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.
Hi Dr. Buzby-I’m writing for my grand-dog, Rhea, Age 12. ( Her mom, my daughter is ready to give birth and chasing a two year old so I’m asking on her behalf.)
Here is the vet’s note:
“ Rhea’s ALP is elevated ALP (a non specific liver enzyme) is elevated at 965 (normal range is 29-291)- all of her other liver enzymes are normal. “. She feels that it might be Cushings but Rhea doesn’t have any of the other symptoms. To complicate matters, this vet is 45 minutes away and my daughter doesn’t feel she can be taking her back and forth for more tests or surgery in the next few months. ☹️ Can you tell me if it’s a reasonable request that Rhea be started on meds for Cushings to see if it/they help-kind of a diagnostic tool?
Hi Kim,
Bless you for reaching out and trying to help your daughter and grand-dog. While there are many instances where I would recommend starting treatment without a diagnosis to see if the condition will improve, this unfortunately is not one of them. The medication that is used to treat Cushing’s (Trilostane) has lots of side effects that can sometimes be worse than the disease itself. Also, the main reason we treat Cushing’s disease is to minimize symptoms. So, if Rhea doesn’t have any symptoms, I definitely wouldn’t recommend treatment. My best advice is to consider moving forward with the Cushing’s testing or to talk to Rhea’s vet about other options. In this case, the vet may recommend starting a liver supplement and rechecking lab work in a month or two. You can also talk to her about additional testing such as more in-depth lab work or even an abdominal ultrasound. Luckily, with only the ALP being elevated it should be ok for your daughter to wait until after the baby comes to move forward with the investigation. Thank you for being an advocate for Rhea. Wishing you and your family all the best!
My 7 yr old dog was on Kepra for 5 yrs for seizures. After the first of this year 2026, it was changed to Phenobarb. In February her ALP was over 5560. Now in May, 2026 it has jumped to 7756. So high I’m worried about liver damage. My Vet is working on it now. So curious what you think. She also has severe allergies that is ongoing, leaky heart valves, heart murmur,
Hi Lisa,
I am sorry your pup is facing this unknown liver issue. It is very common for phenobarbital to cause an increase in liver enzymes but can be tricky to determine if there is actual irreversible liver damage. More investigation is usually required such as liver specific lab work, abdominal ultrasound, etc. Your vet may decide to change seizure medications to see if the liver values improve after discontinuing the phenobarbital. You can also ask for a consultation with an internal medicine specialist. Hoping for clear answers and an easy solution. Feel free to keep us updated on how things go.
My 10.5 year-old morkie was just diagnosed with swollen lymph nodes, the vet put him on prednisone and an antibiotic which he just finished the day before his follow up where she did bloodwork that showed 1500 on ALP with elevated 150 on sugar and then some minor that were only about a point. Yeah, only thing she could get out of the x-ray, and I had to point it out was the narrowing of his throat which is why I took him there in the first place, because he started making odd noises when he breathes or slept. So now she wants to do more extensive tests But I honestly don’t know if I can pay. Especially since I just lost my 14 1/2 year-old three weeks ago with Xtreme vet bills. I need help and decision making. Thank you.
Hi Lesa,
I am sorry you are facing this difficult situation with your senior pup. Without playing a personal role in his medical care it is hard to offer specific conclusions and recommendations. Was any lab work done prior to starting the prednisone and antibiotics (wondering if treatment has made these numbers better or if there was no beneficial effect)? Has your vet mentioned trying to get a needle aspirate of one of the lymph nodes to look at the cells under the microscope? You can ask your vet if they can make a call to a specialist and see about a phone consultation that might provide some valuable insight. My heart aches for you with the loss of your other dog a few weeks ago. I can only imagine how emotional all this must be. Hoping you can get some answers and praying for a positive outcome for your sweet boy.
Hi, we have three small dogs. Our one little guy we’ve had since he was about two. Three months after adopting him he had his first seizure. Bloodwork was done, some of his liver enzymes were high, the emergency vet thought he might have been poisoned in some way. He gave him some medications as a precaution. However, about a month later he seized again, back to the vet. After the third seizure the vet diagnosed him with epilepsy and put him on medication. Long story short, ultimately wound up with phenobarbital. About four years ago we switched vets to a fantastic vet who has taken great care of all the dogs. He has continued to have high liver enzymes, over the years we’ve monitored it closely. While we had him on kibble she talked about changing his diet because his triglycerides had gone up. (He continued having seizures about one a month). After trying various types of fresh foods we started making our own. Since changing to this his seizure activity is almost non existent! He’s down to maybe two in a year. But recently his liver enzymes have increased significantly. Three months ago he had his senior panel and the ones for the phenobarbital levels (oh, he’s 11 years old). She put him on a hepatic enzyme and I brought him back after three months. His number was even higher!! It’s only his ALP that’s high. The rest are normal but the ALP went as high as 2190! So today he had an ultrasound. We have to wait for the results but my armchair doctor brain wonders if #1 we should wean him off the phenobarbital and #2 if we might be giving him too high a portion of protein in his food.
