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.
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.