Chocolate Ingestion
Posted: Wednesday, September 13th, 2023 | Updated: Wednesday, September 13th, 2023
Posted: Wednesday, September 13th, 2023 | Updated: Wednesday, September 13th, 2023
General Information:
Chocolate comes in multiple forms such as 100% cocoa, dark, milk, and white. Each type of chocolate presents with varying levels of toxicity. Dark chocolate and 100% cocoa contain the most amount of toxins as compared to milk or white which usually contain far less. The toxic compounds in chocolate are known as methylxanthines (theobromine and caffeine). These compounds stimulate the release of catecholamines. Increased levels of catecholamines within the body may result in hypertension, tachycardia, anxiety, muscle tremors, and hyperactivity. Gastrointestinal irritation and pancreatitis may be seen as well, especially if the chocolate contains a large amount of fat. Generally, clinical signs of chocolate toxicity may begin up to 8 hours after ingestion and last up to 12-72 hours. Methylxanthines may be reabsorbed through the bladder wall, so it's often the case that patients be walked more frequently to encourage urination. The ingestion of chocolate does have the possibility to lead to collapse, seizures, coma, and/or death when not treated. It's important to note that chocolate ingestion may be accompanied by foreign material ingestion (packaging) and/or xylitol ingestion. Treat each case separately. Activated charcoal is being used less frequently with chocolate toxicity due to the added osmotic effects. Methlyxanthines may act as a diuretic and chocolate may have osmotic properties when containing sugar. Therefore, activated charcoal is best suited for those patients who have ingested toxic levels of chocolate where emesis of the material has not been successful. Chocolate tends to take a longer time to digest, so emesis is usually warranted even greater than 2-4 hours post ingestion
Chocolate comes in multiple forms such as 100% cocoa, dark, milk, and white. Each type of chocolate presents with varying levels of toxicity. Dark chocolate and 100% cocoa contain the most amount of toxins as compared to milk or white which usually contain far less. The toxic compounds in chocolate are known as methylxanthines (theobromine and caffeine). These compounds stimulate the release of catecholamines. Increased levels of catecholamines within the body may result in hypertension, tachycardia, anxiety, muscle tremors, and hyperactivity. Gastrointestinal irritation and pancreatitis may be seen as well, especially if the chocolate contains a large amount of fat. Generally, clinical signs of chocolate toxicity may begin up to 8 hours after ingestion and last up to 12-72 hours. Methylxanthines may be reabsorbed through the bladder wall, so it's often the case that patients be walked more frequently to encourage urination. The ingestion of chocolate does have the possibility to lead to collapse, seizures, coma, and/or death when not treated. It's important to note that chocolate ingestion may be accompanied by foreign material ingestion (packaging) and/or xylitol ingestion. Treat each case separately. Activated charcoal is being used less frequently with chocolate toxicity due to the added osmotic effects. Methlyxanthines may act as a diuretic and chocolate may have osmotic properties when containing sugar. Therefore, activated charcoal is best suited for those patients who have ingested toxic levels of chocolate where emesis of the material has not been successful. Chocolate tends to take a longer time to digest, so emesis is usually warranted even greater than 2-4 hours post ingestion
Cases of Chocolate Ingestion
Patient #1: Young Male Canine
Presentation: Sinus tachycardia, febrile, anxiety, vomiting, ate a couple of dark chocolate Hershey kisses with the foil greater than two hours prior to presentation
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG
Diagnosis: Chocolate ingestion
Treatment Included: Supportive care and monitoring at home. The patient received anti-nausea (cerenia) and subcutaneous fluid therapy. Induction of vomiting did not occur because the patient had already been vomiting previously
Presentation: Sinus tachycardia, febrile, anxiety, vomiting, ate a couple of dark chocolate Hershey kisses with the foil greater than two hours prior to presentation
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG
Diagnosis: Chocolate ingestion
Treatment Included: Supportive care and monitoring at home. The patient received anti-nausea (cerenia) and subcutaneous fluid therapy. Induction of vomiting did not occur because the patient had already been vomiting previously
Patient #2: Young Female Canine
Presentation: Sinus tachycardia, high normal temperature, anxiety, ate a large brownie with chocolate chips two hours prior
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG
Diagnosis: Chocolate ingestion
Treatment Included: Induction of vomiting (apomorphine) with supportive care and monitoring at home. The patient received anti-nausea (cerenia) and subcutaneous fluid therapy
Presentation: Sinus tachycardia, high normal temperature, anxiety, ate a large brownie with chocolate chips two hours prior
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG
Diagnosis: Chocolate ingestion
Treatment Included: Induction of vomiting (apomorphine) with supportive care and monitoring at home. The patient received anti-nausea (cerenia) and subcutaneous fluid therapy
Patient #3: Young Female Canine
Presentation: Sinus tachycardia, febrile, anxiety, ate Godiva dark chocolates containing xylitol at an unknown time
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG, bloodwork
Diagnosis: Chocolate and xylitol ingestion
Treatment Included: Induction of vomiting (apomorphine) with supportive care. The patient received anti-nausea medication (cerenia), activated charcoal for the chocolate ingestion, intravenous fluid therapy (LRS) at 90 ml/kg/day, and dextrose supplementation at 2.5% Dextrose. Blood glucose checks were performed every 2 hours. The patient was discharged the next day with an intravenous catheter left in place to facilitate treatment at the regular veterinarian for the remainder of the next day. A liver panel was recommended to be completed after 72 hours or 3 day to monitor any residual effects of xylitol ingestion
Presentation: Sinus tachycardia, febrile, anxiety, ate Godiva dark chocolates containing xylitol at an unknown time
Diagnostics: brown in vomitus; likely chocolate ingestion, ECG, bloodwork
Diagnosis: Chocolate and xylitol ingestion
Treatment Included: Induction of vomiting (apomorphine) with supportive care. The patient received anti-nausea medication (cerenia), activated charcoal for the chocolate ingestion, intravenous fluid therapy (LRS) at 90 ml/kg/day, and dextrose supplementation at 2.5% Dextrose. Blood glucose checks were performed every 2 hours. The patient was discharged the next day with an intravenous catheter left in place to facilitate treatment at the regular veterinarian for the remainder of the next day. A liver panel was recommended to be completed after 72 hours or 3 day to monitor any residual effects of xylitol ingestion