Hi Kaye,
I understand your concern for your pup and this unknown issue with his ALP. I think the ultrasound was a great idea and am glad your vet has been doing more in-depth testing. What did the ultrasound results show? Hoping you received some definitive answers and were able to make a plan for the future. Feel free to leave an update if you have a chance.
Hi, I have a question. Can mexiletine cause a rise in ALP in senior dogs that already have an elevated ALP?
Hi Ann,
Yes, mexiletine is known to potentially cause issues with liver function. So, any dog taking this medication would need to have their liver enzymes routinely monitored for changes. Hoping you can discuss risks vs. benefits with your veterinarian and work together to find the best path forward. Wishing you and yours all the best.
My 13 year old Chihuahua Terrier mix is seemingly healthy other than his liver enzymes. His energy levels are surprisingly good as he still runs.
A year ago 1/15/25 I took him to TruVet specialty because he looked like he was in a lot of pain was getting growly when his stomach was touched or if I tried to pick him up. A full blood panel and urinalysis was done, but I could not afford to do medical imaging as well. He had urinary crystals and hes overweight so they prescribed me a urinary SO metabolic kibble. They sent me home and said it’s probably a slipped disc and/or osteoarthritis and he’s been on Galliprant & Dasuquin since then. Only other medication he is on is Simparica trio. And the dog food.
At that time, his ALP was 386 U/L
Since that vet visit a year ago, Leo nows displays all of the symptoms of Cushing’s.
I just had another blood panel done and now his ALP’s are in the 1500s.
The vet wanted to do a low-dose dex so he did that we just got the results back and they were negative. Now she wants to do an abdominal ultrasound, possibly a liver biopsy.
I feel like we are back at square one. 
What would you recommend doing next?
In your professional opinion does this case still give you hints of Cushings and would an abdominal ultrasound rule out liver disease?
I was thinking I would ask about the Denamarin supplement.
Hi Jessica,
I am sorry your pup has been through so much over the past year. I am not sure what other symptoms of Cushing’s your boy is exhibiting at home, but the elevated ALP alone would not necessarily point me in that direction. I think an abdominal ultrasound is a great next step. Not only can you get an idea of what the liver looks like, but it can also rule out other issues such as a gall bladder mucocele, kidney or bladder stones, and certain kinds of cancer. Denamarin is wonderful and you can definitely discuss it with your vet. Hoping for clear answers and an easy solution. Feel free to keep us updated on how things go.
My 5-year-old Shih Tzu, who is slightly overweight, had TPLO surgery in May 2025. Pre-op blood work showed ALP levels in the 400s. Since then, we’ve retested her regularly, and her ALP fluctuates between the 300s and 700s. Most other blood values are normal, except for a slight increase in her ALT above the normal range in one test. The internist prescribed Denamarin and Ursodiol, after which her ALT returned to normal and her ALP dropped by 200. She has also had several ultrasounds, which showed all her organs look fine, with just a bit of sludge. Moving forward, we will continue monitoring and retesting in a couple of months. Additionally, she has a grade 2 luxating patella in her non-TPLO knee. She used to eat a high-fiber, raised right pancreatic support diet with psyllium husk, but now she eats Royal Canin Shih Tzu and a homemade chicken and rice recipe. She behaves normally and has lots of energy. I am unsure why her ALP levels keep fluctuating.
Hi Goli,
I understand your concern for your young pup and think it is wise you have taken such a proactive approach to this liver issue. Without playing a personal role in your dog’s medical care, it is hard for me to make specific conclusions. I can say that I am very suspicious that the sludge seen in the gall bladder may be the underlying culprit. I assume the ursodiol helped to reverse some of the gall bladder problems and that is why the ALT was able to return to normal. As long as there are mild ongoing issues with the gall bladder, the ALP will probably continue to fluctuate. Routine monitoring is a great way to ensure things remain stabilized. Wishing your sweet girl continued success and many happy years ahead.
