Grape and Raisin Toxicity in Dogs

Erin Connolly, DVMGrand Rounds

March 21, 2013

OverviewSpecific mechanism is unknownNot definitely known to be dose-

related Toxic dose for dogs: 0.7 oz/kg for grapes Toxic dose for dogs: 0.1 oz/kg for raisinsSome dogs may show no adverse

signsReports of cats and ferrets

developing signsSigns have been seen with currant

ingestion

Clinical SignsLethargyAnorexiaVomiting Diarrhea Acute renal failure

(ARF)

EtiologyMycotoxins or pesticide residuesInability to metabolize a component of the fruitOrganic, homegrown, seedless, seeded

NephrotoxicGrapeseed extract has not been shown to be

toxic

Metabolism

Not rapidly broken down or absorbedMay be seen intact several hours after

ingestionMetabolism and excretion suspected within

kidneys

Systems AffectedRenal/urologicGastrointestinalHepatobiliaryEndocrine/metabolicNeuromuscular

Signalment and HistoryAny age, sex, and breed of dogPreexisting renal disease is a risk factorWitnessed or suspected ingestionVomiting within 24 hours following

ingestionAnorexia, lethargy, and diarrhea follow

Clinical FindingsPhysical exam: Dehydration, lethargy, uremic

breathElevated creatinine, phosphorus, BUNHypercalcemia and hyperphosphatemia

mineralizationElevated serum calcium levelsDecreased urine outputOliguric or anuric renal failure: -Hyperkalemia, metabolic acidosis, hypertension

Differential DiagnosesARFDrug/toxicities: NSAIDs, AGs, ethylene glycolRenal ischemia: Hypovolemia, trauma,

sepsis/SIRSSystemic: leptospirosis, pyelonephritis, neoplasia

Differential DiagnosesVomitingDietary indiscretion, foreign body, infectious disease, pancreatitis, pancreatitis, Addison’s disease

HypercalcemiaHyperparathyroidism, Cushing’s disease, rodenticide

DiagnosticsCBC

Mild anemiaThrombocytopenia

ChemistryElevated BUN and creatinineElevated liver enzymesElevations in amylase/lipaseDecreased TCO2Electrolyte abnormalities

DiagnosticsUrinalysisIsosthenuria/hyposthenuria, proteinuria, glucosuria

RadiographyGenerally WNL, may appreciate soft tissue mineralization

Abdominal UltrasonographyRenomegaly, hyperechoic renal cortices, pelvic dilation

Pathological FindingsModerate to severe renal tubular necrosisProteinaceous debris within damaged renal tubules Intact basement membranes

Therapeutics

1. Decontamination2. Supportive care3. Monitoring

DecontaminationEmesisRisk for aspiration pneumoniaActivated charcoalRepeated doses not currently recommended Assess hydration and serum sodium levels

Supportive CareIV fluid therapy for asymptomatic patientsDiuresis preserves renal blood flow, increases

excretionGastric protectants and antiemeticsCritically ill patients may require dialysis

Supportive Care

CRI: Dopamine, furosemide, mannitol

Antihypertensive therapyOral phosphate binders

Monitoring Renal valuesPotassiumBlood pressureUrine outputCVP

DietEncourage patient to eat normallyLow-protein, low-phosphorus diet

Expected Course and PrognosisPrognosis good to poor depending on clinical

signsPet Poison Hotline: 500 cases between 2004-

2009Overall, prognosis good with aggressive

therapy ASPCA: Poorer prognosis if vomiting for 24-48

hours prior to presentation

Expected Course and PrognosisFor more than 50% of dogs that ingest

grapes or raisins, there will be minimal to no clinical signs

For patients with fulminant ARF, prognosis is poor to grave

Long TermMost will have no long-term renal

insufficiencyLong-term follow-up in veterinary studies

has not been evaluated

“Emma”9-year-old FS Bichon FriseExposure to trail mix containing raisinsDistended abdomen, otherwise normal

afterwardThe next morning, continued abdominal

distension, ataxia, and lethargyNo previous medical problems

Physical ExaminationWt: 8.6 kg, T: 101.7, P: 108, R: 72Quiet and depressed, disoriented, ataxic Abdominal distension with slightly

tympanic stomach, uncomfortable on palpation

Diagnostics and TreatmentAbdominal radiographsInduced emesisVomitus contained large amount of peanuts

and 22 raisinsChemistry/electrolytes: All values WNL

Diagnostics and TreatmentASPCA consulted: -Ataxia is sometimes reported -IV fluid diuresis: 2x maintenance for 48 hours -Recheck chemistry profile in 48 hours -Prognosis good to guarded150 mL bolus LRS, then 40 mL/hr IV60 mL activated charcoal with sorbitol PO

21 hours post-admissionBright and interactive, ataxia resolvedAdequately hydratedAbdomen relaxed and comfortableAte baby food wellUrinating wellChemistry panel: All values WNLTransfer to RDVM for continued care

Questions?

References available upon request