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6. Chocolate
There are a wide variety of chocolate and cocoa products to which pets may be exposed,
including candies, cakes, cookies, brownies, and cocoa bean mulches. Not surprisingly, the
incidence of accidental chocolate exposures in pets occurs around holidays, especially Easter,
Halloween and Christmas. The active (toxic) agents in chocolate are methylxanthines, specifically
theobromine and caffeine. Methylxanthines stimulate the CNS, act on the kidney to stimulate
diuresis, and increase the contractility of cardiac and skeletal muscle. The relative amounts of
theobromine and caffeine will vary with the form of the chocolate (see table).
Cocoa beans may contain up to 255 mg theobromine per ounce of beans, although the exact
amount will vary due to natural variation of the cocoa beans. The LD50's of theobromine and
caffeine are 100-300 mg/kg, but severe and life threatening clinical signs may be seen at levels
far below these doses. Based on NAPCC experience, mild signs have been seen with
theobromine levels of 20 mg/kg, severe signs have been seen at 40-50 mg/kg, and seizures
have occurred at 60 mg/kg. Accordingly, less than 2 ounces of milk chocolate per kg is
potentially lethal to dogs.
Clinical signs occur within 6-12 hours of ingestion. Initial signs include polydypsia, bloating,
vomiting, diarrhea, and restlessness. Signs progress to hyperactivity, polyuria, ataxia, tremors,
seizures, tachycardia, PVC's, tachypnea, cyanosis, hypertension, hyperthermia, and coma.
Death is generally due to cardiac arrhythmias or respiratory failure. Hypokalemia may occur later
in the course of the toxicosis. Because of the high fat content of many chocolate products,
pancreatitis is a potential sequela.
Management of chocolate ingestion includes decontamination via emesis followed by gastric
lavage. Because methylxanthines undergo enterohepatic recirculation, repeated doses of
activated charcoal are usually of benefit in symptomatic animals (vomiting may need to be
controlled with metaclopramide). Intravenous fluids at twice maintenance levels will help maintain
diuresis and enhance urinary excretion. Because caffeine can be reabsorbed from the bladder,
placement of a urinary catheter is recommended. Cardiac status should be monitored via EKG
and arrhythmias treated as needed; propranolol reportedly delays renal excretion of
methylxanthines, so metoprolol is the beta-blocker of choice. Seizures may be controlled with
diazepam or a barbiturate. In severe cases, clinical signs may persist up to 72 hours.
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