My rat terrier Ollie had an elevated ALP for the first time at his annual physical. He has a very round belly, but none of the other accepting symptoms of Cushing’s. However my vet ordered a first catch analysis which was negative for Cushing’s. Then he received an all day Dexamethasone Suppression Test which was also negative. He will occasionally wake up in the morning not hungry, will eat some grass sometimes we vomit but usually not and we’ll get his appetite sometime later in the day. He is a very active little guy, about nine years old.. my vet also did an ultrasound it did not find any abnormalities in the liver. The vet advised to wait and then recheck the urine and blood. She also wanted him to lose weight and we have been pretty successful, I have started feeding him fresh Pat chicken which is low in fat and cut way down on the treats. He has lost from 26 pounds to under 25 pounds in about a month.
He seems so happy now, and other than this abnormal test result and the occasional tummy upset which she has really always had often on. I am just really reluctant to put him through more testing.
In trying to do research on my own about what could cause this that was not liver disease or Cushing’s I saw the effect that long-term steroid treatment can have. My little dog has suffered with allergies on his skin and repeated ear infections. For the ears he has been given Mometamax many many times. Could this cause the elevation in his ALP?, I do not have the exact value but it was described as mild. I want him to be happy and to feel good, but I am afraid that if I don’t pursue this he may suffer and I don’t want him to deteriorate physically either.. I wonder about repeating bloodwork for this liver enzyme after he has been off this ear medication that I now know contains steroids, and to make sure that he is fasting when he has his blood work. I know that’s very conservative but I’ve had many many dogs over my lifetime and have learned that sometimes the way your dog acts is the best indication as to whether medical treatment needs to be more aggressive. Since he does not have Cushing’s, could my theory that his ear medicine is causing this mild elevation in ALT be correct?
As a result of the Dex Suppression test he is terrified to even go into the waiting room of the vet. When I took him in to get his nails trimmed he practically climbed on top of my head and did everything he could to get out of the office and back to the car. This is very unusual he is not usually this way at the vet. I am worried that this emotional state will also affect the bloodwork result. Is that a valid concern?
I am hoping that limiting steroid based medicines and continuing to lose weight will be adequate conservative treatment of this elevated enzyme but I don’t want to have my dog suffer long-term health affects for me not pursuing this in more depth.
Ollie looks a lot like the little dog in the picture at the beginning of your story. Even the little gray face. He is quite the corker, and except for the days when he seems to be off his kibble for a few hours in the morning leads a very active life. We walk every day about 2 miles and he plays with his toys in the house. Although at age 9 he also likes just chilling with me.
Thank you for listening to my story and being a sounding board. This has been the most helpful article I have ever read on the elevated ALP.
Hi Sharon,
I understand your concern for Ollie and think he is very lucky to have you advocating for his health and well-being. While topical steroids can cause changes to the body, I can’t say for sure if this is what is happening with your pup. It is wonderful that your vet is taking such a proactive approach and has done all the preliminary testing. I hope that nothing major will come from this and the liver enzymes will start to stabilize. Wishing your sweet boy many happy years ahead. Feel free to keep us updated on how things go.
My 11 year old Boston Terrier was scheduled for cataract surgery, 12/3. He had all the testing done due to anesthesia. On his bloodwork, his liver values were high. ALT-835,
AST- 99 and his ALP was 1900. The opthamologist wants to postpone surgery until he is seen by his internal medicine vet.
He had been seeing her for a couple years for GI issues. They found he had severe reflux, and delayed gastric emptying.
He was doing well on meds and recently lost interest in his food unless I cooked boiled chicken and boiled hamburger. We noticed his reflux got worse than usual as well. We finally did get him eating well by buying the fresh dog food and he loves that and gobbles it down, so then I thought he was just being picky.
They mentioned possible Cushings due to the elevated liver values, but doesn’t have the typical appearance and pot belly, etc.
I will be making an appointment with his internist on Monday. Of course we are disappointed to put off the surgery since he’s blind and it’s sad watching him bump into things, but we’d rather have him safe.
Do these values look indicative of Cushings and since his reflux is worse, possible gallbladder?
I’m glad I found this article on elevated ALP values. You get searching around Google and see the worst scenarios that it could be.
Hi Kathy,
I am sorry your boy is facing these unknown issues with his liver. I understand your disappointment about having to postpone his cataract surgery but agree it is for the best. These numbers don’t seem typical of Cushing’s disease to me, but that doesn’t mean it isn’t a possibility. They do make me suspicious about a gallbladder problem, and this definitely warrants further investigation. I am glad you are already planning to have the internist evaluate your pup. Hoping for definitive answers and a clear path forward. Wishing you and your sweet boy all the best.
Hi Sharon!
I’m going through almost the exact same thing with my dog. Suspected Cushing’s, but the low dex test was negative and now they want to do an ultrasound.
I would love to connect with you!
Heres my email if you’d like to connect!
