. In contrast, dry cocoa powder has 737mg theobromine and 70mg of caffeine per ounce.  Now what does that mean? 

Animals can show mild signs after only ingesting 20mg/kg of either theobromine or caffeine. Severe signs are seen at 40mg/kg and seizures at 60mg/kg. So if you have a 20 pound dog (roughly 10 kg) it would have to eat 400 mg of the toxins to start showing some signs.  So only 1/3 of an ounce of the dry cocoa powder can be dangerous and only one ounce of the cocoa bean hulls in the mulches could do it as well. Less than 1 ounce of milk chocolate per pound of body weight is potentially lethal for dogs. Milk chocolate is nearly 100 times as toxic as white chocolate. Baker's chocolate is SIX TIMES more toxic than milk chocolate. 

A lot of figures, I know but I wanted you to see the comparisons. If your dog decides he likes your dark chocolate candy bar you've been saving in your purse, you very well may have an emergency on your hands. 

 For an article about chocolate intoxication and a chart that includes the amounts of the types of chocolates and caffeine sources click HERE. It's a page on the ASPCA website with articles aimed more for veterinarians. The article is a PDF that will download to your computer if you click on the link.

It's not only the actual amount of chocolate we have to worry about when our pets ingest these kinds of foods. More often than not, the ingestion takes the form of eating candy in wrappers. Those can be just as bad leading to obstructions in the stomach and bowel loops. Even if the mulches are of the variety that have been treated to remove the theobromine, the debris itself could cause an obstruction if enough is eaten.  

What are the clinical signs to look for?

Usually withing six to twelve hours of ingestion you will see the first clinical signs. These include polydipsia (drinking a lot of water), vomiting, diarrhea, bloating and restlessness. If enough of the chocolate has been ingested, the signs can progress to an animal that ends up extremely agitated/hyperactive, urinating a lot, tremors or even seizures.  Other symptoms include high heart rates, arrhythmias, elevated body temperatures, coma and even death.  It's the arrhythmias that can cause death in these patients so it's imperative that you seek immediate veterinary care if your pet gets a hold of any kind of chocolate. It's better to be safe than regret it later.

How is chocolate intoxication treated?

As soon the pet arrives, the veterinary staff will be in motion. Stabilization first involves decontamination of the stomach by inducing vomiting. This will be done only if the patient is stable enough for it to happen. If your dog is seizuring, the induction of vomit will NOT occur. Instead the seizures will be brought under control first. Once more stable then decontamination will occur using stomach tubes to remove as much of the chocolate that remains and to administer activated charcoal without sorbitol. (In the paint ball toxicosis article you will recall that sorbitol is one compound that can cause issues all on it's own. 

If it's been within a two hour period of ingesting the chocolate, emesis (vomiting) will be induced. Trust me, some of the dogs that have come into my clinic after eating chocolate have amazed me with the sheer amount of the stuff in their stomachs. One patient at a box of mint cookies covered in dark chocolate. My treatment room reeked of minty chocolate for hours after that pooch tossed his cookies...pun intended. ;)  

Intravenous fluids, close monitoring of vital signs to make sure elevations of temperature and heart rates don't occur. If the signs do progress, then medications are administered to control seizures and arrhythmias. Usually our patients present early enough that just 12 hours of IV fluids, and monitoring are all that's needed after the decontamination. Activated charcoal is sometimes split into three different doses in order to continue to absorb any chocolate that got into the intestinal tract.  The patients that have the longest recovery are those who are treated after the bad symptoms have already started or they've ingested chocolate that contains other "ingredients" such as marijuana, laxatives, "magic" mushrooms and other recreational drugs. 

So do yourself and your pets a huge favor and lock up all products containing chocolate and caffeine. Even if it's white chocolate containing very little toxin per ounce, it's best to just keep it out of reach. Don't leave any candies out in dishes, Christmas stockings, wrapped under the Christmas tree, in Easter baskets accessible to pets, boxed chocolates on Valentine's Day, or baked goods out where your pets have access.  I know that all seems like common sense, but you'd be surprised by the number of folks who say "my dog never jumps up on the counter. Why would I put the chocolate away?"  Here's another good one, "It's a dog. They don't eat chocolate."  

