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.
Hello Dr. Buzby:
Hope you are well. My Male dog is 12 years old and has a high alp of 270 and 160. These elevations started last year. Last years numbers were: Mild elevation in albumin 4.3 (2.5-4). ALT 169(0-120), ALP 159 (0-140)
The doctor says that he would have to take ursodiol his whole life, is this warranted, are there any other alternatives to naturally lower these numbers? Do natural liberal supplements work like Zesty paws brand for liver? I haven’t received much explanation as to why this is happening just that it’s a progressive disease and age related. No other alternatives or explanations offered. Please let me know what I should do and what questions I should ask because the responses I receive are very brief but without much explanation. I’ve read gastrointestinal issues can cause these elevations as well. What would you recommend be our next step?
Thank you so much for your attention,
Hi Marlene,
I understand your concern with your pup’s elevated liver enzymes and applaud you for doing your research and looking for answers. Thankfully the elevations are still mild at this point, but it is good to keep them on your radar. The list of causes of elevated liver enzymes is unfortunately quite long, which can make it challenging to pinpoint an exact cause in some situations. I’m actually in the middle of writing another blog about elevated liver enzymes, so you can be on the lookout for that one too. But in short, if you want to dig a bit deeper into why these numbers are elevated, you may want to consider making an appointment with a veterinary internal medicine specialist. They should be able to do some additional diagnostics (ex. liver ultrasound, bile acids test, etc.) to get a better idea of what is going on, and then create a treatment and monitoring plan. Since the internal medicine specialists focus just on diseases of the internal organs, they are often able to give more in-depth answers than a general vet, who focuses on disease of the whole animal.
In terms of supplements, I don’t have any experience with the Zesty Paws liver supplement, but it look like it contain milk thistle, which is a popular liver support ingredient. However, my personal favorite liver supplement, and the one I frequently recommend for my patients, is Denamarin. It combines milk thistle and SAMe to help support the liver. Sometimes Denamarin does help lower, or at least stabilize the liver values, so it (or a similar product) could be worth a try!
I hope you are able to find some clear answers and a plan that you can feel confident in. All my best.
Thank you so much for sharing your knowledge. My 12.5 year old golden retriever had a scary episode in July with the appearance of total fatigue and no interest in food. The vet ran blood work and his WBC was 79.1K with Neutrophils of 71K, ALP 174. He started acting normal again and we repeated blood work which showed WBC 14.9K but ALP increased to 207. Vet did a crude abdominal ultrasound as they are not experts but said his organs looked good. He was acting normal except for more particular about food so we decided to watch & wait. Three months later he had two morning seizures so blood work repeated and WBC up again to 40.2K with Neutrophils 35K, monocytes 1.6K and ALP up to 497. His glucose was low at 60. ALT has been in normal range. My vet is thinking insulinoma but I’m wondering why she isn’t worried about ALP.
My pup had an emergency splenectomy two years ago for a massive bleed which turned out to be a benign football sized spleen tumor. Could the absence of a spleen cause elevated ALP? Or WBC? Platelets are high too (500-665).
My vet suggests rechecking glucose with no mention of ALP. I’m not ready to say good-bye so this is a hard road to navigate.
Hi Pam,
I understand your concern for your pup and think it is great you are advocating for his health and well-being. Without examining him myself and playing a personal role in his medical care, it is hard to make specific recommendations. The ALP is not very liver specific and can become elevated for any number of reasons. This may be why your vet is more focused on the obvious issues. They are probably hoping that if they find the cause of the abnormal blood cell counts and glucose, then it will also explain the increased ALP. Hoping you can get some answers quickly and find the best treatment options for your Golden boy. Don’t forget you can always ask about a referral to a specialist if needed. Best wishes for a positive outcome!
Hi Pam! Did your pup ever get a diagnosis? My girl has high wbc (neutrophils) and high alp. The vet is trying to figure it out. We are doing an ultrasound.
