What Happens at the Vet: Grape and Raisin Poisoning Treatment and Prognosis

If your dog arrives at the vet within approximately 2 hours of ingestion, decontamination is the priority. The vet will administer apomorphine (a prescription emetic) by injection to induce vomiting. This removes remaining grape or raisin material from the stomach before it can be fully absorbed. After vomiting, activated charcoal may be administered to bind any remaining toxin in the gut and prevent further absorption. Timing is critical: decontamination is most effective within the first 2 hours, though vomiting may still be attempted up to 4-6 hours post-ingestion in some cases.

Do NOT attempt to induce vomiting at home with hydrogen peroxide. This can cause severe haemorrhagic gastroenteritis and oesophageal burns.

Immediately after decontamination or on arrival, the vet will draw blood for a complete metabolic panel including creatinine, blood urea nitrogen (BUN), phosphorus, calcium, electrolytes, and a complete blood count (CBC). A urinalysis will assess urine specific gravity and look for early signs of kidney tubule damage. These baseline values are critical for monitoring the progression or resolution of potential kidney injury over the following 72 hours.

Intravenous fluid therapy is the cornerstone of treatment for grape toxicity. Aggressive fluid administration (typically at 2-3x maintenance rate) achieves several goals: it dilutes any tartaric acid in the bloodstream, maintains kidney perfusion and urine output, corrects dehydration, and supports the kidneys in flushing toxins. IV fluids are typically continued for 48-72 hours minimum. Dogs with established AKI may require longer fluid therapy or modified fluid composition depending on electrolyte imbalances.

Blood work is repeated every 12-24 hours during hospitalisation to monitor kidney values. Rising creatinine and BUN indicate worsening AKI. Stable or declining values indicate that the kidneys are responding to supportive care. Urine output is carefully measured throughout. The monitoring period is typically 48-72 hours for prophylactic cases and longer for dogs with established AKI.

Alongside fluids and monitoring, vets will typically administer anti-emetic medications (to control vomiting and ensure the dog can rest), gastroprotectant medications (to protect the stomach lining from acid and any chemical irritation), and electrolyte corrections as needed. Pain management may be provided if the dog shows signs of abdominal discomfort.

Dogs that develop established acute kidney injury despite IV fluid therapy face a more serious situation. Treatment options include: continued aggressive IV fluid support at higher rates; sodium bicarbonate supplementation; management of hyperkalaemia (dangerously elevated potassium); phosphate binders; and in severe cases where dialysis is available, intermittent haemodialysis or continuous renal replacement therapy (CRRT). Dialysis for dogs is available at some specialist veterinary internal medicine centres and veterinary teaching hospitals, but is not widely available and is expensive.

Prognosis for established AKI is guarded. Dogs that develop anuria (no urine production) have a significantly worse prognosis.