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Xylitol poisoning in dogs: blood sugar and liver tests

Xylitol is a sweetener found in sugar-free gum, sweets and some peanut butters. It is safe for people but dangerous for dogs. It can make blood sugar crash quickly and, in some dogs, damage the liver. Blood tests over the following hours and days show how the dog is coping.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

In dogs, xylitol triggers a large release of insulin, and blood sugar can fall within 10 to 60 minutes. Some dogs then develop liver injury, seen as a rise in ALT and bilirubin, sometimes with low platelets and clotting problems. Vets follow blood glucose closely for at least 12 hours and liver values for at least 3 days. Dogs with low blood sugar alone usually do well with prompt care; dogs with liver failure have a guarded outlook. If your dog eats a product that may contain xylitol, contact your vet or a pet poison center right away, whatever the amount.

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Why xylitol is dangerous for dogs

Xylitol is a sugar alcohol used to sweeten sugar-free products. It is also sold as birch sugar or wood sugar [2]. In people it does not trigger insulin release, but in dogs it is absorbed quickly and causes a strong release of insulin from the pancreas [2]. Dogs are the only domestic species in which xylitol poisoning has been reported [1].

In an experimental study, insulin rose from 20 minutes after dogs swallowed xylitol, peaked at 40 minutes, and blood glucose started to fall at 30 minutes [3]. Why the liver is sometimes damaged is still unclear [1].

  • Where it hides: sugar-free gum, sweets and mints, baked goods, some peanut and nut butters, toothpaste and mouthwash, chewable vitamins, supplements, cough syrup and some medicines [1, 2].
  • How to check: read the ingredient list of anything labeled “sugar-free” or “low sugar” [1, 2]. Use only pet toothpaste for your dog [2].

What to do and when signs appear

If your dog has eaten something that may contain xylitol, call your vet, an emergency clinic or a pet poison center right away, even if your dog seems fine [2]. Do not try to make your dog vomit at home: because blood sugar can drop fast, vets advise doing it only under veterinary supervision [1].

Studies have reported low blood sugar above roughly 100 mg of xylitol per kg of body weight, and severe liver injury in some dogs above roughly 500 mg/kg [1]. But in a 2025 study of 95 dogs, the dose eaten did not predict which dogs developed liver changes [6]. Product contents vary, so contact your vet or a poison center immediately, whatever the amount.

  • Low blood sugar: can occur within 10 to 60 minutes [2]. Signs may be delayed up to 12 to 18 hours with some gum products, which slow absorption [1].
  • Liver enzymes: often rise within 4 to 12 hours, while signs of liver injury may only show after 24 to 48 hours or more [1].
  • Signs to watch: vomiting first, then weakness, staggering, collapse or seizures [2].

What the blood work shows

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
GLU Glucose45mg/dL76–119L
  1. Abbreviation GLU or glucose: the first value followed after xylitol [1].
  2. Result 45 mg/dL in this illustrative line: clearly low. In a study of 192 dogs, hypoglycemia was defined as 60 mg/dL or less [5].
  3. Unit mg/dL in the US; mmol/L in Europe: 45 mg/dL ≈ 2.5 mmol/L (÷ 18).
  4. Laboratory interval The example uses the dog interval of the Merck Veterinary Manual [10]; each laboratory sets its own.
  5. Flag L: below the interval. After xylitol, a normal first value does not end the watch: glucose fell after arrival in most dogs [5].

Unit converter

Equivalent values

  • Glucose, mmol/L–
  • Glucose, g/L–

Conversion only changes the unit. Compare the result with the interval printed by the laboratory that measured it.

Changes reported after xylitol ingestion. Not every dog has all of them.
TestWhat can be foundWhat it means
GlucoseLow, sometimes very lowExcess insulin; the main early danger [1, 3]
PotassiumLowReported after xylitol; low potassium at arrival was linked to later liver changes [1, 6]
PhosphorusLow early; high with liver failureLow values reported after xylitol; high values in dogs with liver failure [1, 3, 4]
ALT and ASTHighLeak from injured liver cells [1, 3]
BilirubinHighLiver injury, sometimes with jaundice [1, 4]
Platelets and clotting timesLow platelets, long clotting timesSeen with severe liver injury; risk of bleeding [4]

Not every dog with liver injury had low blood sugar first, possibly because glucose can rebound after an insulin surge [1]. Read liver results with high liver enzymes in dogs.

How dogs are monitored

  • Blood glucose: the Merck Veterinary Manual describes checks every 1 to 2 hours for at least 12 hours. Low blood sugar can last 24 hours or more [1].
  • Liver values: ALT and other liver tests every 24 hours for at least 72 hours [1].
  • Electrolytes: potassium and phosphorus, which can be low after xylitol [1, 3, 7].
  • Clotting tests and platelet count: if liver values rise, to look for a bleeding risk [4, 7].

