What would you do in a case of raisin ingestion?

RE: What would you do in a case of raisin ingestion?

Mellora Sharman — Thu, 03 Aug 2023 08:54:00 GMT

I think that is a challenging question to answer without large scale epidemiologic studies.

RE: What would you do in a case of raisin ingestion?

jane alexander — Thu, 03 Aug 2023 08:52:18 GMT

Would the apparent reduction in chronic kidney issues in dogs (I see far fewer than when I first graduated) possibly be linked to Leptospirosis vaccinations or the reduction in grape feeding?

RE: What would you do in a case of raisin ingestion?

Mellora Sharman — Thu, 03 Aug 2023 08:36:26 GMT

Hello!

Grape / Raisin / Sultana toxicity is an interesting conundrum as we don't know the toxin, there doesn't seem to be a dose dependent relationship necessarily, and the reaction may be very idiosyncratic and incredibly difficult to predict which patient might be more likely to succumb to toxicity.

I remember feeding grapes to our family dog when I was a kid with no adverse effects, but I wouldn't do it now days given new knowledge that there is a risk.

A relatively recent study shows that risk to be relatively small - see: Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005 - 2014): 139 cases. https://onlinelibrary.wiley.com/doi/full/10.1111/vec.12905 . However the consequence of that risk is relatively high with only ~50% of those dogs affected surviving, such is the nature of AKI - often expensive to manage whilst carrying a guarded prognosis.

So I would certainly discuss emesis, and supportive care, including IVFT, whilst monitoring renal parameters in a case that raisin ingestion has occurred in. This might end up being more than what an individual needs, but until such time we understand more about the toxicity overall and someone can tell me which dogs are susceptible, or give me a cheap test to determine this, it seems a more sensible approach than offering nothing at all.

Best Wishes,
Mellora

RE: What would you do in a case of raisin ingestion?

Peter Rushton-Taylor — Wed, 02 Aug 2023 21:26:19 GMT

I have always suspected that most treatment for grape/rasin "toxicity" is unnecessary. As is much of the use of IVFT in practice. I have never encountered an even suspicious case of renal damage caused by grapes/rasins. When I qualified, grape/raisin toxicity was not a thing. Just before Christmas one year our 35Kg labrador ate the entire Christmas cake mixture consisting of about 3Kg dried fruit, mainly raisins and sultanas. He showed no ill effects whatever other than being slightly unstead on his feet for a few hours as my wife had already added the brandy.

RE: What would you do in a case of raisin ingestion?

Mark Holmes — Fri, 07 Jul 2023 05:57:58 GMT

I agrée entirely Gillian, we completely overlook the negative impact our good intentions can have. I suspect we would have to treat several hundred dogs with 48 hours of fluids unnecessarily to make a difference to even one dog. (Assuming fluids do make a difference). I cannot believe that unnecessary hospitalisation of hundreds of patients can be considered “Gold Standard “.

Even assuming it works I don’t think the risk/benefit stacks up.

RE: What would you do in a case of raisin ingestion?

Roger Wilkinson — Thu, 06 Jul 2023 15:30:44 GMT

Actual evidence on optimal strategy in dogs in this scenario is sadly lacking. However, we can probably extrapolate a bit from human research.

E.g. academic.oup.com/.../361600

'fluid therapy in the prevention of AKI

Useful reviews on the role of fluid therapy in the prevention of AKI are available [27–29]. Despite the recognition of volume depletion as an important risk factor for AKI, there are no randomized controlled trials (RCTs) that have directly evaluated the role of fluid hydration versus placebo in the prevention of AKI. However, RCTs have compared different fluids and have combined fluid hydration with other interventions [30]. Furthermore, comparisons between outcomes seen in these trials [30] and historical untreated control subjects [31] suggest a large benefit from fluids. One small RCT [32] of 53 patients who underwent non-emergent cardiac catheterization found that IV hydration with saline was more effective than unrestricted oral fluid intake.'

A unifying factor in all the human literature is the importance of pre-existing risk factors for acute kidney injury such as comorbidities, medication etc. We should probably factor in those things too when making decisions.

Overall, I can agree with a lot of the opinions expressed in this thread. Atm I think all one can do is give owners an idea of the uncertainty and let them decide.

All the best

Roger

RE: What would you do in a case of raisin ingestion?

