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 (lepto in dogs), 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 too am dealing with this with my 11 year old beagle, Scout. he just got his yearly bloodwork done and his ALT is 309 and his ALP is 7730! the vet is very concerned. unfortunately, she doesnt have the ability to do imaging so I have to have someone else do it so I am figuring that out. she said that is the best option to see what is going on but said with those levels, she almost guarantees there is a mass. he is eating and drinking fine and is still very active and loves to play so I guess that is good. it makes me feel better until I can get him into a place to get the imaging done. this article definitely helped me understand better though so thank you!
Hi Edward,
I am sorry Scout is facing this unknown issue with his liver. Hoping you can get the ultrasound scheduled quickly and that it will provide the needed answers. I will attach links to other articles with more information that may prove helpful moving forward. Wishing you both all the best and feel free to leave an update if you have a chance.
1. High Liver Enzymes in Dogs: A Vet Explains What It Means
2. Liver Disease in Dogs: Signs, Symptoms, Causes, Treatment
3. Hepatitis In Dogs: Causes, Symptoms, and Treatment
4. Liver Cancer in Dogs: Types, Treatment, and Prognosis
We have a lab/boxer mix that is 12 years old. In 2021, she had an ALP of 800 that our vet wasn’t concerned about since all other tests were normal. We have recently moved and the new vet is concerned but yet the first blood test with them was the same result. Other than being covered in fatty tumors for a few years, she is completely healthy. We have had several of those lipomas investigated and they are always benign. New vet put her on denamarin and did a recheck although the recheck didn’t get performed until a few months later but the ALP increased to 1200. We are doing another round but of all our dogs she was the healthiest and is the last one standing. She will be 13 soon, living well past the average lifespan. She doesn’t drink a lot, has a great appetite, chases the laser pointer and still follows us room to room like she’s a puppy. My question is can this be because of the lipomas? There are quite a few of them so maybe she has some on her liver? Would/could benign nodular hyperplasia be a concurrent finding with lipomas?
Hi Jennifer,
I understand your concern for your senior girl and think she is lucky to have you advocating for her health and well-being. Benign lipomas will not affect the liver. Even malignant liposarcomas rarely metastasize and the liver is very low on the list of potential sites for them to infiltrate. On the other hand, benign nodular hyperplasia is a very common finding and tends to develop with age. Without playing a personal role in your dog’s medical care, it is hard to offer specific conclusions and recommendations. I can say that if you are wanting to investigate further it may be good to consider a consultation with a specialist. Hoping for answers and a clear path forward. Wishing you both all the best. ♥
My 7 year old Cocker Spaniel has had an elevated ALP for one year. It started in the 300s, but has been over 2,000 for 6 months. Other liver values are normal. Cushings ruled out. Ultrasound revealed very small liver nodule that appears to be benign. She took Denamarin for 8 months and ALP continued to increase. She’s been on liquid milk thistle and dandelion and ALP is 2461. She’s had extremely elevated lipase and amylase for 2 years, but on a gently cooked low fat veterinary diet and always been asymptomatic. Recent bloodwork shows lipase is normal, but lipase is still high. What should we do next? One internist suggesting trying Ursidiol to see if it helps bring dorm her ALP. However, gallbladder appeared normal on ultrasound. Thank you for any insight!
Hi Angela,
I am sorry your pup has been having these ongoing issues with her liver. I agree with the internist that Ursodiol may be the next thing to try. This is very puzzling, and I can only imagine how frustrating it must be to have done so much testing and treatment and still be left with more questions than answers. Hoping new information will come to light very soon. Praying for a clear path forward and a positive outcome for your sweet girl.
Dear Dr. Buzby,
I hope you see my comment. My Yorkie who is around 10 y. o. has extremely elevated ALP.