[email protected]
About 2 weeks ago we took my pup Fred (10.5 yrs old) to the vet for labored breathing/panting. Upon exam we found out he had a heart murmur and was getting fluid build up around his lungs. They did labs and imaging and suggested we do an echo to see what is going on. We were sent home on an antibiotic and a diuretic to see if it would help and were told nothing else on findings at that time. We found he had B1 Degenerative Mitral Valve Disease after the echo report came back and was told that can happen in senior dogs. No longer than a week had passed since the report came back and we had a serious turn of events. In the morning, Fred went outside, had breakfast and seemed very normal. By 10 am he had collapsed by the back door in a pile of urine and stool and was drooling and panting. We called the vet who suggested visiting an ER as the would’ve best equipped to evaluate and treat him. He had pale gums and was in an unstable condition. During their exam they noted fluid around the abdomen and upon aspirate, found it was all blood. The vet said she noticed on Fred’s most recent labs (that were taken on the first visit above) his alk phos was very elevated (>2000) which led her to believe this was Hemangiosarcoma and a tumor/mass had ruptured suddenly causing these issues. We unfortunately had to make a quick, unexpected decision to put him down due to poor prognosis. Could his increased alk phos have caused some of the fluid build up they initially saw? Looking back on things he had been loosing weight and had quite a round belly for some time. Should we have looked into the alk phos at the same time as the murmur and other respiratory issues or being he was 10 would that value not have alerted you right away to question other possibilities? I feel like there are so many things left unanswered.
Dear Karissa,
I am sorry for the unexpected loss of your beloved pup. An increased Alk Phos will not cause fluid buildup, it is rather just a “warning” sign that something is wrong and needs to be investigated. But with the original heart and lung symptoms your boy had, I too would have focused on the heart issue first as it was more life threatening and critical at the time. Hemangiosarcoma is tricky and can often develop with no symptoms present until it is already at a very advanced stage. Here is an article with more information and I encourage you to read through the comments section as well: Hemangiosarcoma in Dogs: Symptoms, Treatment, and Life Expectancy
Hoping you can see that you made a loving choice to give your boy peace and freedom from his struggles. May his memory stay with you always and continue to be a blessing in your life. ♥
My 8½ year old Smooth Fox Terrier had a blood test 4 days ago. We took him to the vet because he is gaining weight and he barely eats. he always leaves his breakfast so in reality is just eating at dinner time. He has been lame since June but has no injuries, no pain, no arthritis so the vet thinks its because he is carrying around all this extra weight., he is 25kg and probably should be around 15kg. Its very puzzling since he doesn’t eat much as i said.
His ALP levels were 1467 and his glucose is 166. The vet gave us Obesity food and measurement for a 20kg dog instead of the 25kg that he weighs, so it’s quite strict. He’s still not eating breakfast. I have started walking him for longer. I was worried that with him being lame in his back left leg it would cause him pain but he seems to be loving it. We have walked for an hour every morning plus play time in the sea. We are going back in one month for more blood work and a weigh in.
I am just confused how he has gained so much weight and if the ALP and glucose are high because of the weight gain or if there is an underlying problem.
Hi Adele,
I am sorry your pup is experiencing these worrisome symptoms. I agree it is concerning and think it may be time for more in-depth investigation. Did your vet check a urine sample to rule out diabetes? Also, it might be good to rule out Cushing’s disease. Don’t forget, you are your dog’s best advocate and it’s ok to push for more answers if things don’t seem right. Hoping you can partner with your vet to get a definitive diagnosis. Praying for a clear path forward and a positive outcome for your sweet boy.
Hello and thank you for this very very helpful information. Yesterday I learned that my 9 yo Australian shepherd’s ALP levels were shockingly high at 2400 (though after reading through the comments I have seen higher numbers here and your responses were very comforting!). The rest of his bloodwork was normal. We have an abdominal ultrasound scheduled for next week.
My question is, to what extent might stress cause a spike to ALP numbers? We unfortunately had our annual wellness visit during a thunderstorm, so he was already anxious when we arrived, and he hates the vet clinic and hates needles. They had to put a muzzle on him because last time he nipped at the vet while she was aspirating a lipoma. They took him away from me for part of the exam. So I *know* he was wildly anxious. Could this account for the alarmingly high ALP? Did his body just get flooded with cortisol? He seems his normal self otherwise. Appetite is good, energy seems normal, and his bowels are working fine.
Next week I will dose him with gabapentin and trazodone before we go!
Thank you again.
Hi Allison,
I understand your concern for your boy with this new abnormality that appeared on his lab work. I wish we could blame this on stress and anxiety, but unfortunately, that doesn’t really affect this liver enzyme. I am glad you have an ultrasound scheduled and hope it will offer some additional information. Praying for clear answers and an easy solution. Feel free to leave an update if you have a chance.