Finding out your senior dog’s blood work showed a high ALP can be confusing and concerning. Thankfully integrative veterinarian Dr. Julie Buzby is here to help you make sense of high ALP in dogs. She explains, what it is, why it can sometimes be elevated, and what the next steps might be.
Sampson, a 12-year-old Jack Russell Terrier mix with a zest for chewing sticks and chasing squirrels, was in to visit me recently. During a particularly vigorous stick chewing session he had cracked a tooth. As a result, he needed a dental procedure under anesthesia to remove the damaged tooth and clean the rest of his teeth.
I always recommend some basic bloodwork prior to any of my older doggy patients going under general anesthesia. Pre-anesthetic lab work helps ensure a dog isn’t at an increased risk for complications with anesthesia or the specific procedure. It also has the added benefit of occasionally picking up on medical issues before they become a bigger problem. That was how we found that Sampson’s ALP, while normal on his last yearly bloodwork, was now moderately high.
Sampson’s dog mom, Sarah, was the proactive type and had many questions about ALP. I answered her questions in detail before we formulated a plan.
What is ALP in dogs?
The abbreviation “ALP” stands for alkaline phosphatase, which is an enzyme many routine blood panels may measure. Primarily, the liver produces ALP, though there are other sources too. We will come back to this later in the article because it is important.
Within the liver, ALP is found along the outer layer of the liver cells. Even more specifically, it is associated with the liver cells that line the bile ducts. Alkaline Phosphatase’s normal job in the body is complicated, and actually isn’t critical to understand here. But what is important to understand about ALP is that it is a sensitive indicator of liver or gallbladder dysfunction.
A brief physiology lesson
The liver is an amazing organ that has, by many estimates, over 500 critical jobs in the body. To name a few, the liver is responsible for:
- Removing toxins from the bloodstream
- Regulating blood sugar (along with the pancreas)
- Taking old red blood cells out of circulation
- Releasing clotting factors
The liver is also responsible for making bile, which flows through ducts in the liver to the gallbladder. Bile is then released from the gallbladder into the GI tract where it helps with digestion.
With all these important functions, it would only make sense that keeping tabs on your dog’s liver is an important part of keeping him or her healthy. This is where ALP liver enzymes (among other liver enzymes) comes in.
How would the vet detect high ALP levels in dogs?
When your veterinarian performs general wellness blood work on your dog, either as part of a yearly exam or as part of a pre-anesthetic check-up, chances are the blood work will include a chemistry panel. This test measures protein and electrolyte levels. It also includes values that can offer clues about the function of the liver, kidneys, and pancreas.
For a chemistry panel, the vet or vet nurse will draw a small amount of blood from your dog and place in a test tube. Then, your veterinarian may sometimes perform the blood tests with an in-house laboratory machine. Alternatively, he or she can send your dog’s blood to an outside veterinary diagnostic lab. If your veterinarian runs these tests in-house, your results may be ready the same day. But if your vet sends the blood out, it can take several days for the final results to be available.
Liver values
The markers related to the liver on a chemistry panel include ALP, ALT, GGT, and total bilirubin. The liver also makes glucose, cholesterol, albumin, and BUN. These levels can give clues to how well the liver is functioning.
ALT, or alanine transferase, is what is known as a “hepatocellular” liver enzyme. When the cells of the liver are damaged, this enzyme leaks out into the blood. Elevated ALT is often more worrisome than high ALP to veterinarians since it indicates ongoing damage to the liver cells.
ALP and GGT are what are known as “cholestatic” enzymes. This means that elevations predominantly occur if there are issues with the flow of bile, either within the liver, or as it leaves the gallbladder.
Forms of ALP
Earlier we touched on the fact that the liver makes alkaline phosphatase (ALP), but other places in the body make it too. The three most important forms are ALP from the liver (L-ALP), ALP made in the bone (B-ALP), and ALP that is released in response to excess levels of corticosteroids (C-ALP). A chemistry panel measures all three of these forms together as ALP. Therefore, based on the chemistry panel alone, it is not possible to determine which form is contributing most to an elevated ALP.
Liver ALP
As the name implies, L-ALP elevations are often related to issues with the liver. This is the focus of much of the rest of the article.
Bone ALP
Increased ALP activity is common in young dogs who are growing rapidly because normal bone growth releases B-ALP. Generally, these dogs are less than a year old. In a young dog, a mild elevation in ALP is not a worrisome finding if the remainder of the liver values are normal and the dog is otherwise feeling well. However, conditions that cause ongoing damage to the bones, such as bone cancer (i.e. osteosarcoma) or infections within the bone (i.e. osteomyelitis), can also cause elevations in B-ALP levels.
Corticosteroid ALP
The liver produces corticosteroid-induced ALP in response to elevated blood steroid levels. These high C-ALP levels can either be due to the body producing increased amounts of steroids, as with Cushing’s Disease in dogs, or they can be from oral or topical steroid-containing medications.
What causes high ALP in dogs?
Many times, a vet will find high ALP in senior dogs. In fact, it is one of the most common lab work abnormalities in older dogs. An elevated ALP is very sensitive in its ability to assess for hepatobiliary disease (i.e. diseases affecting the liver, gallbladder, or bile ducts) in dogs and cats.
This means that most dogs with significant liver disease will have an elevated ALP. That sounds like great news, right? If that’s the case, an ALP blood test should be the perfect way to help decide if your dog has liver disease.
Unfortunately, it is not quite that simple. While a high alkaline phosphatase level is very sensitive, it is not also a non-specific finding. This means that lots of other conditions aside from liver disease can cause an elevation in ALP. The list of conditions that can cause an elevated ALP includes:
Liver or gallbladder conditions
Any disease that causes a back-up of the flow of bile (i.e. cholestasis) will cause increased serum ALP levels in dogs. Cholestasis can be due to primary liver disease in dogs. Structural problems that block the flow of bile out of the liver, into the gallbladder, or from the gallbladder into the intestinal tract, can also cause a high ALP in dogs. Finally, secondary liver diseases (i.e. other conditions that cause ongoing damage to the liver) also will cause an elevated ALP level.
Primary liver diseases include:
- Infectious hepatitis due to ascending bacterial infections, Leptospirosis, etc.
- Chronic active hepatitis
- Copper storage disease
- Benign nodular hyperplasia
- Vacuolar hepatopathy in dogs
- Hepatocellular carcinoma (i.e. a type of liver cancer)
Gallbladder diseases include:
- Cholelithiasis (i.e. gallstones)
- Cholecystitis (i.e. gallbladder infection)
- Gallbladder mucocele in dogs
- Bile duct carcinoma (i.e. cancer of bile ducts)
Other medical conditions
Many medical conditions that are unrelated to the liver itself can also cause a high ALP. They range from non-worrisome to very concerning. Some of these include:
Endocrine diseases:
- Diabetes mellitus
- Hypothyroidism in dogs
- Cushing’s disease
- Hyperparathyroidism
Non-liver cancers:
- Lymphoma in dogs
- Pancreatic carcinoma
- Osteosarcoma (i.e. bone cancer)
Other diseases:
- Pancreatitis in dogs
- Gastroenteritis (I.e. inflammation of the stomach and intestines from various causes)
- Osteomyelitis (i.e. bone infection)
Toxins
Any toxins that cause substantial liver damage can also cause a high ALP in dogs. However, these elevations will not normally be as significant as the increases in ALT levels. Some toxins that cause liver damage are:
- Xylitol toxicity in dogs
- Cycad palms (i.e. sago palms)
- Zinc
- Aflatoxin
- Amanita mushrooms
- Blue Green algae toxicity in dogs
Breed-related elevations
Certain dog breeds can have increased ALP levels without it being a problem. The most common breed-related cause of increased ALP is Benign Familial Hyperphosphatasemia in Siberian Huskies. Scottish Terriers can also have a similar condition.
Medications
Some medications also are connected with elevated ALP in dogs. Two of the most common are:
Phenobarbital
This is a common medication vets use to treat dog seizures that can benignly increase L-ALP levels. However, phenobarbital can also occasionally cause damage to the liver. This means that if a dog taking phenobarbital has a high ALP, it can be hard to determine if the ALP elevation is no big deal, or if it might indicate a bad reaction to this medication.
If you find your dear dog in this situation, your veterinarian will likely start by evaluating how your dog is feeling. He or she will also look at the levels of the other liver values on the chemistry panel. In cases where the ALP elevation is severe, your dog is feeling poorly, or your dog has other liver enzyme elevations, then your veterinarian may recommend additional liver function testing.
In some cases, dogs will need to stop phenobarbital due to concerns about liver damage. The good news is that in most dogs, the liver values quickly go back to normal when the vet weans them off phenobarbital and onto one of the other medications available to help control seizures.
Steroids
Oral steroids, like prednisone for dogs, commonly cause moderate to severe elevations in ALP. Higher doses of steroids, such as those used for immunosuppression in cases of IMHA in dogs or other immune-mediated conditions, tend to cause higher ALP elevations.
Luckily, the increase in ALP from steroids does not generally correlate with long-term liver damage or liver dysfunction. However, it is important to know that once the dog stops taking steroids, it can take much longer—up to several months—for the ALP levels to normalize.
If your dog has an elevated ALP level, ensure you tell your veterinarian about all the medications your dog is taking or has recently taken. Some eye and ear medications and skin sprays or ointments contain steroids. Even these topical steroids can lead to ALP elevations during or after treatment.
Is a higher ALP automatically worse for dogs?
You may be wondering if you can use the degree of ALP elevation to tell you how bad the underlying problem might be. It would be easy to think that if a dog has a very severely elevated ALP, her or she might have a worse prognosis. Happily, this is not always the case.
Some benign and completely reversible issues, like taking high doses of steroids, can cause very severe elevations in ALP. However, if there is not an obvious reason for the high ALP (like taking a course of steroids), then your veterinarian may use the degree of elevation to help decide how aggressive to be with additional diagnostic testing.
What are the next steps for a dog with a high ALP?
If your dog has a high ALP, your veterinarian will start with a detailed medical history and thorough physical examination. In many cases, clues from the exam and history can help point your veterinarian to the next best diagnostic test to perform.
Every case is different, but the most common and least invasive next step is often to perform full lab work. This typically includes a CBC (i.e. complete blood count), full chemistry panel (if the ALP elevation was found on a “short” panel), T4 level, and urinalysis. If the remainder of your dog’s lab work is normal, he or she is otherwise feeling well, and the physical exam reveals no major concerning changes, then your veterinarian may elect for the “watchful waiting” approach.
With this approach, your veterinarian would hold off on performing any additional diagnostic testing right now. He or she will repeat lab work periodically to monitor trends in the ALP and other liver values. If the ALP improves or remains mildly elevated, then together you may elect for continued “watchful waiting.” If the ALP elevation gets worse, repeat bloodwork shows other abnormalities, or your dog develops any new medical symptoms, then your veterinarian will likely recommend additional diagnostic testing.
Liver function testing
One additional non-invasive lab test that your veterinarian might recommend is a liver function test which measures bile acid levels. Bile acids are made in the liver, stored in the gallbladder, and released into the intestines to help digest fat after you, or your dog, eats a meal. If the liver is working well, these bile acids are pulled back out of the bloodstream to be recycled and used again. However, if the liver is not functioning well, it is unable to remove the bile acids from the bloodstream and the bile acid levels will be high.
Your veterinarian can measure bile acid levels by taking two blood samples and sending them to an outside veterinary diagnostic lab. Your dog must have fasted for 12 hours prior to the first blood draw. Then your veterinarian will feed your dog a small snack, which should cause the gallbladder to release bile acids. Next, the vet will take another blood sample two hours later to see if the liver was able to remove the released bile acids from the bloodstream.
