Raw bread dough made with yeast poses mechanical and biochemical hazards when ingested, including gastric distention, metabolic acidosis, and CNS depression. Although any species is susceptible, dogs are most commonly involved because of their indiscriminate eating habits.
The warm, moist environment of the stomach serves as an efficient incubator for the replication of yeast within the 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 may include unproductive attempts at emesis, 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 the effects of the 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 can be based on history of exposure and clinical signs. Blood ethanol levels are consistently increased in cases of bread dough toxicosis. Differential diagnoses include gastric dilatation/volvulus, foreign body obstruction, ethylene glycol toxicosis, and ingestion of other CNS depressants (eg, benzodiazepines).
With recent ingestions in asymptomatic animals, emesis may be attempted, although the glutinous nature of bread dough may make removal via emesis difficult. In animals 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. Animals presenting with signs of alcohol toxicosis should be stabilized and any life-threatening conditions corrected before attempts to remove the dough are made. Alcohol toxicosis is managed by correcting acid-base abnormalities, managing cardiac arrhythmias as needed, and maintaining normal body temperature. Providing fluid diuresis to enhance alcohol elimination may be helpful. Anecdotally, yohimbine (0.1 mg/kg, IV) has been used to stimulate severely comatose dogs with alcohol toxicosis.