Hershey was the perfect name for the 2-year-old long hair dachshund with chocolate brown fur standing before me.  His sweet brown eyes were now darting nervously from me to his family. This was my first time meeting Hershey. He had arrived at the Veterinary Emergency Center around 11 pm for an evaluation.  Normally at this hour, now midnight, Hershey would be tucked into bed dreaming of getting into trouble.  Hershey had a trick: he would stand on his back legs and twirl in a circle rapidly wagging his tail and barking.  He looked like a circus performer twirling center stage!  Adorable as he was, Hershey had an ornery side to him and a bad habit of getting into mischief.  He loved to steal things that did not belong to him: making off with socks, toys, or even toilet paper rolls.  And, of course, he delighted in the game of chase that ensued to retrieve the stolen objects.  Tonight, his mischief had landed him at the ER.

Hershey had been rescued a year ago when his original family could not keep him anymore.  His new family included two young boys who were his constant companions.  The boys tearfully told me that while the whole family had been out at a soccer game, Hershey had managed to steal a bag of chocolate/caramel treats.  The bag of candy had been intended for the team to snack on but had been forgotten on the kitchen table.  The table, being quite high up, and Hershey being a tiny dog, the family would’ve never imagined it was a place he would be able to reach.  Apparently channeling some inner Cirque Du Soleil maneuvers, Hershey managed to jump from the floor to chair to the table top to steal the bag.  When the family arrived home, instead of greeting them at the door as usual, they found Hershey curled up in his bed. The empty bag of chocolate candy was torn to shreds nearby.  When one of the boys picked him up, Hershey groaned in pain and vomited a small amount of chocolate smelling brown fluid. Realizing what Hershey had done, he was packed up in the car and brought right to the veterinary ER.

Hershey’s family rushed him through the doors of the ER.  He was immediately moved to an examination room to start obtaining a history and vital signs (heart rate, temperature, respiratory rate).  My first impression of Hershey was that he was a very well taken care of little dog who was feeling very crummy at the moment.  On examination, Hershey had an elevated heart rate, rapid breathing, high blood pressure and a very painful abdomen.  He seemed nauseated and burped loudly when his stomach was palpated.  Despite being sick, Hershey remained calm and sweet throughout his entire exam. Even though he was very painful he never tried to snap.  After getting the history of the events of the evening it was likely that Hershey had recently ingested the chocolate and there was a chance most of it was still in his stomach.  I decided to induce vomiting to remove any remaining chocolate in his stomach thus preventing further absorption into his system.  About a minute after the injection was given, Hershey began retching.  He vomited up about of liter of liquid brown chocolate along with some candy wrappers. Hershey immediately felt better.  His heart rate and breathing returned to normal and after palpating his abdomen a second time, I determined he was much more comfortable than before.  Hershey was admitted to the hospital for overnight intravenous (IV) fluid therapy and monitoring. 

Chocolate is made from the roasted seeds of the Cacao plant. It contains caffeine and a substance called theobromine: both of which can be toxic to dogs.  Symptoms of chocolate toxicity can range from mild to severe or even death.  Mild signs include vomiting and diarrhea that can rapidly progress to increased heart rate, heart arrhythmias (abnormal beats) and seizures.  Chocolate toxicity is dose and type dependent.  White and milk chocolate have the least amount of theobromine concentration requiring a larger volume to be ingested to see clinical signs.  In contrast, baking chocolate, has the highest concentration and even one ounce can cause toxicity in a 10-pound pup. 

Hershey weighed 8 pounds and ingested a 12 oz bag of chocolate.  My calculations indicated he was in the danger zone for potentially fatal cardiac arrhythmias.  He had presented with hyperactivity, increased heart rate, and vomiting.   Luckily his heart was showing no signs of arrhythmia so Hershey’s treatment was aimed at addressing his clinical signs and removing any remaining chocolate from his system to prevent further absorption of the toxic substances.  He was kept on IV fluid therapy overnight to help flush the toxic substance from his system. Theobromine is metabolized by the body and excreted in urine.  While the substance is in the urinary bladder it can be reabsorbed through the bladder walls and then recirculate through the body.  To avoid this, Hershey was walked every 2-3 hours to make sure he was emptying his bladder frequently. 

By the next morning, Hershey was bright and happy.  His heart rate and rhythm had stayed normal overnight and he had no further bouts of vomiting.  His family was to take him home early that afternoon.  Hershey readily ate his breakfast, wagging his tail happily while scarfing down the food. He seemed ready to go home. 

Thirty minutes after eating, I noticed Hershey was not the happy pup he had been earlier.  He was lying curled up in his bed whining softly.  I examined him and he tensed when his abdomen was touched and burped.  He looked up pleadingly with his big brown eyes and began retching but seemed unable to vomit.  This was not the normal progression of a chocolate toxicity case.  I was concerned with the change of events and contacted his family.  I recommended we take some radiographs (x-rays) of his abdomen as I was afraid there were still some candy wrappers in his stomach.  Looking at the x-ray, I saw his breakfast sitting in his stomach along with a wad of foil wrappers.  The wad of foil appeared too large to vomit up.  I discussed with Hershey’s family that our options were limited.  The foil appeared too big to pass through the intestines and he was already showing clinical signs of an obstruction.   So, waiting to see if it would pass on its own was not a good idea.  We could attempt to pass a scope down his throat to grab the foil and pull it out; however, it was so large there was potential damage to his esophagus trying to remove it.  Also, having eaten recently, trying to even find the foil would be tedious and would require extra time under anesthesia. Surgery to remove the foil from his stomach was the best option to safely and quickly remove the obstruction.  Hershey’s family agreed and he was moved from ICU to be prepped for surgery.  He was given more pain medication and his abdomen was shaved and prepped for surgery. Within 20 minutes Hershey was back in recovery.  The procedure had gone perfectly.  One small incision into his stomach and the foil was out. The stomach tissue appeared healthy and examining the rest of his abdominal organs: he looked in perfect health. 

Hershey recovered quickly.  By the next day, he was eating readily with no nausea or vomiting.  His abdomen remained comfortable and he was back to his old self.  Much to the delight of everyone at the hospital, Hershey began doing his circus twirls trying to earn extra treats.  Although this quickly had to be discouraged as he was supposed to be resting and healing!

Three days after arriving at the ER Hershey was going home.  His family was elated to have him back and my staff was thrilled he had made such a quick recovery.  Hershey’s family had spent the previous days “dog proofing” the house so their little mischievous circus dog would not spend another anxious night in the ER.  I petted Hershey on the head and he gave me happy kisses.  As they were leaving, the youngest boy brought me a gift bag with a card and thanked me for saving his pal. As the family drove off we opened the gift bag to find a beautifully written thank you card with a hand drawn picture of Hershey.  And at the bottom of the bag…. An assortment of Hershey’s mini chocolate bars with specific instructions: For Human Consumption Only!

Jennifer Paugh, DVM, Blog Signature – Jennifer Paugh, DVM
Dr. Jennifer Paugh enjoys sharing her knowledge and experiences from practicing as a veterinarian in the US and abroad. In her free time you can find her doing yoga on the beach, traveling the world, and spending time with her two Cavalier King Charles Spaniels Finnegan and Olive.

Leigh Hofmeister