Shelter Health

Candy the Canine vs. Chocolate: A Treatment Case Study

Candy, our favorite hypothetical case study, is a healthy, 3-year-old, 25 kg chocolate Lab with no pre-existing conditions, but an increasingly long history of getting into things that she shouldn’t such as garlic, xylitol, and atomoxetine.

On Halloween, our mischievous Lab trick-or-treated at her own house and ate all of the candy her family had planned to give out that night. Candy ingested all the bowl’s contents – including wrappers – which comprised two 10.35-ounce packages of miniature solid milk chocolate bars. Candy’s owners know that chocolate is toxic, so they brought her to your hospital as soon as they realized what she’d done.

Your First Steps

Candy is asymptomatic, so you induce emesis with apomorphine. Candy vomits eight piles that contain large amounts of thick, chocolate material including some chunks, lots of wrappers, and 12 miniature bars still in the wrappers. You give a dose of maropitant to stop further vomiting after she brings up two piles of just light-brown colored fluid.

What’s Your Next Step?

1. Give a dose of activated charcoal
2. Give a dose of diazepam
3. Send Candy home and have the owners monitor her

The best answer is #3: Have the owners monitor Candy at home.

Activated charcoal would not be recommended in this case because the signs that we are expecting to see are not severe. Chocolate can draw water into the GI tract and increase the chance of developing hypernatremia secondary to activated charcoal administration, so in this case the risk would not outweigh the benefit. Diazepam would also not be indicated since Candy is not showing any signs currently and additionally is not likely to show any signs that would respond to diazepam, thanks to your prompt and effective decontamination.

Milk chocolate contains 64 mg/oz of methylxanthines, and Candy’s initial dose was 51.2 mg/kg. At this dose, we can see stimulatory signs, such as hyperactivity and tachycardia. However, because emesis was hugely successful, we can consider that her dose is significantly lower now.

Typically, we will recover 40-70% of the stomach contents. In this case, an estimate of 50% recovery would be very conservative and would decrease her dose to 25.6 mg/kg. At this dosage, we would be concerned mainly about signs secondary to dietary indiscretion (vomiting, diarrhea, polydipsia and potentially pancreatitis as a sequelae).

At-home monitoring and supportive care for GI upset and monitoring for pancreatitis would be very reasonable and appropriate.

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