Jan 30th: 520
Apr 14th: 2800
May 21st: 1925
Today, June 23rd: Over 2400
He’s on organic home cooked diet (chicken, fish, veggies and some berries) and has been on Milk Thistle, Dandelion Root, Turmeric and Mushroom Tincture since April. The ultrasound 2 weeks ago showed normal liver, kidney, and adrenal glands. Gall bladder had an anechoic teat shaped lumen with mild sedimentation. Our vet thinks it could be Cushion’s but my Yorkie does not drink water at all, other than when it’s extremely hot weather. He doesn’t pant, nor has a pot belly, his appetite is normal. The ONLY change that I’ve noticed is sometimes he pees more (longer in one try) than usual but it’s not every time that he goes on a walk AND sometimes there are some urine drops left on the couch/bed when he gets up after laying down.
Considering he has no definite symptoms of Cushion’s and the ultrasound didn’t reveal anything abnormal, what would your suggestion be at this point? Are there any other blood or any other types of tests that I could ask my vet to perform to figure out the underlying cause of such high ALP levels?
Thank you advance!
Olena
Hi Olena,
I understand your concern for your senior guy and agree this is a puzzling situation. Unfortunately, without playing a personal role in your dog’s medical care it is hard to offer specific conclusions or recommendations. It is quite abnormal for the ALP become this elevated without having other values be outside the normal range. Is the ALP the only thing elevated on the lab work? The problem with ALP is it is not very specific and can be affected by many things. If ultrasound shows the liver is normal, then it may be time to look elsewhere. I am suspicious about the gall bladder changes you mentioned. It may be wise to investigate that further. Don’t forget you can always ask for a referral to an internal medicine specialist. Hoping you can get the answers you need to ensure your sweet boy remains happy and healthy for as long as possible.
Hi and thank you for allowing me to comment … and everyone else. Your site is so informative. Well we have a wonderful 10 year old Chihuahua / Italian Greyhound mix. Last year she had a small mast cell tumor removed from her lower belly. She also has developed lipomas;; we have been testing when necessary and all benign. Kynda had bloodwork last year and all was normal. We just had a yearly checkup and her bloodwork showed a normal alt but alp at 199 which was 79. last year. The only difference in her diet is 25mg of Benadryl and a liquid mushroom support supplement daily. I am thinking the mushroom support might be having a negative effect? We just started her on Denamarin. She is happy, acts normal, loves chasing lizards.
I am wondering if we should have an x-ray done or maybe wait the 3 months and have another blood test. Might you have any further comments, please. So appreciate it.
Hi Susan,
I understand your concern for your senior pup with this new abnormality that was revealed on her lab work. I would be very surprised if the mushroom supplement was causing this issue. More than likely the two are completely unrelated. Denamarin is a great idea, and I hope you will see the positive effects reflected on the recheck lab work in a few months. I am not sure an x-ray will offer the type of answers you are looking for. If you wanted to pursue more in-depth testing, abdominal ultrasound is probably the way to go. But honestly, with only a mild increase in this one liver value, I would not normally recommend further testing at this point. Try not to stress over the “what ifs” and take things one day at a time. Praying for favorable results and a positive outcome for your sweet girl.
In Sept 2022, my dog was 10, closer to 11 with ALP of 268. Retested just that 2 months later and it was 257. In May 2024, he had bloodwork for a dental and it was over 350 I believe and the vet recommended an ultrasound which I passed on at the time. We had him tested for Cushing’s last year I believe and that was ruled out. Now he was sick with diarrhea for over a week, went and did all the things, xrays, bloodwork. Still waiting on those results. His PSL levels have been high previously too, with no pancreatitis symptoms, although I can tell when he has nausea, which has been an issue for years. Can pancreatitis cause elevated ALP? What level do you think is considered extremely high and definitely in need of further evaluation? I’m seeing people comment on here with levels over 1000, making me think the 300’s isn’t that bad.
Thank you!