Elevated bile acid levels tell your veterinarian that your dog has a significant problem with his or her liver. But it does not provide any information about the underlying cause of the liver problem. If your dog has elevated bile acid levels, your veterinarian will likely recommend additional testing or referral to an internal medicine specialist.
Imaging
Your veterinarian may also recommend some liver imaging. In general, X-rays and ultrasound are the two most common types of imaging offered in veterinary medicine. While X-rays are a useful tool for many issues, they have limited ability to evaluate the liver.
An abdominal ultrasound is much more useful in this regard. An ultrasound can evaluate for masses or nodules in the liver and can also assess the gallbladder for signs of infection, gallstones, or a mucocele. Plus, ultrasound can help determine if there might be other medical conditions like pancreatitis or Cushing’s disease that are causing a high ALP.
Liver sampling
One limitation to ultrasound is that while it can determine if the liver looks abnormal, it cannot definitively pinpoint the underlying cause of masses, nodules, or other abnormalities. Some nodules are benign changes, while others represent cancer. There may be clues on ultrasound that a mass or nodule is benign or malignant. But to know for sure the vet must take a sample of the liver. The two ways to sample the liver are fine needle aspiration or biopsy.
Fine needle aspirate
If your veterinarian finds nodules, masses, or other liver abnormalities, he or she may recommend a fine needle aspirate as the next diagnostic step. To perform an aspirate, your veterinarian will use an ultrasound probe to guide a small needle into the area of concern in the liver. Once the vet gathers the cells in the hub of the needle, he or she will squirt them onto a glass microscope slide. Then your vet will submit the slide to a veterinary pathologist for review.
In veterinary medicine we often start with fine needle aspirates over biopsies. This is because this testing is less expensive, less invasive, and the vet can do it while your dog is awake or with just mild sedation. The drawback of aspirates is that they do not always yield a diagnosis. If results are inconclusive, the vet may still recommend a liver biopsy.
Liver biopsy
A liver biopsy is the most definitive way to determine the underlying cause of liver enzyme elevations. However, it is more invasive than many of the other tests. To perform a liver biopsy, the vet will remove a small piece of the liver and submit it to a veterinary pathologist. Your vet may obtain the sample through an open abdominal surgery or laparoscopic surgery. Alternatively, your vet may use a large needle tool (i.e. the Tru-cut biopsy technique) which is significantly bigger than the needle for a fine needle aspirate.
Unlike a fine needle aspirate, which your vet can do on an awake dog, the vet will always perform the biopsy under general anesthesia. Although it may raise the question in some dog parents’ minds of “Is my dog too old for anesthesia,” a biopsy can be a very useful tool. It allows the vet to submit an actual chunk of liver tissue for evaluation. This can give a clearer idea of what is going on in the liver than a fine needle aspirate can.
Since biopsies are a more aggressive test, they may not be warranted in cases of mild or even moderate ALP elevations where the dog isn’t symptomatic and/or doesn’t have elevations in other liver enzymes. However, every dog and every case is unique. Your veterinarian will take your furry family member’s medical history, exam findings, and full lab work results into account when making his or her recommendations.
Back to my patient, Sampson
I am sure at this point you are wondering what happened to Sampson. We did perform full lab work, which aside from the ALP elevation, was beautifully normal. Apart from his sore tooth, Sampson was his normal squirrel-chasing self. He was energetic and had a great appetite.
We knew that his tooth was uncomfortable. Together his mom, Sarah, and I decided it was best to go ahead with his dental procedure. I am happy to report that the procedure went great. Sampson recovered uneventfully and is back to enjoying his crunchy dog biscuits and even the occasional stick (although sticks are not on my list of safe chew toys for dogs).
We rechecked lab work a month after his procedure and the ALP elevation was still there. Since Sarah is the proactive type, we decided to schedule an ultrasound for Sampson. The radiologist reported changes in the appearance of his liver that looked consistent with benign nodular hyperplasia, which was good news
I let Sarah know that benign nodular hyperplasia is very common condition in many senior dogs. It causes benign nodules to form in the liver and a mild to moderate ALP elevation without an elevation in the ALT. Changes on ultrasound can make the radiologist suspect this condition. But ultimately it would take a liver biopsy to rule out more nefarious causes of nodules.
After weighing the pros and cons, Sarah decided to continue monitoring for now. Sampson will come back in a month to monitor his ALP value. And then in a few more months he will have another ultrasound. I have a hunch that this is just going to be a blip on the radar for good old Sampson, and that the local squirrels won’t be able to rest anytime soon.
Talk to your vet
If like Sampson, your dog’s blood work showed a high ALP level, the best thing you can do is have an in-depth conversation with your veterinarian. Sometime being presented with all the different diagnostic options can feel a bit overwhelming. But at the end of the day, you and your trusted vet should be able to work together to create a plan for your dog—be it a “watchful waiting” approach or further diagnostics—that you feel confident about.
Hopefully, the elevated ALP will turn out to be nothing significant for your senior dog. But even if it does indicate a more serious problem, remember that your dog has a great ally in you and your veterinarian. Together, you can tackle whatever the future brings and keep making memories in the process.
Has the vet ever found a high ALP level in your senior dog’s blood work?
Please comment below to share your dog’s story.
I have 2 6month old Aussaliers brother and sister Flash, and Molly from the same litter. They just had their little boy and little little girl surgeries this week and we have their first bloodwork done so that we had a baseline in their chart and everything came back normal except their ALKP or both high Molly was 239 and Flash was 262 They have been fasting 12 hours prior to bloodwork being done with this of caused the ALKP to be high? Should I be concerned? The vet says that the mild elevation in their bloodwork is normal because they are growing. I just wanted to get a second opinion. We do not feed them anything except their dog food which is science diet and they are exercised well. Any feedback would be great and appreciated. Thank you.
Hi Melissa,
I know it it can be concerning anytime your dog has bloodwork abnormalities. Hopefully it will ease your mind to know that yes, like your vet mentioned, ALKP elevations do sometimes occur in young growing dogs. In this case, the elevation typically comes from the “bone version” of ALKP rather than the “liver version” so it isn’t usually a cause for concern. Especially since it was the case for both of them, rather than just one of them, bone growth seems to be the most likely explanation. However, there is certainly nothing wrong with asking your vet for some follow-up bloodwork after your puppies are fully grown (or sooner if you are noticing anything is off with them). Hope that helps!
We have a pure bread Beagle named Daisy who is 4 years old.. last November we had ALP bloods checked and they were 353, Had them checked today (one year later) and they are at 903… All else is normal with her, all other bloods were normal range (ALT etc). Had her tested for cushings a year ago and it was negative, also had ultrasound of abdomen a year ago and was negative. Urine test was negative for proteins a year ago.. What are your thoughts?
Hi Emma,
I am sorry Daisy is showing a steady increase in her liver values over the last year. It may be that when the tests were originally performed, the disease process was not far enough along to show any other abnormalities. If you repeated the testing now, you may in fact find something to help point you in the right direction. Also, it might be a good idea to schedule a consultation with an internal medicine specialist. Cases like this are hard when you do everything right but still are left with more questions than answers. I would also recommend talking to your vet about trying a liver supplement such as Denamarin if Daisy is not already taking one. Feel free to leave an update as things progress. Wishing you both nothing but the best.
Our dog is old and his old bones aren’t what they were. However, up to now he had still enjoyed going for a walk and had a big appetite. In the last couple of weeks he’s eaten less and less, and now is not even interested in his treats. He’s a big dog and was 38 kg a few weeks ago but is now down to 34.4 kg. He still likes a walk each day (though it’s usually less than 30 mins, instead of what used to be an hour or more) and drinks normally. Blood tests today revealed a very high ALP level; the vet said it was “in the thousands” (I spoke to him over the phone and it wasn’t a great line) with elevated ALT (I think) levels too. The vet wants to have him in to do an ultrasound and a liver biopsy but he’s over 14 years old and I wouldn’t like to put him through that, especially as he probably doesn’t have much longer anyway. It’s possible he may have had a seizure or TSA recently. He spends most of his time sleeping these days. Is it time to say goodbye?
Hi Mike,
So sorry to hear about your dog’s recent decline. The amount of weight he has lost plus the elevations in ALP (and maybe ALT) are definitely concerning, especially coupled with him not wanting to eat much of anything. I agree with your vet that an ultrasound and biopsy would be the next steps if you wanted to look for answers, but it is also perfectly fine for you to decide that those aren’t things you want to pursue at his age. You know your dog well, and you know what is best for him.
In terms of thinking through when it may be time to say goodbye to him, there is usually a window of time in which euthanasia may be the best choice. Based on what you have said, he may be approaching or already in that window, but I can’t tell you that for sure. Sometimes filling out a quality of life scale or having a conversation with your vet (or an end-of-life-care vet) can help bring some clarity. I’m including links to a few articles that you may find helpful too.
Thinking about you as you wrestle with this difficult decision. ❤️
Here are those links:
1) When to Euthanize A Dog With Liver Failure: A Vet’s Advice
2) Using a Quality of Life Scale for Dogs
3) Preparing for Your Dog’s Euthanasia: 10 Thoughts for Peace
4) How Will You Know When It’s Time to Euthanize Your Dog? 5 Caring, Heartfelt Messages
Hello,
My Siberian Husky Chloe just turned 9y on November 2. I took her to the vet in October since she was having weekly diarrhea with only one case of vomiting each episode. I had a full panel blood test done in October which resulted in ALP just over 1500. she was prescribed a low fat diet which would not settle well with her tummy so I opted for another brand of food that she did do well with to ease the diarrhea symptoms. i followed up with the vet 3 weeks later to do a single panel test and the ALP levels dropped to just over 1000. However her globulin levels were 5.2 over 4.8. She also started to become severely flatulent. However after adding a probiotic supplement to each meal, her flatulence has subsided to just some rare occurrence. she has no symptoms as of today other than mild flatulence and random gulping noises. I assume the gulping is from acid reflux. Also her stools are no longer diarrhea but in the middle of firm and diarrhea. it looks normal but when picked up, the texture feels like loose playdough or cake mix. The vet wants to do a bite test and an ultrasound but I feel as though a wait and see is more appropriate considering her symptoms are very mild. what are your thoughts?
Thank you and regards,
Jeff
Hi Jeff,
Sorry to hear about Chloe’s recent tummy troubles and elevated ALP. It is great that her ALP is going down and her stools are improving, but it sounds like she isn’t quite back to normal yet. Whether you decide to give it more time or pursue further diagnostics at this point is ultimately up to you. I agree with your vet that a bile acids test and ultrasound would be the next logical steps should you want to dig deeper into her significantly elevated ALP. But I also understand where you are coming from with wanting to give it more time since the ALP is trending downward and her symptoms are improving. What you decide to do depends in part on how aggressive you want to be and how the results of the bile acid testing and liver ultrasound could change her treatment and monitoring plan and/or her prognosis. Since I haven’t been involved in her case, I can’t give you more specifics about the pros and cons of waiting vs. doing the testing, but I think it is worth discussing with your vet as he or she would likely have some insights.
I hope you feel peace about whatever decision you make and that Chloe keeps improving!
My 14 and 1/2 year old jack russell has been on Rimadyl for the last 2 -3 years for his arthritis. As part of his heath check he had his bloods tested and his ALP has come back at 566. His other liver and kidney tests are all normal.
Is 566 on the high side and something to be concerned about and could this be caused by the Rimadyl? What should our next steps be?
