Case Description:

Our patient is a two year old spayed mixed breed female dog. She is mostly a house dog with very little exposure to other environments or pets.  The owner was home with her dog when she suddenly vomited several times and collapsed.  She was presented as an emergency to ALTA MESA ANIMAL HOSPITAL and quickly assessed.  On Physical Examination she was found to be in shock and was started on IV fluids to help stabilize her condition.  Whole body radiographs were taken and no cause was identified.  Complete in-house blood count and chemistry revealed an extremely elevated liver value at roughly 20 times above a normal value and low blood platelets.  Potential causes at this point included toxins, liver or other organ torsion and unknown trauma.  An ultrasound was completed within hours of her arrival and her gall bladder was found to be extremely thickened and her liver somewhat abnormal.  That night, she was sent to ARECA (Animal Referral & Emergency Center of Arizona) for overnight care and further diagnostics.  The doctors at ARECA first helped to further stabilize her with IV plasma to aid her blood to clot normally and they then completed an exploratory surgery with a liver biopsy and gall bladder removal.  The organs were sent in for histopathology.  The liver was found to contain wide spread cellular necrosis and the gall bladder was thickened due to hemorrhage.  Our patient was kept in hospital for several additional days for supportive care and was released to the owner's care approximately 1 week later. Upon reviewing the histopathology with the owner a potential cause of xylitol was discussed and the owner did advise that the pet had been chewing on one stick of sugar free gum some time that week but she had not connected this with any potential toxin as the owner assumed this was safe.  The presumptive diagnosis was xylitol toxicity.  Based on the diagnosis the owner's other dog was brought in to have her liver enzymes screened because this dog had potentially gotten into the gum as well, but thankfully, her testing was normal.