What decontamination and treatment steps should I follow for a dog that ingested xylitol?

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Immediate GI decontamination is the priority in xylitol ingestion, followed by inpatient glucose monitoring and hepatic support. Dogs that have emesis induced are less likely to develop hepatopathy than those in which emesis is not induced, making early decontamination a critical intervention.1 Induce emesis as soon as possible after ingestion if the dog is not yet symptomatic.2 Dogs that presented with clinical signs prior to veterinary evaluation were 1.95 times more likely to develop hepatopathy than those without pre-presentation signs, reinforcing that speed of decontamination matters.1 Activated charcoal is not reliably effective for xylitol and is not a standard recommendation for this toxicosis.2 After decontamination, hospitalize for intravenous (IV) glucose supplementation and serial blood glucose (BG) monitoring. Hypoglycemia is defined at a BG ≤ 3.3 mmol/L (60 mg/dL), and BG drops in most dogs following presentation — the initial BG at presentation does not reflect the nadir.3 Dextrose supplementation should be titrated to maintain euglycemia.2 Monitor potassium closely: hypokalemia on presentation is independently associated with development of hepatopathy, and the clinical syndrome includes hypokalemia and hypophosphatemia alongside hypoglycemia.14 Electrolyte abnormalities should be corrected with IV supplementation as needed.4 Hepatic injury develops in approximately 49.5% of dogs following xylitol ingestion, and liver enzyme monitoring (alanine aminotransferase, total bilirubin) is essential throughout hospitalization.13 Dogs with elevated liver values had a significantly lower nadir BG, so the degree of hypoglycemia correlates with hepatic injury risk.3 Hepatic support should be initiated in dogs showing enzyme elevation.4 Acute hepatic failure can be associated with coagulopathy, which warrants monitoring and management if present.5 Prognosis is excellent for dogs that develop uncomplicated hypoglycemia without hepatic failure. All dogs in one coh