Hello Newts,
I’m sorry to hear that your pup had an elevated ALP at the last health check, but thankful that the other liver and kidney values are still normal. ALP elevations are a fairly common finding in older dogs and can have a variety of causes, which can make it challenging to decide how worried to be. Rimadyl has been known to contribute to an elevated ALP in dogs, so it could potentially be the cause. But so could benign nodular hyperplasia (a common condition in older dogs) and many other things. Without being able to examine your dog, I can’t give you any concrete recommendations about the next best steps. However, I do think it is worth talking to your vet about what he or she thinks would be best. Sometimes monitoring the values for now is all that is needed. Other times that might be changing to a different pain medication, adding in a liver support supplement like Denamarin, pursuing further diagnostics, etc.
I hope that you are able to have a good conversation with the vet and leave feeling confident in whatever the plan ends up being.
Hello Dr. Buzby:
Hope you are well. My Male dog is 12 years old and has a high alp of 270 and 160. These elevations started last year. Last years numbers were: Mild elevation in albumin 4.3 (2.5-4). ALT 169(0-120), ALP 159 (0-140)
The doctor says that he would have to take ursodiol his whole life, is this warranted, are there any other alternatives to naturally lower these numbers? Do natural liberal supplements work like Zesty paws brand for liver? I haven’t received much explanation as to why this is happening just that it’s a progressive disease and age related. No other alternatives or explanations offered. Please let me know what I should do and what questions I should ask because the responses I receive are very brief but without much explanation. I’ve read gastrointestinal issues can cause these elevations as well. What would you recommend be our next step?
Thank you so much for your attention,
Hi Marlene,
I understand your concern with your pup’s elevated liver enzymes and applaud you for doing your research and looking for answers. Thankfully the elevations are still mild at this point, but it is good to keep them on your radar. The list of causes of elevated liver enzymes is unfortunately quite long, which can make it challenging to pinpoint an exact cause in some situations. I’m actually in the middle of writing another blog about elevated liver enzymes, so you can be on the lookout for that one too. But in short, if you want to dig a bit deeper into why these numbers are elevated, you may want to consider making an appointment with a veterinary internal medicine specialist. They should be able to do some additional diagnostics (ex. liver ultrasound, bile acids test, etc.) to get a better idea of what is going on, and then create a treatment and monitoring plan. Since the internal medicine specialists focus just on diseases of the internal organs, they are often able to give more in-depth answers than a general vet, who focuses on disease of the whole animal.
In terms of supplements, I don’t have any experience with the Zesty Paws liver supplement, but it look like it contain milk thistle, which is a popular liver support ingredient. However, my personal favorite liver supplement, and the one I frequently recommend for my patients, is Denamarin. It combines milk thistle and SAMe to help support the liver. Sometimes Denamarin does help lower, or at least stabilize the liver values, so it (or a similar product) could be worth a try!
I hope you are able to find some clear answers and a plan that you can feel confident in. All my best.
Thank you so much for sharing your knowledge. My 12.5 year old golden retriever had a scary episode in July with the appearance of total fatigue and no interest in food. The vet ran blood work and his WBC was 79.1K with Neutrophils of 71K, ALP 174. He started acting normal again and we repeated blood work which showed WBC 14.9K but ALP increased to 207. Vet did a crude abdominal ultrasound as they are not experts but said his organs looked good. He was acting normal except for more particular about food so we decided to watch & wait. Three months later he had two morning seizures so blood work repeated and WBC up again to 40.2K with Neutrophils 35K, monocytes 1.6K and ALP up to 497. His glucose was low at 60. ALT has been in normal range. My vet is thinking insulinoma but I’m wondering why she isn’t worried about ALP.
My pup had an emergency splenectomy two years ago for a massive bleed which turned out to be a benign football sized spleen tumor. Could the absence of a spleen cause elevated ALP? Or WBC? Platelets are high too (500-665).
My vet suggests rechecking glucose with no mention of ALP. I’m not ready to say good-bye so this is a hard road to navigate.
Hi Pam,
I understand your concern for your pup and think it is great you are advocating for his health and well-being. Without examining him myself and playing a personal role in his medical care, it is hard to make specific recommendations. The ALP is not very liver specific and can become elevated for any number of reasons. This may be why your vet is more focused on the obvious issues. They are probably hoping that if they find the cause of the abnormal blood cell counts and glucose, then it will also explain the increased ALP. Hoping you can get some answers quickly and find the best treatment options for your Golden boy. Don’t forget you can always ask about a referral to a specialist if needed. Best wishes for a positive outcome!
Hi
Our 11 year old cairn/ yorkie cross had ALP of 2613 in July
We changed to heptatic dog food and cut out treats etc
Yesterday we were told the levels were 4400
The vet hasn’t suggested what the cause is or what this means
She is otherwise healthy for her age and loves to get out for walks
Is there anything you can suggest
Hi Dee,
I am sorry your senior pup has these elevations in his liver enzymes. It sounds like you really have two options. One would be to continue to monitor and offer palliative care. The other is to proceed with more in-depth testing to try and get a diagnosis. This could involve more lab work, ultrasound, or even contacting a specialist. I think it would be best for you to have a more detailed conversation with your vet. Make sure to voice your questions and concerns and be honest with your feelings about how things are progressing. Hoping you can get some answers soon and find the best way forward. Wishing you all the best.
My Ivy girl has been very active and healthy.. She will be 12 in 3 months. She had her first ear infection and while at the vet we decided on her senior panel. Since 2021 her ALT jumped from 36 to 350. ALP from 21 to 500. She eats well, poops great and drinks plenty, pee is good… No signs of anything other than my assumption that older aged has slowed her down.. I don’t know if these numbers are hugely significant since the vet said her enzymes are ‘slightly’ elevated. She lost her umphhh ! I am hopoing for the best . I love that girl and cannot stand the idea of losing her right now… Does Denamarin help or is she past that?
Hi Buck,
I understand your concern for your senior girl and this slow rise of her liver enzymes. There is no way to know for sure if Denamarin will help, but it certainly shouldn’t hurt! If your vet is willing to prescribe it, I would say give it a try. I have seen supplements do wonderous things for situations just like yours.
Thank you for your article. I would appreciate your thoughts on our boston terrier Alice. Her ALP levels were normal in 2019 but from 2020-2023 they have jumped each year from 162 to 506 to 781 to 977. We had imaging done a couple of years ago and they identified a mass in her gall bladder. Rather than pursuing invasive treatments we have been seeing how she does because she acts normally. The .vet suggested we could try Denamarin to see if that helps with her levels. What are your thoughts? Thank you very much!
Hi Jennifer,
I understand your concern for Alice and these increasing liver enzymes. Without examining her myself and knowing all the details it is hard to make specific recommendations. I do love Denamarin and frequently prescribe it for my own patients. I am curious to know exactly what the “mass” was that was seen on ultrasound. It may be possible to have the gallbladder removed and improve your pup’s prognosis depneding on what the actual diagnosis is. Here is a link to another article with more information: Gallbladder Mucocele in Dogs: What You Need to Know
It may be time to think about a consultation with a specialist. Hoping you can find the best way to keep your sweet girl happy and healthy for many years to come. Best wishes to you both!
Hello Doctor, my girl Sage is 8 1/2-9 years old. She’s part dachshund part don’t know. I rescued her from getting euthanized. She started panting hard about 9 months ago and I was worried about her heart because she had gained weight when I had a knee replacement. Took her to 2 vets and finally to a third vet. As soon as he saw her, he said that she looks like she has Cushings. So we tested her.. she tested positive, well it also turns out she has diabetes and her Alp number is super high at 2400, her Alt is 398 . So she’s on insulin. He prescribed the liver supplement but I wanted to know if that’s all we are going to do for her liver. He said yes, because he didn’t have alot of hope for her liver numbers. Well I have an autoimmune liver disease that I take Ursodiol. My daughters dog had liver issues and her vet prescribed Ursodiol. I asked about Sage getting on that and he said he’s never prescribed that for liver issues. Well it’s helped me and it helped my daughters dog. So I told him that I wanted to try it for her. We will be getting our blood work again in a few days. But in the past 3 weeks cushings has started to mess with her so today I’m starting her on Trilostane. Im going to have an ultrasound done on her next week. Im hoping for miracle. I don’t know what else to do for her. Trying to find a good dog food for her but there’s seems to be alot of bad food out there. Boy are we tired! Thanks for reading Georgia
Hi Georgia,
I am glad you were able to get some answers and now know exactly what your girl is dealing with. I hope the ursodiol will help decrease the elevated liver enzymes and offer your pup a better quality of life. Sage is lucky to have you advocating so strongly for her health and well-being. Thank you for sharing your experience with us. Wishing you both the best and keep up the good work!
Georgia, my 10 year old has had similar symptoms. Panting for a couple of weeks and then the first seizure. She is is now on Keppra, but still has heavy panting. Her AlP is at 370 and the vet wanted to test for Cushing but I’m not sure. Did you find out any more on your dig?
My dog is 12 years old and has had IBD for 6 years. She was on low dose budesnoide for the last 6 years which she never had any GI flare ups and recently took a turn for the worse. She suddenly went blind (SARDS) and has bloody diarrhea that ended her in urgent care. She has had two abdominal Ultra Sounds which which were normal but her ALP is at 1900 and shows no signs of coming down. On her last blood work her ALT was 143 ( slightly elevated) but she is on low 4 mg of Medrol and thyroid medication. The vets really don’t say much. Could all this be form the steroids? If she has autoimmune then how is it treated?
Thank you!
Hi Jan,
I am so sorry your senior girl has been through so much. These elevated liver enzymes could definitely be just due to the steroids. Unfortunately, the risk of side effects may be worth it for the benefits they provide. If there was an autoimmune disorder present, the treatment would be to suppress the immune system. This is commonly done using steroids. So, the odds of this being the cause is probably pretty low. I hope your girl can keep fighting and is able to make a full recovery. Sending you all my best. ♥
Hello,
First off I want to say this page has been super insightful and given me so much information about high ALP in dogs, so thank you!
My 11 year old lab mix recently got a routine blood panel test and a couple things came back. His ALP is higher than the normal range at 318, his Total Bilirubin was 0.4, and his CPK was elevated at 954. Lastly, his urinalysis test came back as dilute at 1.007 and trace occult blood. Everything else was in normal levels. My vet said it’s possible that it could be Cushing’s so she wants to do a test for that, but he’s not really exhibiting any symptoms of it (he’s always had a big appetite, always been a big water drinker, no skin issues etc). I think it’s worth doing the test but wondering what other possibilities it could be based on those combinations of elevated results above?
Thank you so much.
Hi Amanda,
I understand your concern for your senior guy and these elevated liver enzymes. I do think the Cushing’s testing would be a good idea. There are just too many other possibilities to list them all, but the most common would be primary liver dysfunction or a mass in the liver. If I had to guess I would say your vet will probably recommend x-rays or an abdominal ultrasound at some point to see what the liver looks like. I hope you get the answers you need to move forward with the best course of treatment. Wishing you both the best of luck for a positive outcome.
Hi Dr. Buzby, thank you for sharing this story. I’m an ER physician myself and you’d think I’d be calm and collected with health news – but not when it comes to Marlowe. She’s an 11 year old Shih-Poo and I’ve had her since my first year of medical school.
She’s in great health physically but over the past year I’ve noticed what I thought (and my vet agreed) were lipomas. Some blood work revealed an elevated ALP – first 403 in March and now 560 in July. Today her lipase came back at 780 and her cholesterol at 8.9.
Her remaining liver function tests, albumin, bilirubin, glucose levels, creatinine, and CBC were all normal, but I’m very worried about her blood work. She has had increased thirst and a rounder tummy lately.
She had a liver ultrasound and it was enlarged but showed no masses. Her adrenals looked ok too. Does this mean it’s a pituitary issue?
Her last Urine SG was concentrated, so the thought of cushings was put aside, but I wonder if that’s what she has. She’s a very happy and healthy girl and I’m so hoping there’s a benign answer for all of this.
