Xylitol is a natural sugar alcohol that is commonly used as a sugar substitute in a variety of products such as gums, candies, mints, peanut or nut butters and baked goods. It may also be found in non-food items such as toothpaste, mouth wash, liquid or chewable human medications and supplements. The use of xylitol in a variety of products for people has increased over the past several decades, consequently increasing the exposure risk to dogs. Once ingested, xylitol is rapidly absorbed and can stimulate the pancreas to release insulin leading to hypoglycemia within 30 to 60 minutes of consumption. Initial clinical signs may include vomiting followed by lethargy, disorientation, weakness, ataxia and seizures. In addition to hypoglycemia, xylitol toxicity may also cause acute liver failure, hepatic necrosis and in some cases coagulopathies. There is no specific toxin screen that can detect xylitol after it is ingested and there is no specific antidote for treatment. The treatment for xylitol toxicity in dogs focuses on decreasing absorption of the toxin soon after ingestion, stabilizing blood glucose levels, hepatoprotective medications for liver support, treating any vomiting or other gastrointestinal upset, and managing any coagulopathies that may develop. It is also important to monitor blood glucose levels, liver enzymes, electrolytes, and coagulation parameters during therapy. It is typically recommended to monitor liver parameters for at least 2-3 days after ingestion and dogs may need hospitalization for a minimum of 24 hours. The prognosis for dogs that ingest lower doses of xylitol and that do not develop acute liver failure or a coagulopathy is good with early recognition and supportive care. The prognosis for dogs that develop acute liver failure is more guarded and will require more involved management and hospitalization. Steps that can be taken to prevent xylitol toxicity in dogs include making sure to check product labels for xylitol, storing any products that contain xylitol out of reach from your pet, not sharing any food or other products that contain xylitol with your dog and only using pet-safe toothpaste.