Raw bread dough made with yeast poses mechanical and biochemical hazards when ingested, including via resultant gastric distention, metabolic acidosis, and CNS depression. Although any species is susceptible, dogs are most commonly affected because of their indiscriminate eating habits.
Bread dough toxicosis occurs when the warm, moist environment of a stomach serves as an efficient incubator for replication of yeast within ingested raw dough. The expanding dough mass causes the stomach to distend, resulting in vascular compromise to the gastric wall, similar to that seen in gastric dilatation/volvulus. With sufficient gastric distention, respiratory compromise occurs. Yeast fermentation products include ethanol, which is absorbed into the bloodstream, resulting in inebriation and metabolic acidosis.
Early clinical signs of bread dough toxicosis may include unproductive attempts at emesis as well as abdominal distention and depression. As ethanol intoxication develops, the animal becomes ataxic and disoriented. Eventually, profound CNS depression, weakness, recumbency, coma, hypothermia, or seizures may be seen. Death is usually due to metabolic effects of alcohol rather than from gastric distention; however, the potential for dough to trigger gastric dilatation/volvulus in susceptible dog breeds should not be overlooked.
A presumptive diagnosis of bread dough toxicosis can be based on history of exposure and clinical signs. Blood ethanol concentrations are consistently elevated. Differential diagnoses include gastric dilatation/volvulus, foreign body obstruction, ethylene glycol toxicosis, and ingestion of other CNS depressants (eg, benzodiazepines).
In cases of recent ingestion in asymptomatic animals, emesis may be attempted as a treatment for bread dough toxicosis, although the glutinous nature of dough may make removal via emesis difficult. In patients in which emesis (whether induced or spontaneous) has been unsuccessful, gastric lavage may be attempted. Cold water introduced into the stomach may slow the rate of yeast fermentation and aid in dough removal. In rare cases, surgical removal of the dough mass may be required. Patients presenting with signs of alcohol toxicosis should be stabilized, with any life-threatening conditions corrected before attempts are made to remove the dough. Alcohol toxicosis is managed via correction of acid-base abnormalities, management of cardiac arrhythmias as needed, and maintenance of normal body temperature. Providing fluid diuresis to enhance alcohol elimination may be helpful. Anecdotally, yohimbine (0.1 mg/kg, IV) has been used in severely comatose dogs with alcohol toxicosis.