Grape toxicity in dogs

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The consumption of grapes and raisins presents a potential health threat to dogs. Their toxicity to dogs can cause the animal to develop acute kidney injury (the sudden development of kidney failure) with anuria (a lack of urine production). The phenomenon was first identified by the Animal Poison Control Center (APCC), run by the American Society for the Prevention of Cruelty to Animals (ASPCA). Approximately 140 cases were seen by the APCC in the one year from April 2003 to April 2004, with 50 developing symptoms and seven dying. [1]

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It is not clear that the observed cases of kidney failure following ingestion are due to grapes only. Clinical findings suggest raisin and grape ingestion can be fatal, but the mechanism of toxicity is still considered unknown. [2]

Cause and pathology

The reason some dogs develop kidney failure following ingestion of grapes and raisins is not known. [3] Types of grapes involved include both seedless and seeded, store-bought and homegrown, and grape pressings from wineries. [4] A mycotoxin is suspected to be involved, but none has been found in grapes or raisins ingested by affected dogs. [5] The dose-response relationship has not been determined, [2] but one study estimated 3 g/kg or greater for grapes or raisins. [6] An April 2021 letter to the editor of JAVMA hypothesized that the tartaric acid in grapes could be the cause. [7] The most common pathological finding is proximal renal tubular necrosis. [8] In some cases, an accumulation of an unidentified golden-brown pigment was found within renal epithelial cells. [6]

Clinical signs and diagnosis

Vomiting and diarrhea are often the first clinical signs of grape or raisin toxicity. They often develop within a few hours of ingestion. Pieces of grapes or raisins may be present in the vomitus or stool. Further symptoms include weakness, not eating, increased drinking, and abdominal pain. Acute kidney failure develops within 48 hours of ingestion. [5] A blood test may reveal increases in blood urea nitrogen (BUN), creatinine, phosphorus, and calcium.

Treatment

Emesis (induction of vomiting) is the generally recommended treatment if a dog has eaten grapes or raisins within the past two hours. A veterinarian may use an emetic such as apomorphine to cause the dog to vomit. Further treatment may involve the use of activated charcoal to adsorb remaining toxins in the gastrointestinal tract and intravenous fluid therapy in the first 48 hours following ingestion to induce diuresis and help to prevent acute kidney failure. [9] Vomiting is treated with antiemetics and the stomach is protected from uremic gastritis (damage to the stomach from increased BUN) with H2 receptor antagonists. BUN, creatinine, calcium, phosphorus, sodium, and potassium levels are closely monitored. Dialysis of the blood (hemodialysis) and peritoneal dialysis can be used to support the kidneys if anuria develops. Oliguria (decreased urine production) can be treated with dopamine or furosemide to stimulate urine production. [2]

The prognosis is guarded in any dog developing symptoms of toxicosis. A negative prognosis has been associated with oliguria or anuria, weakness, difficulty walking, and severe hypercalcemia (increased blood calcium levels). [8] In cases where an animal is azotaemic the survival rate is approx.50%. [10]

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Azotemia, also spelled azotaemia, is a medical condition characterized by abnormally high levels of nitrogen-containing compounds in the blood. It is largely related to insufficient or dysfunctional filtering of blood by the kidneys. It can lead to uremia and acute kidney injury if not controlled.

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<span class="mw-page-title-main">Uremia</span> Excess urea in the blood due to kidney dysfunction

Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which would normally be excreted in the urine. Uremic syndrome can be defined as the terminal clinical manifestation of kidney failure. It is the signs, symptoms and results from laboratory tests which result from inadequate excretory, regulatory, and endocrine function of the kidneys. Both uremia and uremic syndrome have been used interchangeably to denote a very high plasma urea concentration that is the result of renal failure. The former denotation will be used for the rest of the article.

Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. In those with greater levels or rapid onset, symptoms may include abdominal pain, bone pain, confusion, depression, weakness, kidney stones or an abnormal heart rhythm including cardiac arrest.

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References

  1. ↑ "ASPCA Animal Poison Control Center Issues Nationwide Update: Raisins and Grapes Can Be Toxic To Dogs". ASPCA. July 6, 2004. Archived from the original on April 7, 2007. Retrieved February 13, 2007.
  2. 1 2 3 "Food Hazards: Raisins/grapes". The Merck Veterinary Manual. 2006. Retrieved February 13, 2007.
  3. ↑ "Grape and Raisin Toxicity in Dogs | VCA Animal Hospitals" . Retrieved 11 December 2015.
  4. ↑ McKnight, Katrina (February 2005). "Grape and Raisin Toxicity in Dogs" (PDF). Veterinary Technician: 135–136. Archived from the original (PDF) on December 6, 2006. Retrieved February 13, 2007.
  5. 1 2 Mazzaferro, Elisa M. (2006-01-11). "Doc, What did He Get Into? Emergency Approach to Toxins". Proceedings of the North American Veterinary Conference. Retrieved 2016-06-30. (Requires registration.)
  6. 1 2 Morrow, C. M. K.; Valli, V. E.; Volmer, P. A.; Eubig, P. A. (2005). "Canine Renal Pathology Associated with Grape or Raisin Ingestion: 10 Cases". Journal of Veterinary Diagnostic Investigation. 17 (3): 223–31. doi: 10.1177/104063870501700302 . PMID   15945377.
  7. ↑ McReynolds, Tony (April 1, 2021). "What causes grape toxicity in dogs? Playdough might have led to a breakthrough". American Animal Hospital Association.
  8. 1 2 Eubig P, Brady M, Gwaltney-Brant S, Khan S, Mazzaferro E, Morrow C (2005). "Acute renal failure in dogs after the ingestion of grapes or raisins: a retrospective evaluation of 43 dogs (1992–2002)". Journal of Veterinary Internal Medicine. 19 (5): 663–74. doi:10.1892/0891-6640(2005)19[663:ARFIDA]2.0.CO;2. PMID   16231710.
  9. ↑ "News and Views". Veterinary Forum. 23 (1). Veterinary Learning Systems: 12. January 2006.
  10. ↑ Reich, Colin F.; Salcedo, Mallory C.; Koenigshof, Amy M.; Hopp, Molly M.; Walker, Julie M.; Schildt, Julie C.; Beal, Matthew W. (2019-11-12). "Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005–2014): 139 cases". Journal of Veterinary Emergency and Critical Care. 30 (1). Wiley: 60–65. doi: 10.1111/vec.12905 . ISSN   1479-3261.
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