Any insight about what could be contributing? Any chance there’s a dietary or exercise fix?
My primary vet offered referral to the vet general surgeon which I was thinking about.
If you had any thoughts about what your next steps would be if she was yours, I’d be super grateful. I’d do anything for my dog.
Hi Gemma,
I understand your concern about this elevated ALP in Marlowe. You are right that these symptoms could be early signs of a pituitary dependent Cushing’s disease, but not necessarily. Have you discussed Cushing’s testing with your vet? Also, it might be worthwhile scheduling a consultation with an internal medicine specialist. I feel like you are on the right track with the diagnostics that have already been performed. Your girl might also benefit from a trial course of a liver supplement/protectant such as SAMe, Milk Thistle, or Denamarin. Your vet probably has a favorite they keep in the clinic and recommend to their clients. Hoping you can get to the bottom of this puzzling situation. Wishing you and Marlowe the best for a bright future. Feel free to keep us updated on how things progress!
Huckleberry, 9, m/n, raw-fed pittbull who is 107lbs of perfect love bug.
Hx of EVERYTHING THAT CAN GO WRONG DOES GO WRONG as he is an ER and specialty RVT’s dog 😛 typical.
Parvo (type c) as a fully vaccinated at 1 yr old (almost lost him!) anaphylaxis for no reason we could find, ruptured ear drums, foxtails, pneumonia, torn and repaired ACLs, allergies….the works.
He is my $40,000 dog.
polyuria/polydipsia for 1 month.
bloated.
grunting. restless and trouble sleeping.
hesitant to give him carprofen as my most recent BW was 2.5 yrs old.
Cushing’s? peritonitis? ascites? My mind when to cancer.
Brief u/s showed enlarged but healthy spleen (visible on the right side) , no free fluids or abnormalities.
Only BW that wasn’t WNL were:
RBC 8.86 5.39 – 8.70 M/μL H
Hematocrit 60.8 38.3 – 56.5 % H
Hemoglobin 21.2 13.4 – 20.7 g/dL
ALP 264 5 – 160 U/L H
Chloride 107 108 – 119 mmol/L
Cleared for tram/carprofen and it’s been a little better. He can relax. The tramadol helps him a LOT (not super common ya) and has even reduced the drinking–which our doc said can be from stress and a sort of self-soothing thing.
Can the bloating and thirst be the very start of Cushing’s?
He does have some thinning skin on his abdomen.
They told me to not worry about it yet as it’s a difficult and expensive Dx but I can’t help but think that’s what it is.
Maybe it’s the case of “you know more than the average joe so you assume the worst” but it’s hard not to with Huckleberry as he had an affinity for near-death experiences his entire first 5.5 years of life.
He one time HIT A CAR.. HE… hit the car!! I almost fainted.
If I wanted to pursue these weird symptoms, would the next step be a Cushing’s day at the vet?
Full ultrasound with IM?
Do you have any suggestions?
This was helpful to read and I appreciate you.
Thank you for doing what you do.
Hi Cole,
I agree it is SO HARD to be subjective with your own dog! We know too much and sometimes it’s just enough to be dangerous. LOL. Of course, I have to give you the disclaimer that since I haven’t personally examined your pup I can’t make specific conclusion and recommendations. With that being said, this could be the early stages of Cushing’s. The problem with that disease is we usually only treat if symptoms are present even if you get a positive diagnosis. You are treating to get the symptoms to resolve. So, I’m not sure that even if you get a positive Cushing’s result you would want to risk the possible side effects of the medication to treat bloating and increased thirst. There really isn’t a right or wrong answer at this point. If having “answers” will give you peace of mind, then I say go for it. Just know you may spend the money and time and end up exactly where you are right now. I wish I had some super helpful advice but at least you’ll know you aren’t alone and I’m keeping you in my thoughts. Wishing you and Huckleberry the best. Feel free to keep us updated!
Hello. Our 10 year old Maltipoo has ALP of 1400. All other values were in the normal range. He is on 3 different eye drops. Latanaprost, NeoPolyDex, and Dorzolimide. Can these eye drops affect ALP?
Thanks,
Hi Steve,
I understand why you are concerned about this elevated ALP in your senior pup. Eye medications can definitely have systemic side effects, but they are usually mild. Specifically, the “Dex” in the NeoPolyDex is a steroid and steroids can cause elevated liver enzymes. But the dose that is in the eye medication is VERY small and even if it had an effect on the liver, I would not expect it alone to cause an increase of 1400. To find the cause of this abnormal ALP results I think you will need to look elsewhere. You may want to talk to your vet about what the next best step would be (abdominal ultrasound?) to get a diagnosis. Wishing you the best of luck!
My 8 year old Dalmatian has ALP of over 2000+ but doesn’t have cushings has he was tested 3 weeks ago. What else could cause this issue? It’s been this high for over 2 months. He had a quick ultrasound on his liver when he was having a CT for a spinal issue. But vet couldn’t see anything.
Hi Katie,
I understand why you are concerned about this extremely elevated ALP. I am glad the ultrasound was normal but feel like this may still need some additional investigation. Unfortunately, there are just too many possibilities to list them all. Some of the first things your vet may try to rule out are tick borne diseases, an autoimmune disorder, atypical Cushing’s disease, or damage from a toxin. Don’t forget that you can always ask for a consultation with an internal medicine specialist if needed. How is your sweet boy doing today? Hoping things have started to turn in the right direction. Praying for a positive outcome.
I just learned our almost 12 year old, small, mixed breed (chiweenie terrier) dog has very elevated ALP, plus elevated ALT and GGT. We had the blood work done because his water consumption has grown enormously. This has led to incontinence due to his very full bladder and him having less control at his age. He has an ALP of 2191, an ALT of 370 and a GGT of 43. All other blood chemistry markers were normal. He’s pretty healthy otherwise, still has a great appetite and still loves his play. He is slowing down a bit all the same. Long walks are harder for him.
My vet told me the ALP was off the charts, but I didn’t realize how abnormal until I read the “elevated” ALP values people have posted here for their dogs. Now I am even more worried.
Our vet said an ultrasound would be the next step, possibly followed by a biopsy, but I really don’t know that I would want to put him through that and the outcomes are likely limited anyway. I’m in a quandary as to what we should do next, other than watch and wait, perhaps retesting in 6 months.
Hi Bruce,
I can understand your concern with your senior pups elevated liver enzymes and increased thirst. It can be difficult to know how deep you want to dig to find the reason for those changes. I would agree with your vet that an ultrasound is often the next logical step in the search for answers, but I also don’t think there is anything wrong with you deciding to recheck the values in a few months. A lot of it really does come down to how badly you want to know the “why” behind the enzyme elevations and how that information would change the plan for your dog’s medical care. If you decide to take a wait and see approach, you could always ask your veterinarian about liver-support supplements like Denamarin, SAMe, or milk thistle. They probably have a favorite product that they think works well. I hope you are able to find clarity about how to proceed. Please feel free to keep us updated!
Last year the vet found my dog’s ALP to be elevated. It was over 1000. I was told to wait a year and see if had changed. On 5/18/23 they rechecked, and her ALP is 1581. They prescribed SAMeLQ 225 tabs. I’m to take her back in 3 months. No one said anything or asked questions about what she eats. Surely her diet would be a good starting point in helping reduce her ALP? She is a seven-year-old Cairn Terrier. She doesn’t overeat, but her belly is large.
Thank You.
Hi Laura,
I understand your concern for your dog and this abnormal ALP result. While diet can be important, it probably will not have much effect on lowering the liver enzymes unless there is something in the food causing the liver to become aggravated in the first place. I am sure if the SAMe supplement has not helped to reduce the ALP at the next recheck then your vet will move forward with additional testing. Since you mentioned your girl has a large belly, they may want to test her for Cushing’s disease. It is possible they might also recommend additional blood work or even an abdominal ultrasound. I hope you can get some answers and find a clear path forward with treatment. Wishing you both the best and feel free to leave an update if you have a chance.
Today I took my Coco in for her yearly shots. Since she had finished the SAMeLQ 225 tablets, I asked to have the ALP rechecked. It’s now higher. She has been on Hills liver dry and a little wet dog food. I am to take her back in a few months for another recheck. I’m concerned that it’s Cushings. Is there anything else I can do?
Regards,
Laura
Hi Laura,
I am sorry Coco’s ALP is still elevated despite the SAMe supplement you have been giving. If you have lingering concerns and want to go ahead and pursue further testing, I highly recommend you discuss this with your vet. As long as you understand it can take some time to get a diagnosis and are willing to commit to the financial aspect of investigating, I see no reason why your vet would not be willing to schedule some diagnostic tests. Many times, veterinarians will err on the side of caution and give things some time because we get fussed at about how much testing costs. I am not saying this is the reason your vet has recommended another recheck in a few months, but it could be. Without playing a personal role in your dog’s medical care it is hard to make specific conclusions. It is never wrong to voice your opinion and ask questions until you are comfortable with how things are proceeding. Hoping you can get some answers soon and help Coco start getting back to living her best life.
I am taking my 14 year old peak-a- tease in for an abdominal ultrasound. He had geriatric blood work done and it was Overall good but his ALP, was at 537 in August 2022 and now has increased to 1699. He is healthy otherwise. I just feel nervous as to what we might find in the ultra sound, if anything I suppose. Reading these other posts have been helpful.
Hi Christina,
I understand your concern for your senior guy and this abnormal liver value on his blood work. I am glad you decided to move forward with an ultrasound in hopes of obtaining some answers and possibly a diagnosis. What did you find out? Praying for good news. Feel free to leave an update if you have a chance.
My dog’s ALP level was 64 in October and as of last week was 223. She’s also had high ALT levels for a while. Last week they were 392 and that’s after six months of specialty food and taking denamarin.
My dog’s ALP went from 64 in October to 223 last week. She also has high ALT level at 392. Her MCH and MCHC levels are low.
I’m not sure what any of this means. She’s almost six, is a mixed breed, and has lots of energy.
Hi Christine,
I understand you have concerns about these elevated liver enzymes on your dog’s blood work. It can be difficult to find a cause without investigating further and doing some additional testing. Please make sure you are discussing this with your vet. They may recommend abdominal ultrasound, more lab work, or even a consult with a specialist to try and make a diagnosis. I am hopeful you will find the answers you need to ensure your girl is happy and healthy. Best wishes and good luck!
I have a 10 yr old Great Dane that has severe v. tach. The vet wants to put her on Propafenone as the solatol is not helping on its own. However she has a alp of 685 and I understand that the new drug should not be given with pre-exitsting liver damage. I was looking for a second opinion if this drug should be used given the circumstances? Any information would be helpful as I have worn out the internet trying to find any type of answer.
Thanks for any insight
Hi Yolanda,
I am sorry your Great Dane is struggling with chronic V. Tach. I have to admit I do not have much personal experience with treating this condition and can’t give you advice on if the Propafenone is a good idea. It is hard to weigh the pros and cons when thinking about the heart arrhythmia, possible liver dysfunction, and the fact your pup is already of advanced age for her breed. This is where I would suggest scheduling a consultation with a specialist. A veterinary cardiologist or internal medicine specialist would be a wonderful resource for this situation. Hoping you can get the answers you need to make the best choices for you and your sweet girl. Bless you both.
Our 11 yr old Husky showed an ALp of 176
5 months ago. In the past 3 days she has had a sudden onset of blindness, from seeing to not seeing . Trouble getting into a vet. Could this be an infection that if treated soon could stop or reverse her sudden loss of eyesight?
Hi Barbara,
Yes, this sudden onset blindness could be due to an infection. There are also many other possible causes such as high blood pressure, diabetes, cancer, idiopathic retinal detachment, etc. When dealing with eye issues, time is always of the essence. I highly recommend you have your dog evaluated by a vet as soon as possible, even if that means taking her to an emergency hospital. Praying for a positive outcome for your sweet girl.