Mark Holmes — Tue, 04 Jul 2023 05:39:55 GMT

If my own dog Keats one raisin I wouldn’t do anything at all. I know we don’t have a toxic dose in raisin cases but I think we need to keep a sensible head on. That said if s client approached me in similar circumstances I would discuss emesis and fluids to cover my arse which is possibly what VN we’re doing. I just wish they word drop the term “gold standard.” There is no gold standard.

RE: What would you do in a case of raisin ingestion?

Nicola Cole — Mon, 03 Jul 2023 20:58:09 GMT

[quote userid="8958" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion/241885#241885"]This surely is one of the easiest things to get some kind of statistics on, if referral centers / OOH centers put their mind to it[/quote]

Honestly I’m not so sure. Dogs eat random things every day so getting a proper control group is nigh on impossible.
Raisin/grape toxicity appears to be very rare.

From memory (yes I know that’s not hugely accurate) I’ve only ever made one dog vomit after raisin exposure (relatively large amount) and they were fine.
But on the other hand, have seen a handful of young dogs with renal failure (with no known toxin exposure) over 15 years.

Whilst this may not reflect everyone’s experience, unless the number of dogs affected by raisins is significantly above the background, then you’re not going to get anything statistically significant-unless I’m missing something!

RE: What would you do in a case of raisin ingestion?

Arlo Guthrie — Mon, 03 Jul 2023 19:31:27 GMT

Sigrid Gibbon Hi, could I ask you to please change the settings in your account to display your real name and then ideally add some info in your profile (at least year of qualification). As we move to the Q and A format, it is important for everyone to know who we are, and to read answers in the context of the poster’s quals and experience,

This is a really important aspect of making this community a really useful resource for you all.

RE: What would you do in a case of raisin ingestion?

Sigrid Gibbon — Mon, 03 Jul 2023 19:14:19 GMT

Raisin toxicity is not really dose dependant. Some dogs eat a whole bunch with no il effect and others develop kidney failure from just one so I think the vet was right.

RE: What would you do in a case of raisin ingestion?

Jonathan Mills — Mon, 03 Jul 2023 18:30:26 GMT

So, my personal view (and this applied to all grape/raisin ingestion).....

Firstly, the scarce published data does not suggest any reliable link to quantity ingested and probability of illness or severity of illness. So I take the same actions regardless of quantity ingested.

Secondly, has anyone ever met or spoken to a living vet who has seen a dog become ill after ingestion of grapes or raisins? I certainly haven't and don't know anyone who has? Are they actually toxic? I'm not convinced they are but the textbooks say they are, so I have to assume there might be some risk.

Is there any advantage to bloods at the time of ingestion? - no (except to establish a baseline), if the kidneys are damaged, it will be 48 hours before you see anything.

Is there any advantage to fluids? - no. If the kidneys are damaged by the alleged grape toxin then anuria is the reported consequence. If you give fluids to a patient that can't excrete water, you'll just get pulmonary oedema and death.

Do I induce emesis - yes, it's easy, low risk and therefore seems a sensible precaution in case the text books are right.

Do I give activated charcoal - yes, see above.

Have I ever encountered a dog with actual illness caused by grapes? - no (and I've been doing this for 30 years!).

RE: What would you do in a case of raisin ingestion?

Paul Dowie — Mon, 03 Jul 2023 18:15:55 GMT

I had a client with a Cocker spaniel that raided a shopping bag in hallway and snaffled some raisins in a bag. Thought nothing of it at the time ,but next morning the dog was subdued. A blood test registered Creatinine at 462 ...do not remember urea. Fluid for 36 hours resolved the issue. Still plenty of do not knees on this. I too would not rush my dog for emergency emesis for 1-2 raisins but more? Yes

RE: What would you do in a case of raisin ingestion?

Neil Wheadon — Mon, 03 Jul 2023 09:59:55 GMT

[quote userid="8663" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion/241888#241888"]my understanding is that someone interested in the donkey work contacts them and Vetcompass lets then use their database[/quote]

Do any final year students still do electives?

This is perfect isn't it?

Neil

RE: What would you do in a case of raisin ingestion?

Alasdair Hotston Moore — Mon, 03 Jul 2023 09:57:17 GMT

my understanding is that someone interested in the donkey work contacts them and Vetcompass lets then use their database

RE: What would you do in a case of raisin ingestion?