Hi Gloria,
I understand you are hesitant to pursue further testing for your pup. While an ALP in the 300’s is not an extreme elevation, it is cause for concern. Also, your vet is not just looking at this one result but rather evaluating the trends. If there is any chance there is a liver problem that just hasn’t become severe enough to cause symptoms yet but could be caught early while treatment is still possible, your vet would rather be proactive than reactive. Yes, pancreatitis can cause other internal organs to become irritated, but again, your vet is looking at the trends over a period of time. Ultimately, you have to do what you are comfortable with and decide how far you want to go. Hoping for answers and a clear path forward. Praying for a positive outcome for your sweet boy.
This is the most informational article I have found. My vet didn’t even give me this type of info. So our little Bella is 12 and is in great shape from what I can tell. She had blood work a little over a year ago and her ALP was 1,460 and she mentioned I just needed to watch for increased drinking and urination. We just had her tested again last week and it’s up slightly to 1,487. She said it’s not increasing much and to take the wait and see approach (but then suggested almost $1,000 worth of tests). As you can imagine I am worried but should I be? I mean is that super high? Her panel came back great other than Globulin at 4.7 and Reticulocyte Hemoglobin at 21.7. Neither looked that far out of range. She does have some minor stomach issues (West Highland Terrier) but I have gotten them under control. I would live some advice and should I get a 2nd opinion without spending tons more money. I’d love to try something naturally first. Thank you!
Hi Shelley,
I understand your concern for your girl and think it is great you are searching for advice. While her ALP is quite elevated, I am happy to see that it hasn’t changed much over the past year. You could start her on a liver supplement such as Denamarin and then recheck her levels in a few weeks/months. But it may be time to think about more in-depth testing to ensure nothing serious is being missed. Abdominal ultrasound can be helpful to get a look at the shape and size of the liver and see if any nodules or masses are present. There are also other blood tests that offer additional information on how the liver and other organs around it are functioning. Ultimately, you have to do what you feel most comfortable with. You can take things as slow as you like or decide to be more aggressive with testing at any point along this path. With Bella’s current situation, I don’t think there is truly a right or wrong choice. Hoping you can get the answers you need to find a clear path forward. Wishing you both all the best and praying for many happy days ahead for your sweet girl.
about three years ago suddenly my beloved service dog was ill and cleared in pain. went right to the vet … blood work showed ALT 508 ALKP 279. …..he was put on a pill.with SAMe and sillimartin….and told he must never be given commercial dog food,no beef ….and only a diet of homemade white rice, chicken breast,i added blueberries and one egg a day and olive oil….he took the medicine as long as possible,but he is allergic to milk thistle….he recovered. Thank God for the healing….today he had a liver panel done…ohhhhh ALP 328 ohhhh….ALT 111….. tomorrow he will be tested for inflammation in his adrenals …he will be at the vets all day …..he is my beloved service dog…my stroke left me without feeling in my throat….when i was severely ill with covid he woke me up at three am ..a piece of chicken was swollen in my throat.. blocked my airway. sonce then he listens to me breath. and awakens me if my breathing changes….. he is a nine year old boarder collies lab mix…. please share your thoughts. very kind regards Suzanne Smith RN
Hi Suzanne,
I am so sorry your beloved pup is facing this unknown liver issue. I am glad your vet is planning to do some testing and hope they can get definitive answers. Don’t forget you can always ask for a consultation with an internal medicine specialist if needed. Praying for a clear path forward and a positive outcome for your sweet boy. ♥
Hi. My dog Chico just tested high for ALP. All of this other bloodwork results were in the ideal range, and he is a very healthy and active 9-year-old. He has epilepsy and has been on phenobarbital and Levectracetam for years. Last year his ALP was 700 and now it’s 1200.
My vet recommended several possible options. We could put him on a milk thistle supplement called Denamarin, which sounds kind of woo to me. We could test him for Cushing’s disease, or we could have an ultrasound test. Because of his general lab results and excellent health, I’m inclined to think it’s phenobarbital-related and not something to freak out about. On the other hand, he is my little muffin boy. Would you recommend changing his seizure meds? Is Denamarin legit?