Wow, this was such a great article! The most detailed one that I have found on the internet so far related to ALP. Thank you for this and thank you for allowing us to ask questions!
I was able to cross reference all these other levels (ALT, GGT, and total bilirubin….and glucose, cholesterol, albumin, and BUN) to the blood work we have done. Luckily my 10 yr old (almost 11yr old) cocker spaniel doesn’t have the other levels high. They are normal except for most recently higher amounts for Lymphocytes (5,256) and Cholesterol (375). The vet prescribed antibiotics (Cephalexin 500mg – 24 pills) because when he checked him he said he had an ear infection. They didn’t do the detailed ALP test to show the 3 levels. But the ALP for my dog is at 1,699. What I find interesting is that is has gone up over the years….
In May 2018 the ALP was 187, Nov 2018 the ALP was 291, in July 2019 it was 785, in Jan 2020 it was 1,215 and now in March 2023 it is 1,699. Does that sound alarming? He drinks a lot of water. He has a lot of energy. I haven’t had any other tests done on him but I am wondering if it has to do with Cushing’s Disease because he has a pot bellied appearance. I will read up on that. The vet that I took him too said the high ALP could be related to muscle pain or teeth tartar. Would love to get a second opinion? Thank you Dr. Buzby!!!
Hi Tanya,
Thank you for the kind words and positive feedback about the article! Of course, since I haven’t personally examined your dog, I can’t make specific conclusions. But I too would be a bit suspicious about Cushing’s disease, especially since you mentioned the potbellied appearance. It might be a good idea to talk to your vet about pursuing an abdominal ultrasound. This way you can get a better look at the liver itself and evaluate the other internal organs for abnormalities. Since you mentioned reading up on Cushing’s, I will attach links to other articles with more information. I am hopeful you will find the answers you need to make sure your sweet boy is well taken care of. Best wishes and good luck!
1. Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
2. Trilostane for Dogs With Cushing’s Disease
Hi Dr. Buzby,
I’d like your opinion. My 10 year old affenpoo had his senior blood work done. I took him in because I noticed he’d been peeing more frequently. I thought maybe old age but let’s get him checked out. All blood work, red and white blood cells, and liver enzymes except ALP came back normal. His ALP was 1400. They also did an ultrasound of the bladder and a urine analysis. Bladder was fine. Urine analysis not so concentrated. They want to a low dose dexamethasone suppression test as the next step. But from what I’ve read there seems to be other things that could cause an elevated ALP and would also result in a positive pituitary cushing’s disease. After reading your article I wonder if the next best step is an abdominal ultrasound?
My worry is is receiving a positive cushing’s disease when something else may be ongoing. Any thoughts would be appreciated.
Sincerely,
Melissa
Hi Melissa,
I understand your concern with these abnormal results in your senior pup. Without playing a personal role in your dog’s medical care I can’t really make specific recommendations. An abdominal ultrasound could be a good idea and definitely won’t hurt (other than costing you some money). You may also want to consider scheduling a consultation with an internal medicine specialist. From my point of view, more information is always better. I hope you can find the answers you need to get to the bottom of this puzzling situation. Wishing you both the best and praying for a clear path forward.
My almost 10 year old cocker spaniel had knee surgery in January. ALP then was 340. doc was ok with that number as he’s an older dog. On Feb 10 he had a follow up and weighed 39 lbs. I noticed weight loss, loss of appetite and changes in stool. Took him in yesterday and repeat blood work shows ALP 8000. Dog is eating and drinking, good spirits, hasn’t had a bowel movement yet. Dr is keeping him on fluids and running more tests. He said he’s only seen this 1 other time. Thoughts on this number? I while heartedly trust my vet but just doing a little reading up on high numbers.
Hi Jennifer,
I am sorry your senior guy is having issues with elevated liver enzymes. While this high ALP is alarming, it may not be anything serious to worry about. There is really no way to know for sure without a definitive diagnosis. Since I haven’t examined your pup, myself, I can’t make specific conclusions. I do think running more tests sounds like the best course of action. I am confident your vet will try their best to keep your sweet boy happy and healthy. Praying for answers and a clear path forward. Feel free to leave an update if you have a chance.
My almost 12 year old Lab, Carley, two months had an episode where her gait was affected. She seemed like she couldn’t walk right. This had happened 6 months previously as well. My vet examined her after the first episode, When it happened again she suggested doing lab work, CBC and CM.
Her lab work was all good except the ALKP was 570 and ALT was 626. I started her on Denamarin. Lab work was repeated in 2 months and the ALKP is now 1166 and ALT is 739.
I am for the last week feeding her a Liver Care diet. Last night she started having a twitching most of the night and seemed more restless.
I have been in contact with my vet last night and today. She seems to be doing better today. Pretty much her normal self. The way things looked last night I felt like she might need to be euthanized. The vet suggested starting her on Prednisone 5 mg but after reading about prednisone it looks like it might cause the ALKP to increase more.
I plan to call her back now to ask about that. Any ideas or suggestions would be helpful. Thank you.
Hi Linda,
I am sorry Carley is having issues with elevated liver enzymes. You are correct that prednisone can cause these liver values to increase more depending on the situation. Did you vet mention what they are trying to achieve with the steroids? If an immune mediated disease is suspected, then prednisone would be the best way to start treatment. While you are discussing these concerns with your vet, you can also ask about some additional testing such as blood work to check bile acids, tick titers to rule out diseases like leptospirosis, and possibly abdominal ultrasound to make sure there is no mass present in the liver. Without examining your dog, myself, it is hard to make specific recommendations. I hope these suggestions will be a good starting point and will help guide the conversation a bit. I am hopeful you will find the answers needed to find the best course of treatment for your sweet girl. Praying for a positive outcome. Best wishes and good luck!
Dr, Buzby,
Our 9 year old Sheltie had an elevated ALP level in September of 322 and ALT of 295. Took Milk Thistle and rechecked this past week due to an abscess caused by secera an infected tooth and the ALP had shot up to 800 and ALT dropped some to 232. We are doing an ultrasound next week but I can’t help but worry it will uncover something bad. He does not act sick, is playful, eats well and hasn’t had any changes in behavior or eating drinking. The vet mentioned Cushings and arthritis being a possible contributor but my question is could it be all dental related? His teeth weren’t great in September but he now has severe dental disease, which could explain the spike from 322 to 800. (Vet stated his genes cause him to have excessive plaque build up even with frequent dentals at the vet.) If it were cancer, wouldn’t there he be exhibiting symptoms? Trying to stay hopeful for our sweet boy……
Hi Susan,
I understand your concern with these elevated liver enzymes in your Sheltie. I am not sure that dental issues alone would cause the numbers to be this high, but it definitely could have contributed to the recent increase since September. I think ultrasound is a great next step in this investigation. Did you get some answers? I am very curious to know what the results showed. Praying your senior girl is feeling ok and there is a clear path forward with treatment. Feel free to leave an update if you have a chance.
We adopted our dog about 2.5 years ago when she was about 3 years old from our local humane society. About five months ago we had. a baby. At the same time we had a baby, we noticed our dog was drinking more water, peeing more, and her legs would shake at random times. We thought it was a behavioral issue related to the baby, so we put off getting her to a vet. Last week, we took our dog to a vet. Her physical exam was fine, but in her blood work they found elevated ALP and GGT. Our dog also went from 24 pounds in July to 17.4 pounds in January (her ideal weight). The vet recommends a Cushing’s test. Could it be anything else?
Hi Kat,
I understand your concern with these elevated liver enzymes in your pup. Yes, these abnormal results could be something else other than Cushing’s, but this is also the testing I would perform first. You have to start somewhere, and this is the most logical testing to begin with. I am sure if the Cushing’s test is negative your vet will recommend the next step. You may be looking at more lab work and possibly an abdominal ultrasound. Try not to worry yourself too much in the meantime. I pray you can take things day by day and will have the strength to navigate the unknown road ahead. Hoping for the best for your sweet girl and congrats on the new baby!
My senior (will be 13 in May) pit mix, Jazmine, just went in for her annual checkup, which includes full blood panel at her age. Her ALT was 378 and her ALKP was 1429! Aside from having a small heart murmur, she is very healthy. But she is starting to slow down a lot. She also has an odd occasional cough. Like a choking sound. My vet put her on Denamarin Advanced, and will recheck in 8 weeks, unless something changes. My first baby passed away at 13, out of nowhere. She was fine one day, throwing up the next, rushed her to the vet thinking pancreatitis, because she’d had it before, they kept her overnight, and called the next day for me to come in. They said her blood count was dropping so fast, she wouldn’t make it through the day. I still have no idea what happened.
Hi Katie,
I understand your concern about Jazmine and these elevated liver enzymes. I am glad you had her examined by your vet and have started her on the liver supplement. If things do not improve as hoped, the next step will probably be x-rays or ultrasound. If at any point you want to proceed with more diagnostics instead of waiting for the recheck, don’t hesitate to let your vet know. I hope you find the answers you need to help restore your sweet girl’s health and quality of life. Praying for a positive outcome.
My 11 year old beagle has a ALT of 512, AST of 92 and ALP of 5901.
She’s been on Denamarin for about a month since the tests were done.
She recently started not eating her dry food – she eats it and then spits it out, so we switched to canned food (prescription). And now has a rash on her abdomen as well…
Any thoughts on next steps – or things to look for? Can older dogs with this high of levels be helped with Denamarin typically?
Hi Amy,
I understand your concern for your Beagle and these elevated liver enzymes. I have seen Denamarin help cases like this but of course many times it requires additional treatment. It sounds like it may be time for further investigation. Make sure you are staying in close contact with your vet and keeping them updated. They may decide to do additional blood testing like checking bile acids, screening for tick borne diseases, or ruling out other issues like leptospirosis. Ultrasound of the liver is also a common next step. If at any point you feel the need to reach out to a specialist (internal medicine) just ask your vet. They should be able to make the referral. I hope you can find the answers you need to help your senior girl continue living her best life. Feel free to leave an update if you have a chance.
My 9 and 1/2 year old rescue mix received high ALP scores about six months ago. She’d gained some weight with the rest of the household through covid and had gone from her usual 10 pounds to around 19 (she looks like a tiny teddy bear and my boyfriend can’t stop himself from giving her treats!) so they recommended we put her on Denamarin and work on getting her weight down. She’s been on Denamarin for about six months now and her ALP remains high, despite a deep dental clean and more than 5 pounds weight loss, so her doctor is recommending an ultrasound so she’ll have a better sense of what might be happening so she can recommend next steps. The veterinary hospital is still operating under covid protocols, which I totally respect and appreciate – but it means we don’t get a lot of time with her veterinarian to discuss.
Hi Tara,
I understand your concern with these elevated liver enzymes in your senior girl. I am glad you are planning to move forward with the abdominal ultrasound. Please make sure you let your vet know you need some more time to discuss your dog’s situation and have your questions and concerns addressed. You may be able to request an appointment slot just for a consult. This way you get plenty of one on one even if it has to be over the phone. I hope the ultrasound results will help to guide the treatment process. Praying for a positive outcome for your sweet girl.
Hi,
I have a 12 year old American Bulldog who I adoptee at age 1. Prior to his adoption he was nearly bald with red skin that the adoption center treated and told us he had a yeast allergy and to do non grain/ limited grain diet. Over the years that is what wr have done. He’s done fairly well but with fairly consistent red allergic paws the past few years that vets said likely food allergy or seasonal allergies. As we stick to yeast free, they said it could be a protein allergy or seasonal allergies now too.