Neil Wheadon — Mon, 03 Jul 2023 09:53:54 GMT

[quote userid="8663" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion/241886#241886"]a great study for VetCompass?[/quote]

So who contacts them?

Neil

RE: What would you do in a case of raisin ingestion?

Alasdair Hotston Moore — Mon, 03 Jul 2023 09:17:45 GMT

a great study for VetCompass?

RE: What would you do in a case of raisin ingestion?

Neil Wheadon — Sun, 02 Jul 2023 21:53:22 GMT

This surely is one of the easiest things to get some kind of statistics on, if referral centers / OOH centers put their mind to it

The vets posting on this forum are mostly experienced ones that have formed their own opinions and this rings out in this thread.

However there are hundreds of cases and I daresay a reasonable number in centers right now that are being dripped. The cases are almost always younger healthy dog with few co morbidities. We see those discharged, but how many have gone on to develop renal failure? It could be argued that 2xmaintanance prevented them all, but as Evelyn posted this isn't all that is required.

It's not rocket science in my opinion

Neil

RE: What would you do in a case of raisin ingestion?

Miriam Lodewyks — Sun, 02 Jul 2023 20:25:55 GMT

Well, we could start with a simple poll:

I have personally dealt with a confirmed case of grape/raisin toxicity.
I have never personally seen a confirmed case of grape/raisin toxicity.
I have dealt with a case of suspected grape toxicity.
I have never heard of or dealt with the aftermath of suspected grape toxicity.

Perhaps gathering data of the incidence of this alleged “problem” in the profession at least, is a start?

RE: What would you do in a case of raisin ingestion?

Nicola Cole — Sun, 02 Jul 2023 11:52:04 GMT

An adverse outcome after raisin/grape ingestion is supposed to be very rare-so I would suspect the numbers required to statistically prove/disprove would be so massive that it wouldn’t be possible any time soon. Also, very difficult to get a control group of dogs.

RE: What would you do in a case of raisin ingestion?

Miriam Lodewyks — Sun, 02 Jul 2023 08:49:44 GMT

How is it that we all preach EBM all of the time, but then bow under the first hint of pressure from Dr Google?
Where is the EVIDENCE?

And until there is any, why are we all being so super cautious and defensive? The whole grape toxicity makes NO SENSE, I’ve never seen one, suspected one or even heard of a proven case, yet I admit that I too have caused much misery to poor unsuspecting pups by making them feel as sick as a dog for a couple of hours… probably for nothing.

Is there a way we can collate enough “personal experience” data on this forum perhaps to statistically prove or disprove it perhaps?

RE: What would you do in a case of raisin ingestion?

Rob Loxley — Sun, 02 Jul 2023 07:57:31 GMT

also https://journals.sagepub.com/doi/10.1177/104063870501700302

https://onlinelibrary.wiley.com/doi/10.1111/jvim.15884

RE: What would you do in a case of raisin ingestion?

Beats — Sat, 01 Jul 2023 21:16:13 GMT

There are dogs that have died after eating a myriad of things.

I would guess the most common one I have seen may be sausage (certainly more than grapes, where I have never seen a resultant ill / dead dog personally - and I don't make them vomit generally).

If I was to start making dogs vomit after eating a few grapes or raisins, by logic I should apply the same strategy to sausages, chicken, dog-treats from bargain shops, something they were sniffing at in the bushes, a dirty puddle they drank out of, something on the beach etc etc.

I have seen more dogs ill or dead from carprofen or meloxicam. Do I see a dog in for a suspected infectious cough, give it some nsaids (I don't, to be clear), send it home, then get them back when I realised they've taken one of the potentially toxic medicines I prescribed and make them vomit and put them on a drip?

Then there is the risk of getting to the vet clinic. I suspect a fatal road traffic collision could be a higher risk. Indeed I have known more dogs jump out of windows of moving vehicles into oncoming traffic than dogs dying from grapes/raisins; I even recall a dog jumping out of an owner's boot and running on to a nearby road and being hit by a car - it had only come for a kennel cough vaccine. A visit to a vet is not risk-free for owner or pet. I have personally known more people to be struck by lightning while on the phone than dogs die from grapes - perhaps even phoning me is too big a risk? (well, on a landline in a thunderstorm anyway...)