In one well-documented case, low blood sugar appeared within 1 to 2 hours, liver values rose within 12 hours and clotting problems within 24 hours. The dog recovered and its liver values were normal within a month [9].

Outlook

The outlook is generally good for dogs that only have low blood sugar and are treated promptly [1, 7, 8]. In 192 dogs seen at three university hospitals, 30 became hypoglycemic and 30 had a rise in ALT or bilirubin. All survived to discharge [5]. In the 2025 study of 95 dogs, about half (49.5%) developed liver changes, but none developed liver failure [6].

Liver failure is rare but serious. In the first report of 8 dogs with liver failure, 5 had bleeding and 5 died or were euthanized [4]. Mild rises in liver enzymes usually settle within a few days [1].

Related articles

Blood sugar in dogs

Normal glucose levels and what a low result means.

Read the article

Low platelets in dogs

What a low count means and the bleeding signs to watch.

Read the article

Other foods toxic to dogs: grapes and raisins and onions and garlic.

En français : xylitol et chien.

Questions to ask your veterinarian

  1. Is my dog’s blood glucose low, and how often will it be checked?
  2. How long should my dog stay in hospital for monitoring?
  3. Are potassium and phosphorus normal?
  4. Are ALT and bilirubin rising, and when will they be rechecked?
  5. Are the platelet count and clotting times normal?
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Frequently asked questions

My dog ate gum with xylitol. What should I do?

Call your vet, an emergency clinic or a pet poison center right away, even if your dog seems fine, whatever the amount [2]. Low blood sugar can start within 10 to 60 minutes, and with some gums signs can be delayed by 12 to 18 hours [1, 2].

What peanut butter has xylitol?

Some peanut and nut butters contain xylitol. Check the ingredient list before giving any nut butter to your dog, especially products labeled sugar-free [2].

What is the downside of xylitol in dogs?

In dogs, xylitol causes a strong insulin release that can make blood sugar crash. Some dogs also develop liver injury, and rarely liver failure with bleeding problems [1, 4].

Is xylitol dangerous for cats?

Xylitol poisoning has only been reported in dogs among domestic species. Cats do not appear to be at risk of low blood sugar or liver injury [1].

Can a dog survive xylitol poisoning?

Yes, most do. In 192 dogs treated in university hospitals, all survived to discharge [5]. The outlook is guarded when liver failure develops [1, 4].

Sources

  1. Hayes C. Xylitol Toxicosis in Dogs. Merck Veterinary Manual, reviewed 2024. merckvetmanual.com/toxicology/food-hazards/xylitol-toxicosis-in-dogs
  2. U.S. Food and Drug Administration. Paws Off Xylitol; It’s Dangerous for Dogs. Consumer Update. fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs
  3. Xia Z et al. Experimental acute toxicity of xylitol in dogs. J Vet Pharmacol Ther. 2009;32(5):465-469. doi.org/10.1111/j.1365-2885.2009.01065.x
  4. Dunayer EK, Gwaltney-Brant SM. Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. J Am Vet Med Assoc. 2006;229(7):1113-1117. doi.org/10.2460/javma.229.7.1113
  5. DuHadway MR et al. Retrospective evaluation of xylitol ingestion in dogs: 192 cases (2007-2012). J Vet Emerg Crit Care. 2015;25(5):646-654. doi.org/10.1111/vec.12350
  6. Lovell T et al. Retrospective Evaluation of the Incidence and Risk Factors Associated With the Development of a Hepatopathy in Xylitol Ingestion: 95 Dogs (2018-2022). J Vet Emerg Crit Care. 2025;35(5):571-576. doi.org/10.1111/vec.70041
  7. Murphy LA, Coleman AE. Xylitol toxicosis in dogs. Vet Clin North Am Small Anim Pract. 2012;42(2):307-312. doi.org/10.1016/j.cvsm.2011.12.003
  8. Murphy LA, Dunayer EK. Xylitol Toxicosis in Dogs: An Update. Vet Clin North Am Small Anim Pract. 2018;48(6):985-990. doi.org/10.1016/j.cvsm.2018.06.004
  9. Schmid RD, Hovda LR. Acute Hepatic Failure in a Dog after Xylitol Ingestion. J Med Toxicol. 2016;12(2):201-205. doi.org/10.1007/s13181-015-0531-7
  10. Merck Veterinary Manual. Serum biochemical analysis reference ranges. merckvetmanual.com/reference-values-and-conversion-tables/reference-guides/serum-biochemical-analysis-reference-ranges

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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