b'ARTICLEIts 8pm on a Tuesday when a client calls: their Labrador has just eaten a handful of grapes. They know grapes can be toxic and theyre looking to you for clear guidance. For years, the profession took comfort in being able to give a straightforward, protocol-driven response. With grape toxicity, that meant one standard approach: induce emesis and hospitalise for 48 hours on intravenous fluids. EndWhat if true clinical of discussion. confidence isnt found in But the landscape has changed. Gone are the daysreciting dogma but in expertly of unquestioned compliance.navigating the grey?Todays clients are information-savvy, digitally literate and oftenacute kidney injury (AKI) is remarkably come armed with their ownlow: just 1 g/kg for grapes (approximately research. Recent media coverageone-fifth of a grape per kg) and 2.8 g/around overtreatment and cost,kg for raisins. The VPIS stated in 2023: much of it triggered by the CMAAlthough it is likely that a single grape investigation, has added an extraor piece of dried fruit is unlikely to be layer of scepticism. Clients nowa risk, dogs ingesting more than this expect to be part of the decision- should ideally receive an emetic and making process and crucially they want us to explain and justifya repeat dose of activated charcoal. why we recommend a particularBecause this threshold is so low, gastric course of action, not just what wedecontamination remains a crucial step want them to do. for almost any confirmed ingestion.What we might say to the client is:What we know from the data is that This evolution forces us to ask: what iftheres no established safe dose. Even the right answer isnt so black andthough not every dog develops kidney white anymore? And what if true clinicalproblems, the smallest amount ever confidence isnt found in reciting dogmareported to cause acute kidney injury but in expertly navigating the grey?is extremely low and we still dont The debate around managing grapeunderstand which dogs will be affected toxicosis is a perfect illustration of thisor why. It therefore makes sense to try to shift. It offers a powerful opportunity toremove as many of the grapes as possible rethink how we communicate and towhile theyre still in the stomach. The build deeper trust with our clients throughsafest option at this stage is to bring your evidence-based contextualised care. dog in so we can make them vomit.First steps: triage What next?In my experience, a common questionThe traditional risk-averse approach from clients, particularly owners of dogserrs on the side of caution. Although who frequently scavenge is: But its onlyacute kidney injury develops in only a few grapes do we really need to comea small proportion of cases, when it down and pay the out-of-hours charges? does occur, the consequences can be So do they? To answer that, we need tosevere, with reported mortality rates of look to the evidence. 4550%. Faced with this low-probability high-impact risk, proponents argue that First, consider decontamination. The dataroutine hospitalisation with 48 hours tell us that some dogs can ingest largeof intravenous fluids is a reasonable quantities without consequence, yet thesafeguard for any dog with a known lowest reported dose associated withingestion.www.inspiredvet.co.uk21'