Did your pet eat something toxic?

Mystery Diagnosis – By Dr. Carrie Davis

A dog presented to the ER after the owner returned home from work to find her abnormal.  She was indoor and the only animal in the house.  She seemed normal that morning before the owner left for work.  Now, she smelled like alcohol (booze), was stumbling, falling over, acting drunk, was burping and had flatulence.  The owner does not know what she could have gotten in to.

a-Drunk (alcohol ingestion)
b-Antifreeze poisoning
c-Bread dough ingestion
d-Marijuana ingestion
e-Mushroom ingestion

Upon questioning the owner, there was no alcohol available.  There were no illegal drugs in the house and no medications she had exposure to.  She only goes out in a fenced yard when the owners are home.  The owner reported that her husband had made bread the night before, but she had no idea how the dog could have been exposed to the dough, or when.

On physical exam, I found a gooey white substance on the rectal exam.

Answer:  C, Bread dough ingestion

Explanation:  Bread dough ingestion can cause ethanol toxicosis (alcohol toxicity).  During the process of rising, yeast produces ethanol.  Internal body temperature (while in the stomach and small intestines) causes the dough to rise rapidly, producing more and more ethanol.   This ethanol is rapidly absorbed from the gastrointestinal tract, making the dog “drunk”.   Alcohol is metabolized in the liver by an enzyme.  This enzyme limits the breakdown of alcohol, so the duration of symptoms will vary.

Ingesting bread dough is an emergency which should be evaluated by your veterinarian.  In addition to the “drunk” behavior, other severe complications are possible.  Because dough expands, enlarges and produces gas, severe complications are possible such as obstruction, GDV (bloat and twist of the stomach), and even rupture of the stomach.   Severe mental depression can occur such that the dog is unable to protect their airway and aspirate any vomit they may produce.  Further, they can literally have severe sedation and difficulty breathing.  Low body temperatures, low blood sugar and muscle tremors are possible complications.   There are metabolic toxins produced with the breakdown of alcohol, as well.

Depending on the timing of ingestion, your vet may decontaminate (vomiting or stomach pump), administer charcoal (if safe, they must be alert enough to not aspirate!), perform blood work, hospitalize on IV fluids and supportive care. We monitor the blood sugar, metabolic stability, body temperature, ECG, electrolytes and breathing/awareness.  We may try to increase the metabolism of the alcohol with IV dextrose (sugar), warming the body and liver support medication.

Do NOT induce vomiting at home.  Your dog should first be evaluated for safety of the airway/alertness and ability to vomit safely.  Also, timing of ingestion (if it is not in the stomach, vomiting will not help).  Any history of vomiting or retching will also direct our treatment plan.  If your dog is retching with no production of vomit, then it is not safe to induce vomiting.  We may advise radiographs prior to any further treatment and then to decontaminate with a stomach pump.

Outcome:  This dog did great.  She was fully recovered in about 15-18 hours of supportive care.  She had blood work, radiographs, charcoal administered and was supported with heat to maintain a normal body temperature and IVF with dextrose.  Her ingestion was chronic and the dough was not in the stomach any longer.  So, vomiting or decontamination was not needed.  However, she still required supportive care.

The prognosis for ingestion of bread dough is excellent if treated promptly.

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