Hi
Our 11 year old cairn/ yorkie cross had ALP of 2613 in July
We changed to heptatic dog food and cut out treats etc
Yesterday we were told the levels were 4400
The vet hasn’t suggested what the cause is or what this means
She is otherwise healthy for her age and loves to get out for walks
Is there anything you can suggest
Hi Dee,
I am sorry your senior pup has these elevations in his liver enzymes. It sounds like you really have two options. One would be to continue to monitor and offer palliative care. The other is to proceed with more in-depth testing to try and get a diagnosis. This could involve more lab work, ultrasound, or even contacting a specialist. I think it would be best for you to have a more detailed conversation with your vet. Make sure to voice your questions and concerns and be honest with your feelings about how things are progressing. Hoping you can get some answers soon and find the best way forward. Wishing you all the best.
My Ivy girl has been very active and healthy.. She will be 12 in 3 months. She had her first ear infection and while at the vet we decided on her senior panel. Since 2021 her ALT jumped from 36 to 350. ALP from 21 to 500. She eats well, poops great and drinks plenty, pee is good… No signs of anything other than my assumption that older aged has slowed her down.. I don’t know if these numbers are hugely significant since the vet said her enzymes are ‘slightly’ elevated. She lost her umphhh ! I am hopoing for the best . I love that girl and cannot stand the idea of losing her right now… Does Denamarin help or is she past that?
Hi Buck,
I understand your concern for your senior girl and this slow rise of her liver enzymes. There is no way to know for sure if Denamarin will help, but it certainly shouldn’t hurt! If your vet is willing to prescribe it, I would say give it a try. I have seen supplements do wonderous things for situations just like yours.
Thank you for your article. I would appreciate your thoughts on our boston terrier Alice. Her ALP levels were normal in 2019 but from 2020-2023 they have jumped each year from 162 to 506 to 781 to 977. We had imaging done a couple of years ago and they identified a mass in her gall bladder. Rather than pursuing invasive treatments we have been seeing how she does because she acts normally. The .vet suggested we could try Denamarin to see if that helps with her levels. What are your thoughts? Thank you very much!
Hi Jennifer,
I understand your concern for Alice and these increasing liver enzymes. Without examining her myself and knowing all the details it is hard to make specific recommendations. I do love Denamarin and frequently prescribe it for my own patients. I am curious to know exactly what the “mass” was that was seen on ultrasound. It may be possible to have the gallbladder removed and improve your pup’s prognosis depneding on what the actual diagnosis is. Here is a link to another article with more information: Gallbladder Mucocele in Dogs: What You Need to Know
It may be time to think about a consultation with a specialist. Hoping you can find the best way to keep your sweet girl happy and healthy for many years to come. Best wishes to you both!
Hello Doctor, my girl Sage is 8 1/2-9 years old. She’s part dachshund part don’t know. I rescued her from getting euthanized. She started panting hard about 9 months ago and I was worried about her heart because she had gained weight when I had a knee replacement. Took her to 2 vets and finally to a third vet. As soon as he saw her, he said that she looks like she has Cushings. So we tested her.. she tested positive, well it also turns out she has diabetes and her Alp number is super high at 2400, her Alt is 398 . So she’s on insulin. He prescribed the liver supplement but I wanted to know if that’s all we are going to do for her liver. He said yes, because he didn’t have alot of hope for her liver numbers. Well I have an autoimmune liver disease that I take Ursodiol. My daughters dog had liver issues and her vet prescribed Ursodiol. I asked about Sage getting on that and he said he’s never prescribed that for liver issues. Well it’s helped me and it helped my daughters dog. So I told him that I wanted to try it for her. We will be getting our blood work again in a few days. But in the past 3 weeks cushings has started to mess with her so today I’m starting her on Trilostane. Im going to have an ultrasound done on her next week. Im hoping for miracle. I don’t know what else to do for her. Trying to find a good dog food for her but there’s seems to be alot of bad food out there. Boy are we tired! Thanks for reading Georgia
Hi Georgia,
I am glad you were able to get some answers and now know exactly what your girl is dealing with. I hope the ursodiol will help decrease the elevated liver enzymes and offer your pup a better quality of life. Sage is lucky to have you advocating so strongly for her health and well-being. Thank you for sharing your experience with us. Wishing you both the best and keep up the good work!