Owners would be best to walk round with "apo-pens" loaded and ready to go.

I have never seen a complication from a dog being given apomoprhine either, but has anyone else? Does this need factored in?

I have heard of a dog that ingested some grapes, was brought to a veterinary clinic, had emesis induced and put on a drip, chewed out the drip, had a new drip placed and a buster collar, kept in overnight like this, and through a freak accident strangled itself in a kennel with the buster collar and died. Could there be other cases where blood sampling, emesis, intravenous fluids etc have caused harm?

I'm reminded of the old WSAVA thing about doing serology testing to reduce the risk from vaccines... without any assessment of what the risk of blood sampling 10,000 dogs might be for comparison with the 10,000 vaccinated...

Finally., if I see a dog with AKI believed to be due to a toxic reason, and it is eating and drinking apparently normally, I don't put it on a drip (should I be doing this?). If I was to do bloods and identify unexpected azotaemia after raisin/grape ingestion - what logically could I do about it if the dog was eating and drinking normally?

I dug up these links which aren't on the first page of google for balanced anecdotes of dogs surviving grape exposure, for those who take a less interventional approach so they don't feel too alone when faced with the front page of google (lots of pages linked to Barbara Andrews, so I've only included two of them):

https://www.thedogplace.org/Canine-Nutrition/Grapes-Poison-Dogs-Myth-09061-bja-nl.asp

https://www.thedogpress.com/DogSense/Grapes-no-longer-toxic-to-dogs-b19A04.asp

The VIN new summary popped up as quite balanced for a more professional slant: https://news.vin.com/default.aspx?pid=210&catId=174695&id=11105724

I don't advise feeding grapes to a dog at all, but I also rarely advise inducing emesis when folks enqure after having seen this on google. I do take each call on its own merits however.

RE: What would you do in a case of raisin ingestion?

Neil Wheadon — Sat, 01 Jul 2023 17:53:50 GMT

[quote userid="10813" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion/241874#241874"]Can you point to these case reports, Rob? I've never seen anything convincing, and I've never seen any real evidence of a causal pathway for AKI from grapes or raisins. How were the 'minimum toxic doses' arrived at?[/quote]

Try this https://pubmed.ncbi.nlm.nih.gov/31714003/

In my honest opinion it seems to be an American manifestation with occasional reports? in the UK

With so many dogs going through the 2 day on a drip treatment , I've blood sampled at least 4 post fluids in the last 2 years, there simply must be someone somewhere who is looking into this. Shame we haven't got a vet version of NICE

Neil

RE: What would you do in a case of raisin ingestion?

David Shepherd — Sat, 01 Jul 2023 17:48:57 GMT

Can you point to these case reports, Rob? I've never seen anything convincing, and I've never seen any real evidence of a causal pathway for AKI from grapes or raisins. How were the 'minimum toxic doses' arrived at?

RE: What would you do in a case of raisin ingestion?

Rob Loxley — Sat, 01 Jul 2023 14:17:39 GMT

[quote userid="10397" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion"]

Emesis was induced , no raisin seen. They were advised Gold standard would be IVFT and follow up bloods. The owners did decline this further work.

What are everyone's thoughts on this?

[/quote]

[quote userid="9440" url="~/f/clinical-questions/30704/what-would-you-do-in-a-case-of-raisin-ingestion/241849#241849"]So if presented with a dog which has eaten a couple of grapes or raisins , has been made sick and is clinically well and there are raisins or grapes in the vomit . Would it be better to just take bloods after 48 hours or so to look for kidney injury rather than putting every patient on fluids ?[/quote]

We would probably induce emesis if recent ingestion and no other contraindications to, since there are enough case reports of AKI (with overally not great short and longterm clinical outcomes) following grape/raisin ingestion to be a reasonable intervention; though there are some suggested minimum toxic doses in g eaten per kg bodyweight for grapes and raisins that can be referred to when making this decision. If well, we will advise baseline bloods and follow-up bloods a couple of days later to pick up early, preclinical signs of AKI.

Clients should be advised to monitor for any early clinical signs of AKI, especially if they decline initial intervention and follow-up.

Beware of fluid overload if using aggressive fluid therapy in AKI cases...