Grape and raisin ingestion - what to do?

RE: Grape and raisin ingestion - what to do?

Anthony Dennison — Mon, 08 Jan 2018 09:32:34 GMT

We had an Old English Sheep Dog that had eaten mince pies sent over to us just before Christmas from a practice that we do OOH for. They had rung VPIS and told the owners the dog had to be on fluids for at least 48 hours.

It was azotaemic, but 48 hours of fluids made little difference, dog was absolutely fine. If we had kept it in til renal parameters normalised it probably would have been in for a week!

Personally I'll always make them vomit if a very recent ingestion, then home with activated charcoal and rv in 24-48 hours to check renal function.

RE: Grape and raisin ingestion - what to do?

Carl Gorman — Thu, 04 Jan 2018 17:44:49 GMT

Neil - the references are all from a short time period 10 years ago because the article quoted was from 10 years ago. I think that grape and raisin toxicity was a recent hot topic hence the grouping of papers. I haven't done a recent literature search as I think work wasn't done much after that, but I may be wrong.

RE: Grape and raisin ingestion - what to do?

Neil Wheadon — Thu, 04 Jan 2018 14:25:47 GMT

[quote user="Rob Davis"]

[quote user="Carl Gorman"]Certainly renal failure has occurred following ingestion of raisins at estimated doses as low as 2.8 mg/kg (Eubig et al., 2005) and one dog was euthanased after ingestion of 4.7 g/kg (Mazzaferro et al., 2004). Where grapes are concerned 4-5 grapes caused renal failure in an 8.2 kg dachshund (Mazzaferro et al., 2004) doses as low as 19.6 g/kg caused similar effects in another report (Eubig et al., 2005). [/quote]

Given that the majority of incidents of grape/raisin ingestion do not cause any problems, how can we be sure about causality in the small number of reported cases?

[/quote]

The literature reviews are welcome, thanks for that.

3 queries

1) They are all from the same period in time and 13 year old case reports. Is it something associated with grape production, a certain insecticide/pesticide on the grape?

2) Interesting observation on a thread somewhere about chocolate toxicity and changes in blood parameters, does anyone out there check renal values in these after a few days, any changes?

3) Is there any evidence that by simply putting a dog on twice maintenance fluids for 3 days following ingestion actually make a difference?

Neil

RE: Grape and raisin ingestion - what to do?

Rob Davis — Thu, 04 Jan 2018 11:44:10 GMT

Given that the majority of incidents of grape/raisin ingestion do not cause any problems, how can we be sure about causality in the small number of reported cases?

RE: Grape and raisin ingestion - what to do?

Edward Jones — Wed, 03 Jan 2018 08:48:17 GMT

Considering how little seems to be known about this, there's remarkably little recent research.

RE: Grape and raisin ingestion - what to do?

Carl Gorman — Tue, 02 Jan 2018 23:14:13 GMT

I defer to my wiser colleagues in these cases. Extracts from an article by Alex Campbell of VPIS some years ago:

There are now several reports that confirm that ingestion of these fruits can cause renal failure in dogs.The toxic mechanism remains to be elucidated, and the apparent lack of a reproducible dose response relationship has led some authors to suggest this may reflect either a component of the fruits that is present in varying quantities, or the existence of an extrinsic compound that may not always be present (Eubig et al., 2005). Individual variations in response may also occur. So the general consensus at present is that potentially any dose should be considered a problem. Certainly renal failure has occurred following ingestion of raisins at estimated doses as low as 2.8 mg/kg (Eubig et al., 2005) and one dog was euthanased after ingestion of 4.7 g/kg (Mazzaferro et al., 2004). Where grapes are concerned 4-5 grapes caused renal failure in an 8.2 kg dachshund (Mazzaferro et al., 2004) doses as low as 19.6 g/kg caused similar effects in another report (Eubig et al., 2005).

And

VPIS’ OUTLINE TREATMENT PROTOCOL
Ingestion of any quantity of grapes, raisins or sultanas by a dog should be considered treatable.
G Gut decontamination should be considered by

means of emesis or gastric lavage
G Digestion of the fruits appears to be slow and

decontamination several hours post-ingestion may be worthwhile as whole grapes and swollen raisins have been recovered after remaining in the stomach overnight (Eubig et al.

As the toxicity of these items is 'idiosyncratic', i.e. Just because 'my dog has always been ok' doesn't mean that Mrs Jones' much loved (and no doubt valuable) poodle won't be the one to develop renal failure and die. It's simple to try to prevent problems, and although not entirely benign, probably safer than acute renal failure, so why not treat?

We certainly have seen at least two cases of acutely ill dogs, almost certainly related to ingestion of fruit cake.

RE: Grape and raisin ingestion - what to do?

David Mills — Sun, 31 Dec 2017 01:12:47 GMT

I suspect the NNT is in the 1000s. And even then the treatment probably does naff all.

There is no evidence for any of it as far as I can see.

It would be an interesting thing for VetCompass or Savsnet to look at rather than the tired old studies on abx usage in first opinion practice.

RE: Grape and raisin ingestion - what to do?

Neil Wheadon — Sat, 30 Dec 2017 22:00:58 GMT

We've been here before a few years ago.

Personally I have looked (and quite hard) for a confirmed case that caused death, and come up short, but a friend may have seem a death due to 6 grapes.

The wisdom? seems to be that in a susceptible dog a single grape with an algal bloom will cause renal failure and it is on this that we act.

It's a problem isn't it? Thousands of dogs have emesis induced for a risk that is barely there (if at all, but one person in the last thread did confirm a case?) In reality I do this, however I'm not at all convinced that keeping a dog on twice maintenance fluids for 48 hours is of any help and the last time I saw this was 4 years ago, so this certainly isn't the default position.

Dave Leicester has contributed recently, as a clinical lead with Vets Now he's pretty knowledgable, so maybe he'll give his take?

Neil