4-year-old, Female, Spayed, Chihuahua

This case was presented in our monthly virtual Abdominal Rounds with Donald E. Thrall DVM, PhD, DACVR in May 2021. If you’d like to join us in these sessions. please click this link.

History:  Presented with a history of ingesting approximately 1/3 cup of raw dough*.

Imaging.  Left lateral (1A), right lateral (1B) and ventrodorsal (1C) radiographs of the abdomen were acquired.


*Dough is a mixture of flour and water and commonly has added yeast, fat or sugar.

Findings: 

  • Marked distension of the stomach with heterogeneous material having multiple gas pockets.
  • No evidence of material trapped in pylorus, or fluid accumulation in stomach.
  • No evidence of gastric malpositioning.
  • The small intestine is displaced caudally secondary to the gastric distention.
  • The small intestine contains gas and fluid and a small amount of material similar to that in the stomach.

Conclusions:

  • The material in the stomach is consistent with the reported dough ingestion.
  • The gas pockets are most likely due to yeast fermentation of carbohydrates.
  • There is no evidence of gastric outflow obstruction at this time, based on lack of fluid accumulation in the stomach.
  • Ingestion of raw dough is often associated with toxicity resulting from ethanol production in the fermenting dough.

Recommendations:

  • Induced emesis is not recommended due to the congealed nature of the dough.  This could result in gastric rupture
  • Gastrotomy should be considered.
  • Evaluate for clinical and metabolic signs of ethanol toxicity and treat accordingly.

Discussion:

                There are many common household items that are toxic to dogs and cats.  These include chocolate and chocolate-based products, Allium spp. (onion, garlic, leek and chives), Macadamia nuts, Vitis vinifera fruits (grapes, raisins, sultanas and currants), products sweetened with xylitol, alcoholic beverages and unbaked bread dough. (Cortinovis & Caloni, 2016).  Toxicity associated with unbaked bread dough is particularly interesting as this is mediated through the action of yeast. (Means, 2003) (Suter, 1992) (Thrall, Freemyer, Hamer, & Jones, 1984).

                Many people bake bread during special occasions, which provides an opportunity for ingestion of raw dough by dogs when the dough is left unattended to rise.  When the missing dough is discovered there may be no concern on the part of the owner until toxicosis is manifest, which most often results from ethanol production.

It is fermentation that causes the dough to “rise”.  Yeast consumes sugars in the dough and produces ethanol and carbon dioxide as waste products.  The carbon dioxide forms bubbles in the dough, expanding it to a foam.  The ethanol is largely destroyed during baking but can be present in toxic amounts when raw dough is ingested.

                Common clinical signs of ethanol toxicity are ataxia, lethargy, vomiting and, in severe cases, recumbency.  In more severe cases, hypothermia, disorientation, vocalization, hypotension, tremors, tachycardia, acidosis, diarrhea, respiratory depression, coma, seizures and death may occur. (Valentine, 1990).  Signs of ethanol toxicity are a common reason that dogs are taken to a veterinarian following raw dough ingestion.  There are various sources relating to the treatment of ethanol toxicity (Lohmeyer-Mauzy, 2021).

Signs relating to the expansion of the stomach may also be present.  Care should be exercised when considering inducing emesis in dogs that have ingested raw dough, as a large mass of dough can obstruct the esophagogastric junction and potentially cause gastric rupture.  Small amounts of dough may successfully pass through the gastrointestinal tract, but gastrotomy should be considered for large volumes of dough that are present in the stomach.

References:

Cortinovis, C., & Caloni, F. (2016). Household food items toxic to dogs and cats. Front Vet Sci, 3, 26. doi:10.3389/fvets.2016.00026

Lohmeyer-Mauzy, C. (2021). Toxicology Brief: Ethanol Toxicosis in Dogs. Retrieved May 30, 2021, from VetFolio. Powerec by the NAVC: https://www.vetfolio.com/learn/article/toxicology-brief-ethanol-toxicosis-in-dogs

Means, C. (2003). Bread dough toxicosis in dogs. J Vet Emerg Crit Care, 13, 39-41.

Suter, R. J. (1992). Presumed ethanol intoxiciation in sheep dogs fed uncooked pizza dough. Aust Vet J, 69, 20. doi:10.1111/j.1751-0813.1992.tb09861.x

Thrall, M. A., Freemyer, F. G., Hamer, D. W., & Jones, R. L. (1984). Ethanol toxicosis secondary to sourdough ingestion in a dog. J Am Vet Med Assoc, 184, 1513-1514.

Valentine, W. M. (1990). Short-chain alcohols. Vet Clin North Am, 20(2), 515-523.

Photo by Sharon McCutcheon on Unsplash

One comment

  1. Left- right lateral and ventrodorsal projections of the abdomen of a skeletally mature dog.

    Thoracolumbal transitional vertebra with hypoplastic rib on the left side of L1 and “normal” rib on the right.

    Abdominal volume enlarged.
    Severe distension and dilation of the stomach. Fundus severely filled with heterogeneous soft tissue and gas opaque foamy material. Antrum moderately filled with gas. Non reproducible band-like abrubt diameter reduction of the stomach in the region of the antrum pyloricus in the left lateral projection. Pyloric region homogeneous soft tissue opaque and mildly distendend in the ventrodorsal projection.
    Moderate mass effect of the stomach with cranial displacement of the liver and caudal displacement of the small bowel convolut.
    Spleen in normal posistion.
    Peritoneal detail mildly reduced most likely due to crowding.

    Gastric dilation / overfill.
    Soft tissue opacity in the pyloric region.

    Delayed gastric emptying possible. Mechanical gastric outflow obstruction not excluded. Differentials: accumulation of foregn material in the pyloric region, pyloric hypertrophy. Much less likely: granuloma, hematoma, neoplesia of the gastric wall.

    If clinically indicated, abdominal ultrasound or radiography recheck recommended.

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