Bread dough toxicosis may develop when raw, yeast-based bread dough is ingested. Yeast replication promotes dough expansion in the stomach and ethanol production by yeast. Clinical signs of ethanol intoxication (inebriation, CNS depression) and gastric distention can occur. Treatment entails decreasing yeast replication, managing ethanol toxicosis, and providing supportive care. Measurement of blood ethanol concentration can aid in diagnosis.
When ingested, raw bread dough made with yeast poses both mechanical and biochemical hazards from resultant gastric distention, metabolic acidosis, and CNS depression. Although any species is susceptible, dogs are most commonly affected because of their indiscriminate eating habits.
Pathogenesis of Bread Dough Toxicosis in Animals
Bread dough toxicosis occurs when the warm, moist stomach environment serves as an efficient incubator for yeast replication within ingested raw dough. Dough expansion causes gastric distension and resultant vascular compromise to the gastric wall, similar to that in gastric dilatation and volvulus. With sufficient gastric distention, respiratory compromise occurs. Ethanol, produced from yeast fermentation, is absorbed into the bloodstream, resulting in inebriation and metabolic acidosis.
Clinical Findings of Bread Dough Toxicosis in Animals
Early clinical signs of bread dough toxicosis may include unproductive attempts at emesis, as well as abdominal distention and lethargy. As ethanol intoxication develops, the patient becomes ataxic and disoriented. Eventually, profound CNS depression, weakness, recumbency, hypoglycemia, coma, hypothermia, or seizures may occur.
Death is usually due to metabolic effects of ethanol rather than to gastric distention; however, the potential for dough to trigger gastric dilatation and volvulus in susceptible dog breeds should not be overlooked.
Diagnosis of Bread Dough Toxicosis in Animals
Clinical signs
Elevated blood ethanol concentrations
Presumptive diagnosis of bread dough toxicosis can be based on history of exposure and clinical signs. Blood ethanol concentrations are consistently elevated, although blood ethanol testing is not routinely available at veterinary facilities.
Differential diagnoses include gastric dilatation/volvulus, foreign body obstruction, ethylene glycol toxicosis, and ingestion of other CNS depressants (eg, benzodiazepines).
Treatment for Bread Dough Toxicosis in Animals
Judicious GI decontamination
Supportive care
In cases of recent bread dough ingestion by animals that remain clinically normal, emesis (as described for garlic and onion toxicosis) may be attempted as a treatment for toxicosis, although dough's glutinous nature may make removal via emesis difficult.
In patients in which emesis (whether induced or spontaneous) has been unsuccessful, the animal may be fed cold water to slow the rate of yeast fermentation in the stomach and aid in dough removal although the most effective volume of water to give is unknown; body temperature should be monitored for hypothermia if cold water is given, and effects on slowing yeast fermentation are transient.
In rare cases, surgical removal of dough from the stomach may be required.
Patients with clinical signs of ethanol toxicosis should be stabilized, and life-threatening conditions should be corrected before attempts are made to remove dough.
Ethanol toxicosis is managed via correcting hypoglycemia and acid-base abnormalities, addressing cardiac arrhythmias, and maintaining normal body temperature. Providing therapy to promote diuresis and to enhance ethanol elimination may also be helpful.
Key Points
Ingestion of raw yeast-containing bread dough can result in GI tract obstruction and ethanol toxicosis.
Efforts to remove the expanding dough mass from the stomach may include induction of emesis (provided that patients remain clinically normal) or, rarely, surgery.
Ingestion of cold water may transiently slow the rate of yeast fermentation in the stomach.
Treatment is supportive and focused on managing clinical signs.
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