Georgia, my 10 year old has had similar symptoms. Panting for a couple of weeks and then the first seizure. She is is now on Keppra, but still has heavy panting. Her AlP is at 370 and the vet wanted to test for Cushing but I’m not sure. Did you find out any more on your dig?
My dog is 12 years old and has had IBD for 6 years. She was on low dose budesnoide for the last 6 years which she never had any GI flare ups and recently took a turn for the worse. She suddenly went blind (SARDS) and has bloody diarrhea that ended her in urgent care. She has had two abdominal Ultra Sounds which which were normal but her ALP is at 1900 and shows no signs of coming down. On her last blood work her ALT was 143 ( slightly elevated) but she is on low 4 mg of Medrol and thyroid medication. The vets really don’t say much. Could all this be form the steroids? If she has autoimmune then how is it treated?
Thank you!
Hi Jan,
I am so sorry your senior girl has been through so much. These elevated liver enzymes could definitely be just due to the steroids. Unfortunately, the risk of side effects may be worth it for the benefits they provide. If there was an autoimmune disorder present, the treatment would be to suppress the immune system. This is commonly done using steroids. So, the odds of this being the cause is probably pretty low. I hope your girl can keep fighting and is able to make a full recovery. Sending you all my best. ♥
Hello,
First off I want to say this page has been super insightful and given me so much information about high ALP in dogs, so thank you!
My 11 year old lab mix recently got a routine blood panel test and a couple things came back. His ALP is higher than the normal range at 318, his Total Bilirubin was 0.4, and his CPK was elevated at 954. Lastly, his urinalysis test came back as dilute at 1.007 and trace occult blood. Everything else was in normal levels. My vet said it’s possible that it could be Cushing’s so she wants to do a test for that, but he’s not really exhibiting any symptoms of it (he’s always had a big appetite, always been a big water drinker, no skin issues etc). I think it’s worth doing the test but wondering what other possibilities it could be based on those combinations of elevated results above?
Thank you so much.
Hi Amanda,
I understand your concern for your senior guy and these elevated liver enzymes. I do think the Cushing’s testing would be a good idea. There are just too many other possibilities to list them all, but the most common would be primary liver dysfunction or a mass in the liver. If I had to guess I would say your vet will probably recommend x-rays or an abdominal ultrasound at some point to see what the liver looks like. I hope you get the answers you need to move forward with the best course of treatment. Wishing you both the best of luck for a positive outcome.
Hi Dr. Buzby, thank you for sharing this story. I’m an ER physician myself and you’d think I’d be calm and collected with health news – but not when it comes to Marlowe. She’s an 11 year old Shih-Poo and I’ve had her since my first year of medical school.
She’s in great health physically but over the past year I’ve noticed what I thought (and my vet agreed) were lipomas. Some blood work revealed an elevated ALP – first 403 in March and now 560 in July. Today her lipase came back at 780 and her cholesterol at 8.9.
Her remaining liver function tests, albumin, bilirubin, glucose levels, creatinine, and CBC were all normal, but I’m very worried about her blood work. She has had increased thirst and a rounder tummy lately.
She had a liver ultrasound and it was enlarged but showed no masses. Her adrenals looked ok too. Does this mean it’s a pituitary issue?
Her last Urine SG was concentrated, so the thought of cushings was put aside, but I wonder if that’s what she has. She’s a very happy and healthy girl and I’m so hoping there’s a benign answer for all of this.
