High liver enzymes in dogs can have a multitude of causes, and the outlook may vary significantly. To help you sort through your dog’s liver enzyme elevations, integrative veterinarian Dr. Julie Buzby explains the four main liver enzymes (ALT, AST, ALP, and GGT) and discusses the causes, diagnosis, treatment, and prognosis for high liver enzymes in dogs.
I remember during my second year of veterinary school being a bit discombobulated by the alphabet soup that is the liver enzymes. ALP, ALT, AST, and GGT…Oh My!
Luckily, with 25+ years of experience under my stethoscope, I can now look at chemistry panel results and not bat an eye. It has become almost second nature to interpret high liver values and counsel my worried clients on what we should do next.
I know, though, that even most knowledgeable dog parents can feel overwhelmed if their veterinarian discovers their beloved canine companion’s liver enzymes are high. That’s why I wanted to share some of my expertise and insight with you.
Hopefully, this information will help you confidently advocate for your pup as you work closely with your family veterinarian to navigate the slightly murky waters of elevated liver enzymes in dogs.
- What are high liver enzymes in dogs?
- What does the liver do?
- What are the common liver enzymes in dogs?
- How do vets interpret high liver enzymes?
- What causes high liver enzymes in dogs?
- How worried should you be about high liver enzymes?
- What diagnostics will my vet use if my dog has elevated liver enzymes?
- How do you treat elevated liver enzymes in dogs?
- Will my dog need long term care or monitoring?
- What is the prognosis for elevated liver enzymes in dogs?
- Work with your veterinarian
- What was the cause of your dog's high liver enzymes?
What are high liver enzymes in dogs?
First, let’s get some terminology down. When your vet says that your dog has “high liver enzymes,” this isn’t a specific diagnosis. Instead, elevated liver enzymes (i.e. an increase in ALT, AST, ALP and/or GGT on bloodwork) are merely a symptom that can point to quite a long list of diseases or conditions.
These conditions can be things directly affecting the liver. But they are just as likely to be diseases in other parts of the body altogether. And to add to the confusion, there are many factors to consider when determining if elevated liver values are no big deal, or if they might indicate a serious problem.
Think of it this way. While high liver values are not inherently “bad,” they are still something you and your vet should take seriously. Elevations in liver enzymes can sometimes serve as an early warning sign of liver problems or other health issues. And as with other conditions, the sooner your vet finds and addresses the problem, the better the outcome usually is.
We’ll get to the nitty gritty of the liver enzymes and what they might mean for your dog in a bit. First, a primer on the liver will be helpful.
What does the liver do?
The liver is one of the larger organs in the body. And it sits tucked up in your dog’s abdomen under the ribs, snuggled between the diaphragm and the gastrointestinal (GI) tract. The liver is a powerhouse organ that performs literally hundreds of tasks. So it is no wonder it needs to take up a fair bit of space in the abdomen.
Among other things, the liver:
- Filters toxins from the blood
- Processes the nutrients from the food your dog eats
- Stores leftover energy from food for later use
- Makes proteins needed for vital processes like blood clotting
The gallbladder
The liver also has a buddy—the gallbladder—which is a small, pear-shaped organ tucked into the liver. The gallbladder’s main job is to store bile, a fluid the liver produces to aid in digestion.
More specifically, bile is essential for digesting fats. When your pup eats a meal that contains fat, the gallbladder contracts. This squeezes a bit of bile through the common bile duct and into the small intestines. There, bile helps break the fat into smaller pieces that the GI tract can absorb. Then, as blood from the intestinal tract flows through the liver, the liver pulls out some of the bile components to reuse them again.
The gallbladder and all the bile ducts (i.e. pathways the bile follows through the liver tissue) make up the biliary system.
Liver enzymes
Additionally, the liver contains many enzymes. Enzymes are like tiny, special workers in your dog’s body. Imagine them as little helpers that do specific jobs to keep things running smoothly.
Since the liver has so many jobs to do, there are lots of different enzymes that work within the liver. These enzymes are typically detectable in the bloodstream at levels that fall into a “normal” range. But in some situations (e.g. liver injury or disease), liver enzymes leak out of the liver and into the bloodstream in higher amounts than normal.
A chemistry panel can pick up on these increased enzyme levels, alerting the vet to the fact that the dog has high liver enzymes.
What are the common liver enzymes in dogs?
Typically, when your vet says your dear dog has high liver enzymes, he or she is talking about alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT). These are the liver values that a common blood chemistry panel usually measures.
Sometimes a dog will just have an elevation in one liver enzyme. But in other cases, all the liver enzyme levels may be higher than they should be. Which liver values are elevated can give clues to the underlying cause, so it is worth understanding a bit about each enzyme.