Last month we noticed white flakey patches on his spine, and some balding on his tail and randon red patches . He also began panting very heavily in the evenings after his meal.
We consulted with the vet and did an antibiotic for possible infection om his skin. Bumps changed to more red. Vet saw him last week and discussed could be food allergy related or concerns for Cushions Disease. We drew blood work. Today received the results of Alkaline Phosphatase of 1842! and Platelet count of 500,000.
We are having him do a Dexamethasone test with blood draw twice at 4 hrs and 8 hrs after to see the bodies effect on regulating Cortisol to see if Cushions Disease, while the test can’t necessarily determine up front which Cushions Disease it may be. We will be proceeding with these tests, but I wonder if the high Alk. Phosphasate could be causes by systemic yeast or other inflammatory causes.
A human I know had high levels and found out their levels were due to a systemic yeast, verses a yeast culture. My dog we did a skin test for infection or yeast prior to this blood work with no yeast/ infection showing. Are there tests to check for systemic yeast? or other concerns with our case?
Also, he gets stressed during blood draws so I’m wondering what would be a normal elevated Alkaline Phosphatase level due to cortisol increase in stress.
Hi Lovemydog,
I understand your concerns with this elevated liver enzyme found on your dog’s lab work. Since I have not examined your dog myself, I can’t make specific conclusions or recommendations, but I will try my best to give you good information to research or discuss with your vet. Here is a link to another article about Cushing’s disease: Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
From what you are describing, Cushing’s would be my first suspicion as well. It sounds like your vet is working through all the standard testing to rule out this possibility before moving on to other diagnostics if needed. While stress can raise cortisol levels in the body, I have never seen it cause the ALP to increase outside the normal reference range. With an ALP of 1842 there is no way this is caused by stress alone. Yeast infections are common on the skin of dogs with allergy problems, but I am not familiar with issues of high systemic yeast levels. Gut health is very important, but I am concerned something else is causing your dog’s elevated enzyme levels. Hoping this testing will give you some clear answers and allow your vet to decide on a course of treatment. Best wishes to you and your senior boy.
My little girl is a 10 year old miniature schnauzer weight at 12.5kg. She has a very large fat lump which she was booked in for surgery in June to get removed along with another smaller lump which is growing rather rapidly (it is affecting her balance and soon it will affect her mobility). Unfortunately on the morning of her scheduled operation her blood work came back poor. Her ALP was 1139 and her ALT was 220. Lottie had an ultrasound which didn’t show up any irregularities. She was put on Samilyn, a liver supplement, for a month and then had another blood test to check ALP and test for Cushings; test came back negative but her count had raised to 2812. In September, she had a liver biopsy (and whilst under, a full dental clean – for the first time). Again, biopsy results were normal. On the vets advice we changed her diet to a hepatic diet and Samilyn supplement. Another blood test mid October and her ALP has raised to over 7000. The vet said that they see dogs with liver disease with a 2000-3000 count so they’ve not seen anything like this in a dog who, other than her ALP, is showing no signs of liver disease. They are now recommending a CT scan. It feels like significant costs but backward steps. We are very worried about our little girl.
Hi Tracey,
I understand your concern for your senior girl with these severe increases in liver enzymes. My best recommendation would be to schedule a consult with an internal medicine specialist. They have lots of experience with complicated cases like your pup and may have ideas about other testing that needs to be performed. Has your dog been tested for leptospirosis or tick-borne diseases? It sounds like your vet is staying on top of this and working hard to get some answers. I hope you can get a diagnosis so treatment can be started quickly. Praying for a positive outcome. Feel free to leave an update if you have a chance.
My dog has very similar blood test numbers (negative for cushings and >2000 alp). She seems completely normal in behavior and appetite but the vet wants to do a liver biopsy. Have you found out anything additional for your pup?
Have you found out anything additional? My 11 year old mini schnauzer has the same situation going on and I’m at a loss as to what to do for him next!
Hi good evening . I have a shih tzu 10 years old. A month ago her vet did a full test and my dog has her ALP 900. She has dry skin that make her have dandruff in top of her body. Not in leg no in the belly . Doctor said she is going to treat her with anipryl. 5mg . But I don’t see any improvement. Also doctor prescribed her fluconazole for her skin but not improve as well. I decide to find another internal vetereniarian. Any information that you can give me because I’m worried 😟
Hi Damarys,
I am sorry your senior girl has had some abnormalities show up on her blood work. It sounds like your vet is suspicious of Cushing’s disease. If this is the case, your dog may need more testing to get a definitive diagnosis and decide if the problem is caused by the pituitary gland or the adrenal glands. Anipryl is usually prescribed for Cushing’s that is pituitary dependent. Since I haven’t personally examined your pup, I can’t make specific conclusions or recommendations. It is always ok to get a second opinion if you have lingering questions or concerns. The goal is to find a vet with whom you are comfortable partnering to address your dog’s health issues and wellbeing. I hope you can find the answers you need to make the best choices for you and your sweet girl. Wishing you the best of luck.
Hi, our 11 year old lab/ Dane mix just had his yearly physical and senior blood panel .. all results were perfect except his ALP was 1138. He is acting his normal self , not eating or drinking anymore than his normal piggy self , playing, going for daily walks , skin / fur good . .. vet wants to test for cushings . I’m not sure if we should wait and see or go ahead with testing . I’m reluctant because he has no other blood work numbers out of whack .
Hi Deb,
I am glad you were able to catch this abnormality on routine lab work. It is not a bad idea to pursue further testing. With that being said, it is usually not recommended to treat for Cushing’s unless symptoms are present. So, if your dog is not symptomatic, treatment would not be needed even if the testing is positive. When investigating an elevated liver enzyme, I usually see most vets opt to run additional lab work (bile acids, etc.). Some even like to have an abdominal ultrasound preformed to rule out a tumor. I have also started patients on a liver supplement for a few months and then rechecked blood work to see if the liver values have decreased. I hope you can find the answers you need to make the best choice for you and your pup. Ultimately, I hope you and your vet can work together to maintain your sweet boy’s health and wellbeing. Best wishes!
Our 13 year old male Chihuahua/Terrier mix has a ALP of 219, MCHC of 32.5, ALT 207 and Creatine Kinase level of 219.
We just scheduled his teeth cleaning at the vet and they will be sedating him so, is there any concern doing the teeth cleaning with the blood levels mentioned above?
Hi Jack,
There is always some risk with anesthesia even if blood work is completely normal. Your vet is aware of these liver abnormalities and should be able to tailor the anesthesia protocol to your dog’s specific needs. Many times, dental disease alone can cause an increase in liver enzymes. If blood work is rechecked a few weeks after the dental procedure, you may find these levels have improved just from treating the dental issues. If you have any lingering questions or concerns, don’t hesitate to discuss them with your vet. I hope the procedure goes smoothly and your pup is feeling great again in no time.
Hi Dr. Buzby:
I love reading your blogs and just stumbled across them while looking at your toe grips! I am all about holistic medicine for the whole family including our big floof.
This comment is
1) to ask about Encore Mobility;
2) diet recommendations for our dog with HCC and arthritis;
2) my attempt to illustrate to hoomans why it’s important to advocate for your animals even when a vet chalks new symptoms up to old age.
Our dog Caesar is a 12yo male ChowChow. He was 8 when we rescued him. He was diagnosed with hepatic cellular carcinoma in July 2022 after an ultrasound (ordered to see his adrenal glands/rule out Cushing’s) revealed a 12cm mass on his liver. Adrenal glads were fine. CT w contrast confirmed heterogenous round shape/location, along with some multifocal hypoattenuating cysts within the renal cortices and chronic right-sided coxofemoral joint luxation with pseudoarthrosis formation.
A dexamethasone suppression test confirmed he did not have Cushings, so Caesar underwent an exploratory laparotomy on 8/23/22 where they removed the liver mass with good margins and has fully recovered from the surgery. BIG 13″ incision!
Rewind to when we first got Caesar in 6/2018. At our first check up the vet felt plenty of arthritis in his shoulder and hips and started him on dasuquin advanced and he is still on that. When an occasional limp would present, our vet would just do a 1-2 week course of rimadyl (wonder drug for Caesar) and limit his walks to “bathroom and back” so to rest the affected joint.
Fast forward to summer 2021 –he was snapping and very grouchy to almost everyone except me and my husband (even for a Chow). No limping or whimpering or even licking a foot. After hours of evaluation, his trainer and I concluded he was in chronic pain from his arthritis and the vet concurred. Vet started a course of adequan injections, but I didn’t see any difference after 7 months so we d/c. Vet performed a full body set of xrays in March 2022 and his arthritis had progressed. Vet started him on rimadyl as a maintenance dose and sure enough he was a new dog. (all of this vet work was driven by me driving them crazy).
In April 2022 his annual physical was performed. I reported symptoms of 90-100 breaths/minute 24/7, including at sleep. He was drinking LOADS of water and had a voracious appetite(always been very food motivated tho). The vet felt like his spleen was prominent upon physical examination and did a cardiac xray that was fine.
Full blood panel was performed and his ALK/ALPs were elevated. Vet stopped his rimadyl immediately and started Denamarin, with a plan to begin Galliprant after 10 days of Denamarin. Those 10 days were AWFUL. Trembling hind leg, mobility was worse than BEFORE he went on the rimadyl. He was only on rimadyl for 2 weeks before the bad liver results, and it was like the denamarin was making him worse – which is ridiculous of course (milk thistle can’t hurt anyone).
Finally the “detox” was over and we started the Galliprant (100mg, 1x/day) and he has regained decent mobility, but not as good as on rimadyl.. We repeated a blood test in June 2022 and those ALPs were still elevated. Vet wanted to wait and see – and I insisted on the ultrasound. You already read the rest.
I have worked in the human healthcare environment as a hospital and physician practice administrator for 25 years, so I’ve learned enough clinical info through osmosis to know when we press forward for answers on humans, and I didn’t want our dog to be treated much differently. But if I was a banker, he would still have a grapefuit sized mass in his diaphragm, and on a 60 lb dog, that’s like a beachball to my body.
Result: normal water intake, normalized appetite. Will have an ultrasound in 2 months to see if anything is growing back.
He still struggles with his hips – the CT showed the right one is BAD.
Do you think he would benefit from encore mobility in conjunction with Galliprant? He is also on Curcumin C3 and dasuquin advanced w MSM.
Diet: I blend rosemary, basil and turmeric with water packed sardines and use as a topper on Health Extension venison kibble, along with pureed pumpkin (bc I can’t have that anal gland smell in the house EVER AGAIN).
Any suggestions on ramping up the anti inflammatories through diet?
Longest comment ever – thanks Dr Buzby!
Hi Ashley,
Caesar is one lucky boy to have found you! I applaud you for taking such an active role in advocating for his health and wellbeing. I think his current diet and supplement regimen sound great. As for Encore Mobility, it could be an added bonus to all the amazing things you are already providing. I feel like the New Zealand deer antler velvet is such a game changer and isn’t found in any of the other supplements you currently use. You may also want to look into acupuncture or laser therapy to help with arthritis pain and decrease inflammation. Have you heard of PEMF therapy? I will attach links to other articles that may offer additional information. Best wishes to you both and keep up the good work!
1. PEMF Therapy for Dogs: 7 FAQs Answered by a PEMF Expert
2. Natural Pain Relief for Dogs: 13 Methods
3. Dog Arthritis Treatment: 8 Ways to Help a Senior Dog at Home
My 9 year old Boston Terrier was shedding a whole bunch more than I’d ever noticed. He left a halo of fur where he had been sleeping. I worried about Cushings. He had no other symptoms. He had a senior blood panel and everything was good but ASP was 818. Vet recommended x-ray/ultrasound investigation. However given his overall good health, In leaving towards Denamarin and retesting his liver enzymes. Should a month suffice?