This is where I usually hear Bill Engvall's "Here's Your Sign" routine.  LOL

#FurbabyFridays: Paint Ball Toxicosis in Dogs

I was perusing "Doctor Google" doing additional research for topics I wish to discuss for my Fur baby feature  when I ran into one of the sites that showcase questions answered by regular Joe Schmoes. Occasionally you will see someone who has the credentials answering the questions, but more often than not it's just people giving their two cents.

This time I found a question posted from a person whose dog eats paint balls on a regular basis—a lot of them. You see, they shoot their paint ball guns in their backyard at targets. The dog would then chase those that miss the targets and gulp them down before anyone can stop it. The question this person posed to the group was "Should I be concerned?"

Well, besides the usual "are you an idiot?" answers, there were a few who tried to help. One was a veterinarian who did give the correct information, but a couple of people still weighed in after that response with totally FALSE information although it was coming from the right place and they were genuinely concerned for the dog.

What's the REAL beef with paint balls?

Besides being called "paint" balls, there isn't any actual paint in them at all. Their ingredients vary depending on the manufacturer, but they usually include polyethylene glycol, glycerol/glyerin, gelatin, mineral oil, dye, ground pig skin and water. Many also contain sorbitol. The ingredients highlighted in hot pink are what are of concern here and what can lead to the symptoms associated with paint ball toxicosis. We'll get to that in a moment, but first...

If it's not the PAINT/lead toxicity that's the problem, what is?

Polyethylene glycol, glycerin and sorbitol are all what we refer to as osmotically active agents.  In other words, they pull water from the body's tissues and into the bowels. When this happens, it throws off the electrolyte balance of the body. The most worrisome change would be hypernatremia...elevated sodium levels. It's when this occurs rapidly, like when eating large numbers of paint balls or chronically ingesting them, that we get the problems. The organ most affected by the high sodium is the brain. With rapid removal of the water from the brain cells, you will see a rapid decrease in brain volume, cerebral vessels may rupture causing hemorrhage. This in turn leads to the various neurological signs listed in the next section.

Click HERE to read about one pet owner's experience dealing with paint ball toxicosis in her beloved dog, Lilly.

Special note! The contents of the paint balls are nontoxic to humans with skin contact, BUT they are not intended for consumption by people or animals. So it's best to avoid doing that for any and all species. There are reports of many of these balls being left in wooded areas where wildlife can ingest them. The tell tale signs are the rainbow colored vomit and feces. It's imperative that these forms of "ammo" be contained and properly disposed of for all concerned.

What are the clinical signs of paint ball toxicosis?

Symptoms can occur shortly after ingestion but sometimes can take several hours to become evident. In the case of chronic ingestion of a ball or two at at time, we may not see these signs at all. The body can compensate and correct the abnormalities if there are very little in the system at a time. Unfortunately, with our fur babies, this is usually NOT the case and the amount eaten can be quite large. Some of the containers have hundreds of them. Now add in those left in yards and paint ball game areas, and the number can easily grow exponentially.

Here's the list of the most commonly seen symptoms

1. vomiting and diarrhea with or without the technocolor
2. weakness
3. blindness
4. increased heart rate
5. fever or even low body temperature
6. seizures
7. coma
8. death

How do you treat it?

The dogs must be hospitalized for a minimum of twenty-four hours. If it has been less than one hour after the ingestion, vomiting will be induced. After the first hour, there will be multiple warm water enemas. This serves two purposes. The first is to help promote the passage of the paint balls and the second is to help replace the water the balls continue to pull out of the body the longer they are present in the intestines.

Other supportive therapy will depend on the clinical signs exhibited. These include intravenous fluids, anti-nausea medications, anti-seizure medications, and close monitoring of blood gas and electrolytes. Most patients will recover within 24-48 hours if supportive care is implemented immediately. Paint ball toxicosis can be fatal, so instead of spending time online asking non-veterinary personnel if your dog's habit of eating paint balls should be of concern, call your veterinarian or a veterinary emergency hospital immediately. It could very well mean the difference between life and death for your fur baby. 