Hi Karina,
I am sorry Chico is starting to show some elevations in his liver enzymes. I too would be suspicious about the phenobarbital as the culprit. It may be best to rule out other causes before switching seizure medications as phenobarbital has the highest success rate. But I definitely recommend trying Denamarin. It is the BEST liver supplement available (in my opinion) and the only one I use on my own dogs. It can’t cure liver failure but helps protect the liver from ongoing damage and promotes liver healing and detoxification. Hoping you can get the answers you need to find a clear path forward for Chico. Best wishes to you and your sweet boy.
Hi I was needing some help. My dog over the weekend stopped eating her food but will eat treats or human food. She randomly has that wheezy cough like she’s trying to cough something up so we took her to vet. Ultrasound showed enlarged liver and spleen and gallbladder was normal size but had sludge in it they said. Bloodwork only showed ALP elevated to 170, GGT elevated to 34, and total bilirubin elevated at 1.7. We have no idea what is wrong with her and I’m so scared for my dog. Starting her on antibiotic and ursodiol to see if she feels better and eats again. Do you have any insight into what could be wrong? Also she had a low platelet count that they don’t know why.
Dear Alex,
I am sorry your girl is having some issues and understand your concern for her health and well-being. I wish I could offer insight or guidance, but there just isn’t enough information at this point to make specific conclusions. There are SO many possible causes it is hard to narrow them down to a short list. We do have some great articles about several of the conditions you mentioned. I will attach links, and you can read through them when you have time. Hoping you can continue to partner with your vet as you both navigate this unknown path. Praying for clear answers and an easy solution for your sweet girl.
1. High Liver Enzymes in Dogs: A Vet Explains What It Means
2. Enlarged Spleen in Dogs: 7 Causes
3. Gallbladder Mucocele in Dogs: What You Need to Know
4. Low Platelets in Dogs: Thrombocytopenia
Thank you! They just called me this morning that there is a mass on her spleen so she needs a splenectomy. Unfortunately the low platelet count is our issue now to try to get it up so she can make it through surgery!
Hi Alex,
I am glad you were able to get some answers, but I understand this is just the beginning of a long road ahead. Here is an article you should take a look at: Splenic Masses in Dogs: Types, Diagnosis, Treatment, and Prognosis
Praying for your dog’s platelet count to stabilize so she can proceed with surgery. Wishing you both all the best and feel free to keep us updated on how things go!
Our 11 year old pitbull, Mr. Peaches, had his routine bloodwork late last summer show elevated ALP- around 270. In 2023 it was in normal range. Our vet tested for Cushings and the came back negative. We have had hepatic panels done every couple months since and they increased to 293 the first recheck, and remained exactly the same for the most recent panel. All of his other enzymes are within healthy range. I am curious as far as how elevated his numbers seem after reading some of these comments from other readers- would you call an ALP at 293 mild/moderate/high/severe? We are considering having an ultrasound done, also planning to start denamarin (sp?) soon.
The only other health issues we have noticed with Peaches is over the last year he has had a couple bouts of diarrhea, and one episode of vomiting recently. All tests from those instances did not show anything (X-rays, fecal samples) so vets thought he probably got into something on a walk we didn’t manage to get away from him, but I wonder if it could be related to the elevated ALP? He does whine sometimes but my husband thinks he just wants attention, and usually stops when we both sit next to him (rather than one person sitting next to him).
Hi Maggie,
I understand your concern for Mr. Peaches and think he is lucky to have you advocating for his health and well-being. Different vets will have different opinions about this ALP level, but I would consider it to be a mild elevation. I LOVE Denamarin and think the ultrasound is a great idea. This way you can ensure there are no other issues contributing to the high liver enzymes or catch it early if something definitive is found. Hoping for favorable results and a clear path forward. Wishing you and your sweet boy all the best. ♥