狗不能吃葡萄和葡萄干 🍇 🙅🏻 🐕
无意中听说狗不能吃葡萄会中毒，当即查了一下还真是。查了几篇靠谱的文献看了下。 TL, DR：有毒，可能致死，原因不知道。消化道症状、嗜睡和神经系统表现很常见。
Wikipedia: Grape and raisin toxicity in dogs: > Clinical findings suggest raisin and grape ingestion can be fatal, but the mechanism of toxicity is still considered unknown.
Reich, C. F., Salcedo, M. C., Koenigshof, A. M., Hopp, M. M., Walker, J. M., Schildt, J. C., & Beal, M. W. (2020). Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005-2014): 139 cases. Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001), 30(1), 60–65. https://doi.org/10.1111/vec.12905
回顾性分析 139 例确认食入葡萄/葡萄干的患者（还是叫患狗？）。确认食入：目击到食入，呕吐物、粪便或食道中发现葡萄或葡萄干，或其他证据表明食入比如发现被撕毁的包装纸。
74/139（53%）住院，65/139（47%）门诊，超过 4h 就诊患狗的住院时间显著延长
AKI 发生率为 6.7%（8/128）；呕吐是最常见的临床表现（18/139），通常在 24h 出现；胃肠道去污（灌胃洗胃？）是最常用的治疗手段（88%），但治疗效果尚无定论。仅有 1⁄139 死亡，死于 CRRT 并发症。
复查时并非所有氮质血症或 AKI 患狗有临床表现，因此缺乏临床表现并不意味着不会发生 AKI。由于本研究 AKI 发生率低，因此无法得知食入葡萄/葡萄干后患狗最佳住院时长，仍然推荐以往的做法即住院 2~3 天。
Dogs were included if they had confirmed grape or raisin ingestion (witnessed ingestion, grapes or raisins in vomitus, stool, or oral cavity, or evidence of ingestion such as damaged packaging) or if they showed clinical signs or azotemia after suspected ingestion…The early group was defined as ingestion ≤4 hours of presentation and the late group was ingestion >4 hours postingestion. This designation is based on gastric emptying times in normal dogs ranging from 4 to 6 hours…Dogs were classified as having AKI if creatinine was above the upper reference limit on presentation or if they had at least stage 1 AKI (creatinine increase of ≥26.5 µmol/L [0.3 mg/dL] at recheck) … Seventy-four dogs (53%) were hospitalized and 65 dogs (47%) were treated as outpatients. no difference in the number of dogs hospitalized between the early and late groups…Length of hospitalization was significantly longer in the late group… the prevalence of AKI was 6.7% (8⁄120). The prevalence of AKI in the early presentation (3⁄67) and late (5⁄53) presentation groups were 4.5% and 9%, respectively…Vomiting was the most common clinical sign (18⁄139). One hundred twenty-two dogs (88%) underwent gastrointestinal decontamination… One hundred thirty-eight dogs survived and 1 died….suffered from complications from CRRT.
Vomiting has been noted to be the most common clinical sign following grape or raisin ingestion and generally develops within 24 hours. Other clinical signs include lethargy, anorexia, diarrhea, decreased urine output, ataxia, abdominal pain, and weakness. If azotemia develops, it typically does so within 24–48 hours after ingestion and can be severe.The most common biochemical markers of toxicosis include increased BUN, creatinine, total calcium, phosphorus, calcium–phosphorus product, potassium, and decreased total carbon dioxide concentration consistent with metabolic acidosis. The most common histopathologic change to the kidneys is proximal tubular necrosis, present in nearly all dogs. …the average time to presentation after ingestion was longer in dogs that died… Although numerous studies have suggested that gastrointestinal decontamination (emesis or activated charcoal [AC]) should be performed after ingestion of grapes or raisins, the efficacy of these therapies remains unknown.
Not all dogs that presented with azotemia or developed AKI on recheck in this study showed clinical signs. The absence of clinical signs should not be a signal that AKI will not develop. Based on the low prevalence of AKI and retrospective nature of this study, no conclusions can be made regarding optimal length of hospitalization following grape or raisin ingestion and 48–72 hours as previously recommended is likely appropriate.
Schweighauser, A, Henke, D, Oevermann, A, Gurtner, C, Francey, T. Toxicosis with grapes or raisins causing acute kidney injury and neurological signs in dogs. J Vet Intern Med. 2020; 34: 1957– 1966. https://doi.org/10.1111/jvim.15884
随访时间 17 个月的回顾性分析 AKI 患狗， 15 只葡萄/葡萄干食入 + 对照组 74 只其他原因 AKI 。7/15 + 32⁄74 死亡。 超过 75% 患狗出现神经系统表现，不是氮质血症导致，与死亡无关。
Retrospective study over 17 months. Based on our findings, neurological signs of variable severity…seem to be an important feature in >75% of the dogs…may even dominate the early clinical picture…before signs of uremia emerge…and confuse the initial diagnostic evaluation….not clear that the neurological manifestations are always reversible… dogs diagnosed with grape or raisin toxicosis (GRT) with emphasis on renal and neurological manifestations(n=15), compared to a control group of dogs with AKI from other causes(n=74)…
All dogs with GRT were presented with severe AKI…Eight dogs (53%) survived…42 control dogs (57%) survived…Eleven dogs (73%) had marked forebrain, cerebellar, or vestibular signs. These manifestations dominated the clinical picture in some dogs, but were not associated with the severity of azotemia or the presence of systemic hypertension…Eight dogs (53%) survived, and 5 dogs experienced a complete neurological recovery. Causes of death were unrelated to the neurological manifestations…suggest a reversible functional brain injury specific to GRT and unrelated to uremia. Physical examination at presentation and during hospitalization of group GRT identified lethargy (15⁄15), vomiting (15⁄15), diarrhea (8⁄15), hematochezia (3⁄15), oligoanuria (15⁄15), and hypothermia (15⁄15). Eleven dogs (73%) in group GRT had marked neurological signs at presentation…In group C, only 2⁄74 dogs (3%) had neurological signs… More than 75% of the dogs with GRT showed severe neurological signs, which were reversible in all dogs that survived. The remaining dogs were still neurologically abnormal by the time of euthanasia or death. It therefore is not clear that the neurological manifestations are always reversible, but based on the short survival time of the nonsurviving dogs that were still neurologically abnormal, they likely did not have enough time to regain normal neurological status before death. …Follow-up by phone was performed for the 8 survivors of group GRT, which all were still alive 9 to 13 months after discharge from the hospital. In 6 dogs, serum creatinine and urea concentrations were within normal limits at the last reevaluations with their referring veterinarians, and in 2 dogs, the owners had declined further blood reevaluations since discharge… …a kidney biopsy sample was obtained…indicated…acute renal tubular necrosis consistent with grape toxicosis…
Eubig, P.A., Brady, M.S., Gwaltney-Brant, S.M., Khan, S.A., Mazzaferro, E.M. and Morrow, C.M. (2005), Acute Renal Failure in Dogs After the Ingestion of Grapes or Raisins: A Retrospective Evaluation of 43 Dogs (1992–2002). Journal of Veterinary Internal Medicine, 19: 663-674. https://doi.org/10.1111/j.1939-1676.2005.tb02744.x
回顾性分析 43 只食入葡萄/葡萄干导致急性肾衰患狗。21/43 死亡，近端小管坏死是最常见的组织学表现。呕吐最常见的临床表现，其他常见表现包括嗜睡、厌食和腹泻。尿量减少、共济失调和乏力与不良预后相关。
Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived… All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome.