My dog just ate a sago palm | Dr. Justine Lee, DACVECC, DABT, Board-certified Veterinary Specialist

Posted by justinelee in Animal Safety, Blog, Pet Health

If your dog just ate a sago palm plant, please read this and get to a veterinarian IMMEDIATELY, even if it’s in the middle of the night! That’s because sago palm and plants from the Cycad family are VERY poisonous to dogs, and can result in death untreated.

Typically, the sago palm is found growing outside in warm, temperate regions of the Southern states and Hawaii. However, I recently found them in the grocery store in St. Paul, Minnesota, so now I know they are sold everywhere as a houseplant too!

The sago palm is a member of Order Cycadacae and genera Cycads, Macrozamia, and Zamias.1 More common names of these poisonous cycad family plants include:

• Cardboard palm (Zamia furfuracea)
• Coontie plant (Zamia pumila)
• Cycad (Cycas cirinalis)
• Japanese cycad (Cycad revoluta)

When it comes to the sago palm, all parts of the plant are poisonous, especially the seed (found as nuts on the female plant). As little as two seeds has been reported to cause poisoning in dogs.2

There are 3 main poisons/toxins in this plant:

• cycasin (which causes liver failure)
• β-methylamino-L-alanine (which causes neurologic signs like seizures and coma)
• a third unidentified, high molecular weight toxin. 2

Sago palm poisoning results in clinical signs affecting three main organ systems: the gastrointestinal tract, the liver, and the central nervous system (e.g., brain, spinal cord). Signs include

• Drooling
• Vomiting (e.g., including blood)
• Diarrhea (e.g., including blood or digested blood, which looks like black, tarry stool)
• Lethargy or weakness
• Not eating or decreased appetite
• Jaundiced gums, eyes or skin
• Wobbliness
• Severe weakness to the point of collapse
• Neurologic signs like tremors or seizures
• Coma
• Death

What will your veterinarian find on physical exam or blood work with sago palm poisoning?

• A racing heart rate
• Abnormal fluid in the abdomen
• Abdominal pain
• Increased liver enzymes
• Anemia or increased red blood cell count (secondary to dehydration)
• Abnormal clotting
• Bruising
• Blood work changes associated with liver failure (low blood sugar, low blood protein, etc.)

Some blood work that your veterinarian should do once at the hospital include:

• A complete blood count to evaluate the red and white blood cell count, along with the platelet count
• A biochemistry panel to evaluate the protein, electrolytes, kidney function and liver enzymes
• A clotting test to evaluating the body’s ability to clot (which is prolonged with liver failure)
• Frequent blood sugar monitoring (which is low with liver failure)
• Specific blood tests to evaluate liver function (including an ammonia and bile acids test)
• Abdominal ultrasound (to look at the architecture of the liver and to make sure nothing else is going on).

How do we treat sago palm poisoning in dogs?
Aggressive treatment must be performed, otherwise, severe morbidity or mortality can be seen with this poisonous plant. Typically, hospitalization for at least 48 hours is necessary. Treatment of sago palm poisoning includes:

• Inducing vomiting to get the plant material out of the stomach
• Administration of multiple doses of activated charcoal to bind up the poison from the stomach and intestinal tract
• Aggressive IV fluids (with dextrose or sugar supplementation, if needed) to help hydrate the patient and increase blood flow to the liver
• Anti-vomiting medication
• Antacids
• Liver protectants (e.g., SAMe, n-acetylcysteine)
• IV protein (e.g., Hetastarch) if the protein level is low
• Antibiotics, if liver failure is present
• Blood pressure monitoring
• 24/7 care for at least 48 hours
• Frequent monitoring of the liver values while hospitalized
• Symptomatic supportive care
• Plasma transfusions, if clotting abnormalities are seen
• Vitamin K1, if clotting abnormalities are seen

Prognosis
Unfortunately, only approximately 50% of dogs survive sago palm poisoning.3 In veterinary studies, they found that the higher the liver enzymes, the lower the protein, and the more abnormal the clotting factors, the worse the prognosis. Unfortunately, even with aggressive supportive care, dogs that survive acute poisoning can develop long-term, secondary chronic liver disease.

Prevention
Pet owners can help prevent sago palm poisoning by 1) being able to identify this very poisonous plant, 2) avoiding bringing the Bonsai household plant into the household, 3) removing sago palm from the yard (and appropriately disposing of it). When in doubt, if possible exposure has occurred, an immediate visit to a veterinarian or emergency veterinarian is imperative so that aggressive decontamination and symptomatic supportive care can be implemented. When in doubt, you can also contact an animal poison control center for additional advice.

With any poisoning, the sooner that you identify the poisoning, the sooner it can be treated and the less expensive to your pet. When in doubt, seek immediate veterinary attention for life-saving care with this dangerous, poisonous plant or contact the ASPCA Animal Poison Control Center at (888) 426-4435 for life-saving advice.

References:
1. Klatt CA. Sago Palm. In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp. 743-741.
2. Albretsen JC. Cycasin. In Clinical Veterinary Toxicology. Ed. Plumlee KH. Mosby, St. Louis, MO. 2004. pp. 392-394.
3. Ferguson D, Crowe M, McLaughlin L, et al. Survival and prognostic indicators for cycad intoxication in dogs. J of Vet Intern Med 2011;25:831-837.