Hi Jess,
There is really no way to know for sure how long it may take the liver to respond to the supplement or if it will respond. Since I haven’t personally examined your pup, it is hard to make specific recommendations. A month is a reasonable time period to recheck lab work. If you don’t see the improvements you are hoping for, I think the ultrasound investigation sounds like a very good next step. Best wishes!
Hi Dr Buzby, my 9 year old male Pomeranian Fazzie had an ALP of 934 and ALT of 250. He has had ultrasound which showed enlarged liver and a swollen right adrenal gland. He has been drinking a lot more water and is always hungry. He has had three seizures in the last 5 weeks unfortunately also . We are waiting on more blood work for Cushings and a cortisol check w last blood work which was three separate blood draws at 4 hours apart w fasting for Fazzie
Is there anything else this might
be? And there seemed to be no tumor on adrenals so can it be a pituitary tumor causing the problem I am wondering?
Btw… he had blood work three weeks back and levels were half of the latest results I shared w you
He’s currently taking Proteliv drops and Vit B in liquid form
Thank you David
Hi David,
I understand your concern for Fazzie and these worrisome abnormalities found on lab work and ultrasound. Cushing’s disease can be pituitary dependent or adrenal dependent. The extra bloodwork should help to distinguish the source if your pup is indeed diagnosed with Cushing’s. Luckily, Cushing’s is treatable, and symptoms usually resolve quickly once therapy is initiated. If the testing doesn’t provide the answers needed, you can always schedule a consult with a veterinary internal medicine specialist. I will attach links to other articles with additional information on Cushing’s. I hope you find the answers you need to give Fazzie the best life possible. Praying your vet is able to make a diagnosis and get things stabilized quickly. Wishing you both the best!
1. Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
2. Trilostane for Dogs With Cushing’s Disease
7 year old Maltese/Yorkie has chronically elevated ALT (800) with cell damage, vet said AST very high too. Ultrasound scheduled next week. Our pup has had a few bouts of pancreatitis this past year and sometimes will go 2 days without eating, behavior is definitely changing lately with more naps and less interest of favorite things. Vet mentioned a look at his gallbladder during ultrasound. How many days of not eating should you worry?
Hi Tracey,
I understand your concern about these liver changes and decreased appetite in your little pup. I am glad you have an ultrasound scheduled with your vet and would be interested to know what they find. Since I haven’t personally examined your dog, it is hard to make specific conclusions about when to worry with the lack of eating. There are so many factors to consider such as blood sugar levels, hydration, etc. I hope the ultrasound findings will offer you some answers and guide you in the treatment process. Praying for a positive outcome.
My 11 year old yellow lab, Goldie, had blood work that indicates a high ALT level (296) and a high ALKP level (560). She is on Samilyn and milk thistle. Her ALT level has only increased slightly over the past year (from 219 a year ago to 296 now). Bur her ALKP level has increased from 346 a year ago to 560 now. What else should we do to help our dog?
Hi Cindy,
I understand your concern for your senior Lab and these increased liver enzymes on her bloodwork. If your pup has been on supplements for a year and the values continue to rise, it may be time for some additional testing. There are other liver specific blood tests that can be sent to the lab and an abdominal ultrasound may be warranted to see what the liver looks like. You can also request a consult with an internal medicine specialist. This is the perfect time to talk to your vet and discuss your concerns. Let them know you are ready for the next steps in the diagnostic testing process.
Hi Dr. Buzby. I have a 9.5yo (approx) Corgi/German Shep mix (my service dog) who on a recent exam showed an ALP of 190. Her urinalysis showed that her urine was diluted. It has been incredibly hot and humid and she has been drinking considerable amounts of water; however that fluctuates depending on the heat and this in and of itself it not unusual for her. Her appetite has been high (also, in and of itself not unusual for her), though if you tell her ‘drop it’ or ‘leave it’ she will. That said, she has virtually zero prey drive and I would think if her appetite were insatiable – especially with a cat in the house as well – that would be an issue. Her vet suggested a steroid-challenge blood test, as he suspects Cushings. I asked if we could pull back a bit on her water overnight and retest her urine to see if her body is still diluting; he agreed so long as we don’t totally withhold. That will be done this weekend.
Given that she has always had a hearty appetite, always compensated for heat by elevated water consumption and that her urine came back dilute, is it possible that this is an anomolous finding? I will repeat her bloodwork in a month or two when the weather cools.
Thank you for your input.
I neglected to add one detail – she has ALWAYS had a penchant for eating poop from the cat’s litter box (nasty, I know). We use Breeze pellets for the cat. Do you believe this could be a factor? We started using the Breeze pellets about 3 or so years ago. Thank you again.
Hi Lee,
I would not be worried about the Breeze pellets. And although I don’t think it would contribute to the symptoms you described in your original post; it might be a good idea to make sure your pup is negative for intestinal parasites.
Hi Lee,
I understand your concern for your senior guy and these recent abnormalities found on his bloodwork. As I was reading your comment, I was already suspicious of Cushing’s even before I saw where you mentioned it. I am going to be honest with you…. I think you should go ahead with the recommended testing your vet has discussed and not worry with trying to withhold water. Cushing’s disease causes an elevated level of steroids in the body. One of the side effects of steroids is increased thirst. I think the odds of this being anomalous finding are very low. Here is a link to an article with more information about Cushing’s disease: Cushing’s Disease in Dogs: Symptoms, Diagnosis, Medications
I hope you can get some answers quickly and start the appropriate treatment plan to give your pup the best quality of life. Wishing you both the best of luck.
Hello. My doogy son teddy is somewhere between 11 and 13. He has glaucoma. He has recently had an increase in appetite, decrease in energy, and sometimes trembles. He had bloodwork done and his cardio lab work was all normal. All 4 thyroid markers came back significantly low and he is now on thyroid medication. The vet said everything else was normal, but upon looking at the results, I noticed that his ALP is 249. Could this be because of his low thyroid numbers. Is that why he trembles? Does he need to be on Denamarin? He seems to be in some pain as well. Any guidance is appreciated.
Hi Jeanette,
I understand your concern for Teddy and the health issues he is facing. Since I haven’t examined your pup myself, it is hard to make specific conclusions and recommendations. If liver enzymes are found to be slightly elevated on one set of lab work, that doesn’t always mean there are ongoing liver issues. Thyroid levels can cause changes in almost every system of the body. There can be a one-time spike in liver values that would be completely resolved and back to normal if bloodwork was repeated in a few weeks. Also, many medications can cause changes in values seen on bloodwork. My best recommendation is to discuss your concerns with your vet. They can let you know why this number did not cause worry in your dog’s specific case or if a supplement should be considered. Please be sure to tell them you are suspicious Teddy may be in some pain. Trembling can be a sign of discomfort. I hope you can get the answers you need to feel comfortable with Teddy’s treatment plan. Praying everything can be stabilized and let your sweet boy keep living his best life.
I have a 11 year old GSD mix whose senior wellness bloodwork came back with very high levels of ALP(1110), slightly elevated GGT(17) and very high cholesterol(823). She has also had the following symptoms for the past 6 months:
Thinning hair(Lost a lot of hair – used to have a full bushy tail and now spindly, can see skin. Similar hair loss in other areas)
Very thirsty and drinks about a gallon + of water every day
Has an increasing pot belly
is always hungry and eats anything she can find on the ground
She’s already on proin for her spay incontinence for past 2 years or so. We are suspecting Cushings and she’s going in for her test in a couple of weeks. Any thoughts ?
Hi Guru,
I was already thinking Cushing’s before I made it to the end of your comment. It sounds like your vet is on the right track and this is the first thing that needs to be ruled out. I hope the testing will give you a definitive answer so treatment can be started right away. If your senior guy does have Cushing’s, then you should notice positive changes relatively quickly once the medications are administered. Praying for a positive outcome. Feel free to leave an update if you have a chance.
My dog Phoenix (13.5 yo) has very elevated ALP (1723 UL) and ALT (254). My vet prescribed Denamarin for 30 days. However, after about 10 days, he would throw up, and then had severe diarrhea, so the vet said to discontinue use. What do I do now? He is currently on Hill Science Diet – IB -Low Fat Prescription kibble. as he has a history of pancreatitis. He also takes a probiotic daily, dasaquin, and Welactin Fish Oil, and takes Heartgard monthly. Is there something I’m missing? Thanks for any info.
Hi Joan,
I am sorry Phoenix is dealing with elevated liver enzymes and doesn’t seem to be able to tolerate the Denamarin. The only way to find the best treatment is to first get a diagnosis. If you want to pursue diagnostic testing, the next step would probably be additional labwork and abdominal ultrasound. It would be a good idea to talk to your vet about your concerns and see what they recommend. You can also look into scheduling a consult with a veterinary internal medicine specialist. I think you are doing the right things and Phoenix is lucky to have you advocating for his health and wellbeing. Best wishes to you both.
Hi! I’m curious, does the Denamarin help with the elevated ALP, ALT, or both? Thank you in advance.
Hi Kimberly,
The Denamarin helps with both liver enzymes (ALP & ALT) since it acts as a liver protectant and contributes to liver health and repair.
My almost 8 yr old female spayed Shih Tzu hasn’t been herself for about 6 months and in Feb of this year we had blood tests done and her bloodwork was good except for an elevated ALKP of 451 on 2/22.. Yesterday, Aug. 16, we had more bloodwork done and her ALKP had jumped to 1783 U/L and is quite significant. She is not feeling that good and she, vomited yellow bile two nights in a row last week. No vomiting since. She is a great eater and is still eating and drinking water but her tail is always down and she seems more nervous She whines a lot but that is typical of what she does.. My vet has an ultrasound scheduled for next Wed., 8/24. She weighs 8.2 lbs and is small for her breed. She is also constantly scratching her underside (by her back legs and front legs) for some time now and they cannot find out why. She has no redness or anything on her skin but it’s almost like OCD. I have been spraying those areas with DogMX medicated Hot Spot & Anti-Itch Spray and maybe it helps a little but I just read that it could affect her liver. Is that true? I am worried sick about her and would like your comments on what is going on. Thank you very much.
Hi Elaine,
I am sorry your Shih Tzu is having issues with her liver function. I am glad your vet has scheduled an ultrasound and would be very curious to find out the results. I researched the DogMX spray you mentioned and found that one of the active ingredients is a steroid. Steroids are known to affect the liver if used long term, but this is usually when they are taken orally. Topical steroids like this spray can cause internal changes, but not to the same degree as oral medications. I would be highly surprised if the spray was the culprit behind this issue or if it even contributed at all. Don’t worry yourself too much about it, but it might be a good idea to discontinue the spray for now just until you get a diagnosis. I hope the ultrasound can give you some answers. Praying for good news and that treatment can be started quickly. Feel free to leave an update if you have a chance.
Dexter, my 12 yo soft coated wheaten terrier recently had some elevated, and rising ALKP levels over the past year. After a level of 571 vet recommended milk thistle, and he had a recheck and remained elevated (slightly more so into the 600 level for ALKP). The ALT levels have remained steady at 188. I have decided to proceed with an ultrasound next week. 1) should I be worried regarding the procedure since there is sedation involved? 2) is this a moderate or extreme elevation? 3) are there any other tests I should be asking to have done? Dexter is eating and drinking normally, and his allergies as a matter of fact have been the most under control they have been in YEARS, but the rising liver levels worry me! I hope all goes well with my guy – are there any other things I should be doing or questions I should ask the doc?
Thanks!