Dr. Tammy Talks About Grape and Raisin Toxicity for #FurbabyFridays

The day got away from me and I nearly forgot to continue with the next part in the common pet toxin series. Last week, garlic and onions took center stage. This week it's grapes and their shriveled sweet counterparts, raisins.

For many years people have used raisins for training treats in all species, especially dogs. It wasn't until 1989 that the veterinary community started to notice a trend. Around that time, more cases of acute kidney failure were being reported in dogs who had either eaten grapes or raisins. At that time the Animal Poison Control Center didn't have any idea why these dogs were getting sick from these kinds of fruit, but they continued to collect the data and search for any and all common factors and trends. To this day, there haven't been any breakthroughs. Whether the grapes were fresh from the vine, sold in stores as organic or not, with or without seeds, or different colors, the outcome was still the same. SOME dogs who ingested enough grapes and raisins for their body developed kidney failure. A few never recovered. Most made it after aggressive intervention and therapy.

Anywhere from 24 hours to several days after the dogs eat grapes or raisins, veterinarians can detect abnormalities in blood tests. Consistently they would find hypercalcemia (elevated calcium levels), elevated blood urea nitrogen, creatinine and phosphorus. These all point to damage to the kidneys. At this point in time, you can't tell if it's irreversible. The animal must be treated with aggressive fluid therapy to help flush the kidneys and maybe the remaining toxin out of the system.

How can you tell if your dog ate grapes or raisins?

Many will have vomiting within a few hours of ingesting them and have bits or whole fruit present in the vomitus. This kind of evidence definitely helps you determine that your pet needs immediate attention by your veterinarian or local veterinary emergency facility.

If you are in the majority of pet owners, you won't see the initial symptoms but would see anorexia and probably diarrhea. Fast on the heals of that would find the dogs developing lethargy and signs of abdominal pain: stretching out like in a praying or downward dog yoga position. There have been cases where these symptoms have gone on for several days or even weeks.

Why do these dog's become so ill?

No one knows. They've tested for pesticides, heavy metals, mycotoxins (fungal contaminants)...anything that could be a common link between the cases and still NOTHING. All tests have come up negative. Even grapes that have been privately grown without any insecticides, fertilizers or antifungals used on the plants or fruit have been involved in these toxicities.

Is any amount of grapes or raisins considered below the toxic level?

At this point in time, that is also an unknown. We do know that since raisins are dried grapes and felt to be more concentrated, it would take less raisins to make a dog sick. Researchers have come up with some general guidelines, but again all patients are different. They don't all follow the "rules" so any grape or raisin ingestion is best to be avoided.

It looks like 0.5 OUNCES of grapes per pound of the dog's body weight would be enough to cause symptoms. So it would take 5 ounces of grapes to make a 10 pound dog sick. It would take as little as 2 ounces of raisins or one of those little snack size packages to make the same sized dog ill.

What about other animals? Do they get the same symptoms?

So far it's only seen in dogs, but when I practiced in Michigan and still saw ferrets (before I became highly allergic!) we did start telling those owners to not feed grapes or raisins to them just to be safe. I never had a confirmed case of kidney failure from grapes or raisins in a ferret and haven't seen any in the literature. 

As for cats...well, they make up their own rules about everything. Most cats won't eat a grape or raisin if their life depended on it. Unfortunately so many other things end up being toxic to cats that it's just best to NOT have these fruits out for them to try. The feline doesn't need any other excuse to get kidney failure than it already has! Sure, we can giggle about that, but it's true. Cats are so much more sensitive to toxicities than their canine counterparts. 

So just keep the grapes and raisins for the humans in your family and away from your furbabies. This includes juices, cookies, fruit bars, cakes and breads with these fruits too. Wine is another story altogether and will be covered in alcohol toxicity.  For now, I'll leave you with a way your furry friends CAN enjoy raisins. 

Enjoy!

Dr. Tammy