Any insight about what could be contributing? Any chance there’s a dietary or exercise fix?
My primary vet offered referral to the vet general surgeon which I was thinking about.
If you had any thoughts about what your next steps would be if she was yours, I’d be super grateful. I’d do anything for my dog.
Hi Gemma,
I understand your concern about this elevated ALP in Marlowe. You are right that these symptoms could be early signs of a pituitary dependent Cushing’s disease, but not necessarily. Have you discussed Cushing’s testing with your vet? Also, it might be worthwhile scheduling a consultation with an internal medicine specialist. I feel like you are on the right track with the diagnostics that have already been performed. Your girl might also benefit from a trial course of a liver supplement/protectant such as SAMe, Milk Thistle, or Denamarin. Your vet probably has a favorite they keep in the clinic and recommend to their clients. Hoping you can get to the bottom of this puzzling situation. Wishing you and Marlowe the best for a bright future. Feel free to keep us updated on how things progress!
Huckleberry, 9, m/n, raw-fed pittbull who is 107lbs of perfect love bug.
Hx of EVERYTHING THAT CAN GO WRONG DOES GO WRONG as he is an ER and specialty RVT’s dog 😛 typical.
Parvo (type c) as a fully vaccinated at 1 yr old (almost lost him!) anaphylaxis for no reason we could find, ruptured ear drums, foxtails, pneumonia, torn and repaired ACLs, allergies….the works.
He is my $40,000 dog.
polyuria/polydipsia for 1 month.
bloated.
grunting. restless and trouble sleeping.
hesitant to give him carprofen as my most recent BW was 2.5 yrs old.
Cushing’s? peritonitis? ascites? My mind when to cancer.
Brief u/s showed enlarged but healthy spleen (visible on the right side) , no free fluids or abnormalities.
Only BW that wasn’t WNL were:
RBC 8.86 5.39 – 8.70 M/μL H
Hematocrit 60.8 38.3 – 56.5 % H
Hemoglobin 21.2 13.4 – 20.7 g/dL
ALP 264 5 – 160 U/L H
Chloride 107 108 – 119 mmol/L
Cleared for tram/carprofen and it’s been a little better. He can relax. The tramadol helps him a LOT (not super common ya) and has even reduced the drinking–which our doc said can be from stress and a sort of self-soothing thing.
Can the bloating and thirst be the very start of Cushing’s?
He does have some thinning skin on his abdomen.
They told me to not worry about it yet as it’s a difficult and expensive Dx but I can’t help but think that’s what it is.
Maybe it’s the case of “you know more than the average joe so you assume the worst” but it’s hard not to with Huckleberry as he had an affinity for near-death experiences his entire first 5.5 years of life.
He one time HIT A CAR.. HE… hit the car!! I almost fainted.
If I wanted to pursue these weird symptoms, would the next step be a Cushing’s day at the vet?
Full ultrasound with IM?
Do you have any suggestions?
This was helpful to read and I appreciate you.
Thank you for doing what you do.
Hi Cole,
I agree it is SO HARD to be subjective with your own dog! We know too much and sometimes it’s just enough to be dangerous. LOL. Of course, I have to give you the disclaimer that since I haven’t personally examined your pup I can’t make specific conclusion and recommendations. With that being said, this could be the early stages of Cushing’s. The problem with that disease is we usually only treat if symptoms are present even if you get a positive diagnosis. You are treating to get the symptoms to resolve. So, I’m not sure that even if you get a positive Cushing’s result you would want to risk the possible side effects of the medication to treat bloating and increased thirst. There really isn’t a right or wrong answer at this point. If having “answers” will give you peace of mind, then I say go for it. Just know you may spend the money and time and end up exactly where you are right now. I wish I had some super helpful advice but at least you’ll know you aren’t alone and I’m keeping you in my thoughts. Wishing you and Huckleberry the best. Feel free to keep us updated!