Hi Corey,
I understand your concern with these elevated liver enzymes in your senior pup. Dexter is lucky to have you advocating for his health and wellbeing. I would not be worried about the sedation for the ultrasound. This is generally very light sedation and can usually be reversed if needed. It is hard to say if these elevations are considered moderate or severe. I have definitely seen much higher numbers than what Dexter’s labs are currently showing. There are many more tests that can be done to evaluate the liver and rule out potential causes, but I too would recommend starting with the ultrasound. Wait to see what the ultrasound results reveal, and then further testing can be better tailored to your dog’s specific needs. Also, you always have the option to schedule a consult with a veterinary internal medicine specialist. I hope you receive positive results from the ultrasound and can figure out the best way to help Dexter with his liver issues. Wishing you both the best. Feel free to leave an update if you have a chance!
My female 14yo Mini Schnauzer’s bloodwork showed ALT 824 (251 in early June), ALP 1680 (62 in early June), GGT 23 (normal in June). She’s been drinking a lot, peeing more, loves to eat, and going on sniffaris. She’s her usual self.
Vet sent referral for ultrasound.
Please, how would you explain these elevations, and how would you proceed?
Thank you!
Hi Andrea,
You are right to be concerned about your Schnauzer and these recent changes to her bloodwork. Since I haven’t examined her myself, it is difficult to make specific conclusions and recommendations. I think your vet is on the right track and an abdominal ultrasound would be the best next step in making a diagnosis. There are many diseases and issues that can cause an elevation in liver enzymes. I think the ultrasound results will help to narrow things down and then other lab work or diagnostics can be recommended based on the new information obtained. Best wishes and feel free to leave an update if you have a chance.
A couple of things…..
I have a 13yr old female poodle Shitsu mix. ALP 677 with a normal range of 5-160. My vet prescribed her Danamarin for 30 days and a retest. Good call?
Also, is there prevention either by diet or exercise or do some dogs just get it and others don’t?
Thx
Hi Mike,
Yes, Denamarin is great! Sometimes we will try a supplement to see if it can correct the issue before moving on to more advanced and costly testing. Please know that the testing can be pursued at any point. So, if you are concerned about the effectiveness of the Denamarin or just want to have more answers, your vet can move on to the next step if needed. If the supplement does not help to reduce the ALP, they will probably recommend additional blood tests and possibly an abdominal ultrasound. While there are some toxins and diseases that can affect the liver and cause an increase to the ALP, some dogs just get it, and we don’t know why. I assume genetics are to blame but we don’t know for sure. I hope the Denamarin will be the solution to your senior girl’s problem. Best wishes and good luck!
Hi I have an 8 yr old cockapoo. Just been to have a routine op to remove two small lumps. This was cancelled as routine bloods showed ALP 521 and ALT at 180. Urine showed blood. Liver scan on Thursday and antibiotics for ? UTI. Meg ate a full Easter egg about 6 weeks ago and had medically induced vomiting! She has no other symptoms at all. How worried should I be. I’m a sensible dog mum but she is my world!
Hi Jen,
I understand your concern about Meg and these new abnormalities that have developed on her lab work. I would not be overly worried about the UTI at this point. As long as the bacteria that is causing the problem is sensitive to the antibiotic that was prescribed, it should clear up within a few weeks. As for the elevated liver values, it could be cause for concern, but you won’t know for sure until the testing is completed. It could be something simple that can be resolved with a special diet and a supplement. I am praying that the ultrasound on Thursday reveals positive results and a treatment plan can be started. Feel free to leave an update if you have a chance. Wishing you and Meg the best.
Rocky, my 5yr old pure bred Beagle has a high ALP on his blood work. He has severe allergies so he is on apoquel a d 2 benadryl daily and on Ultamino science diet for almost 2 yrs now. He was throwing up one nigtht and anorexic for almost 2 days so I decided to let him to the vet, his Vet assessed him and his blood got tested. All his other liver enzymes are normal, only the ALP is above 600. Doc prescribed Denamarin 2 tablets daily. How will Denamarin help? Will that reverse his high ALP? How long should he be taking denamarin? Could the apoquel be causing his high ALP count? How about his ultamino?
My dog is also overweight, is that something that can elevate his ALP?
His Vet is great and has known my Rocky for a long time.
Thank you!
Hi MG Rob,
I understand your concern for Rocky and this recently elevated ALP. I am glad you were able to have him evaluated by your vet and get some answers. I really like Denamarin and have seen great results in my own patients. Denamarin is a liver protectant and helps with liver health and repair. At some point, I am sure your vet will recheck Rocky’s lab work. If the ALP has returned to normal, your vet may allow you to discontinue the supplement. Apoquel is supposed to be safer for the liver than other anti-inflammatories, so I would not think this was the cause of the elevated ALP. Diet and weight also should not cause an increase to liver enzymes. You may never know for sure what caused this liver insult. If the supplement does not show the improvement your vet is hoping to see, they may recommend additional lab work or even an abdominal ultrasound to look at the liver. I hope you see positive results at Rocky’s next recheck. Best wishes to you both.
My 9 year old Maltese had senior panels done and almost all levels were normal with the exception of the ALP and cholesterol. The ALP was well over 6,000. They are going to do a 12 hour fasting test in 3 weeks. He has year round allergies, is overweight at 18 pounds, and is on 5.4 apoquel and cytopoint shots every 3 weeks. He always been a huge water drinker. He tends to pant heavily quite frequently. Any thoughts on the 6,000 ALP? I can’t find any other reference of such an extremely high level. I would like to know what food or supplement could help his liver function. I feed him only grain-free foods, both dry and wet food. Thank you!
Hi Cathy,
I know how concerned you must be about this elevated liver enzyme on your senior boy’s blood work. Try not to get too worried at this point as it could turn out to be nothing at all. I have definitely seen levels this high (and higher) resolve with little to no intervention. I am glad your vet has a plan in place for follow up testing. I am curious to know what the results will be. There are several good supplements available that help with liver function such as Denamarin. Your vet probably has one they like and recommend and would be willing to prescribe. I would love an update once the testing is completed if you get a chance to write back. Praying your sweet boy continues to feel good and gets positive results.
Hi,
My 14-month old 43 pound mini bernedoodle has had significantly elevated ALP levels for the past 6 months. His most recent test it was around 2700 and had slightly elevated white blood cells. He has been fully grown for a few months now.
He is clinically healthy and not showing any signs of not feeling good. We put him on a liver supplement for 30 days and the ALP level was higher than his previous test. We have also done an ultrasound which did not show anything.
We are going to do a blood test that they should should help isolate why the level is elevated….liver, bone or muscle.
Has anyone experienced such high levels or these types of numbers in such a young dog?
Hi Nathan,
I am sorry you are dealing with such difficult issues in your young pup. It sounds like you have a good partnership with your vet and a plan for further testing. Unfortunately, this may be a long road ahead before you get a diagnosis. Don’t forget you always have the option to consult with a veterinary internal medicine specialist. They may be able to offer additional information or pursue more advanced imaging/testing that might not be available in general practice. I hope you can find the answers you are looking for. Praying your sweet boy can turn this around and live a long happy life. ♥
My 12 year old 7kg dachshund Chihuahua mix Sophie just measured 2577 for her APL (her vet told me 131 was normal). Her ALT was 150 so a bit above normal. She needs dental work done including cleaning and this was caught on the pre anesthesia blood work. She has degenerative heart valve syndrome, a grade 3 heart murmur and has been on vetmedin 1.25mg for the last 6 months for that. She has a history of interverbial disc disease and had surgery 2015 to correct paralysis from that. The high APL came out of nowhere. 6 months ago when I found out about her heart condition I changed her food to a mix of hills prescription diet kidney care wet food and hills prescription diet digestive care dry food. She’s going to have an ultrasound in a month to see if there’s a tumour or something. Everything else with her is good, I did add in the greenies tooth brush chews to help with her teeth a month or so ago and she is not good with changes to her diet so had some diarrhoea issues but had the fortaflovia (spelling may be wrong here but the powder on her food). I’m panicking a lot since we don’t know the worst/best case scenario but this 2577 with 131 as a normal range seems really bad 🙁
Hi Courtney,
I understand your concern for your senior girl with these high liver values. Fortunately, it sounds like your vet is staying on top of things and has a plan to follow up with ultrasound. Dental disease by itself can cause increased liver values which may return to normal after a thorough dental cleaning has been performed. Yes, your girl’s ALP is quite high, but I have seen them even higher and still return to normal after making a diagnosis and starting the appropriate treatment. So, I do think you need to keep running tests and looking for answers but don’t forget to stay positive and hold onto hope for a good outcome. Wishing you and your pup the best.
My 6 year old male schipperke just got bloodwork done and they found slightly elevated ALP levels, but nothing else seems to be wrong. He is on a liver supplement now and we will retest in a month. In the meantime we are just really hoping it turns out to be nothing. Very worried about our not-so-senior boy. He’s always been so healthy. Not sure where we went wrong.
Hi Kelly,
It doesn’t sound like you have done anything wrong. In fact, I applaud you for having routine wellness lab work done! This allowed your vet to catch this early and intervene on your little guy’s behalf. It is quite possible that everything could be normal on his recheck labs and this was all just a “fluke”. I hope the liver supplement does its job and all the worry will be over soon. Best wishes to you all.
I have a Mini Schnauzer 16 lbs who will be 12 next month. She had bladder surgery at 1 and has been on Hills CD since. Last September (after eating approved treats from a new vet at our same office) she started a new stone and was quite ill. At that time xrays were done as well as extensive blood work and medications. She recovered. Although her liver ALP was elevated. In November she had another blood test and it was up to 431 and she started taking Hipaticlear. Yesterday she had blood work in prep for a dental on 2/14 and again her ALP was elevated to 617. The vet (the young one who suggested the treats is no longer there) said she is good for the dental and we will do another blood test 30 days after. She suspects her teeth may be causing the increase although she did have a cleaning last year as well. My question is the number (I did find ant info on the actual numbers) and whether she is in any danger.
Hi Kathie,
I am glad to hear your girl recovered from her most recent bladder stone episode. I am amazed that she hasn’t had any other issues with them in the past 11 years! Your vet is correct that dental disease can cause ALP to be elevated. Many times, the ALP will return to normal or decrease after the dental procedure is completed if the dental disease is the underlying cause. Since I haven’t examined your dog myself, I can’t make specific conclusions or recommendations. There are additional ways to check liver function such as more advanced blood testing and ultrasound. You won’t find specific information about ALP numbers and their correlation to what is happening in your dog’s body because a high ALP doesn’t point out a specific issue or disease process, but rather gives you a broader picture that something is off. And just because the ALP is high doesn’t tell you if the underlying cause is life threatening or rather benign. If you have any concerns about your girl’s risks with anesthesia, make sure to discuss them with your vet. I hope you can find the answers you are looking for to help make a decision you are comfortable with. I wish you and your sweet girl the best.
My senior dog (16 year old cockapoo) has an increased ALP from October (2300) to January (7000). Her ALT was slightly elevated.
My dog is having trouble with her back legs, having accidents in the house (both) and just starting to look like she is failing.
Dr. would like to do ultrasound, however, whatever is found, we would not seek treatment, so we are taking the wait approach.
Dr. gave us a number of things it could be but just wanted to know if you have any insight as to whether this increased level mean she is dying.
Thank you.
Hi Diane,
I am sorry your senior girl is starting to struggle with her back legs and having accidents in the house. I understand how frustrating it can be to see your dog decline and not know how to help. As for your question about the high ALP and the possibility of it being fatal, I think this is exactly why your veterinarian was recommending additional testing. Without getting a definitive diagnosis there is really no way to know what the prognosis is or what the future may hold. There are many reasons for ALP to become elevated, some are pretty benign issues while others could be life threatening. If you need more information or want to better understand what is happening with your girl, I highly recommend you talk with your vet and consider going forward with the ultrasound. Best wishes to you and yours.