Alanine aminotransferase (ALT)
ALT (alanine aminotransferase) is an enzyme that is found primarily inside liver cells (i.e. hepatocytes). However, muscles, the kidneys, and red blood cells also contain small amounts of ALT.
When the liver is healthy, ALT levels in your pup’s blood are low because most of the ALT stays inside the liver. However, if something is wrong with your dog’s liver, such as liver injury or inflammation, the liver cells can release ALT into the bloodstream. This makes ALT a sensitive marker of injury to liver cells, especially since, out of all the liver enzymes, it is the most specific indicator of a problem within the liver itself.
Since ALT is fairly liver-specific, there really aren’t many other issues besides liver damage that can cause elevations in ALT. Occasionally, severe muscle damage may cause ALT values to be high. But if this is the case, usually your veterinarian will see other obvious changes on the chemistry panel, such as a concurrent severe elevation in a muscle enzyme known as creatine kinase (CK).
Also, it’s worth knowing that the body clears ALT from the bloodstream quickly. This means if ALT is high, then the liver has suffered a recent injury or insult. This trait also makes ALT especially useful when monitoring a dog’s recovery after an acute liver injury because ALT levels decrease quickly once liver damage ceases.
Aspartate aminotransferase (AST)
AST (aspartate aminotransferase) is another enzyme that is found inside liver cells. It also occurs in moderate amounts in several other types of cells, like those within the heart and the muscles. AST generally increases in parallel with ALT. However, AST is less specific for liver injury than ALT because AST levels can also rise due to an insult to the heart, muscle, or from red blood cell destruction.
AST levels stay elevated in circulation for an even shorter time than ALT. This means AST levels will go down and (hopefully) normalize even faster than ALT levels in patients who have suffered a sudden and severe insult or injury to their liver that has now resolved.
Alkaline phosphatase (ALP)
ALP (alkaline phosphatase) is an enzyme found in liver cells too. But only certain liver cells—those that line the bile ducts within the liver—contain ALP.
While an elevated ALP in dogs often indicates a problem with the liver, gallbladder, or the flow of bile, it is not nearly as specific of an indicator of a problem in those organs as some of the other liver enzymes. Bone also produces ALP, so growing young dogs often have a mildly elevated ALP. Plus, ALP elevations also occur in patients with bone infections or bone cancer (i.e. osteosarcoma in dogs). And since high steroid levels can cause ALP levels to rise, dogs with Cushing’s disease in dogs and those receiving oral or topical steroids also commonly have increased ALP values.
This is just a snapshot. Many disease processes, both within the liver and in other parts of the body, can cause high ALP values. And mild to moderate ALP elevations can even be present with several age-related benign conditions.
So if your pup only has an elevated ALP, take a deep breath, check out my high ALP in dogs article, and know that the odds are in your favor that your furry family member will have a favorable prognosis.
Gamma-glutamyltransferase (GGT)
GGT (gamma-glutamyltransferase) is also present in the liver cells lining the ducts where bile flows. It specifically works within the outer lining, or cell membrane, of those cells. Just like ALP, elevations in GGT are a marker of a problem with the flow of bile. The issue usually occurs either as the bile flows through the liver or as it exits the gallbladder.
In dogs, GGT is more specific for disease within the gallbladder or liver than ALP. And its levels are less likely to be high from other non-liver or non-gallbladder-related problems.
How do vets interpret high liver enzymes?
Often a chemistry panel will measure all four of these liver enzymes (plus many other values too). Being able to look at the ALT, AST, ALP and GGT at the same time is helpful for the vet because there are several patterns of enzyme elevations that can provide clues about the source of the issue.
1. Hepatocellular pattern
A hepatocellular pattern happens when the main elevations are in ALT and AST. Since both of these enzymes live inside liver cells, concurrent elevations in ALT and AST levels suggest that something has damaged the liver cells themselves.
2. Cholestatic pattern
In a cholestatic pattern, enzymes like ALP and GGT are higher than the ALT and AST levels. This pattern tends to indicate that there is a problem with the bile ducts or the flow of bile from the liver to the small intestine. This bile flow “traffic jam,” which can be caused by conditions like gallstones or a blockage in the bile ducts, is also called cholestasis.
3. Mixed pattern
However, sometimes things are not so cut and dry. Dogs may have a mix of liver enzyme elevations, including both hepatocellular (ALT and AST) and cholestatic (ALP and GGT) enzymes. This can suggest a combination of liver cell damage and issues with bile flow.
What causes high liver enzymes in dogs?
There are some specific diseases and conditions that tend to cause each pattern of elevated liver enzymes. This makes the pattern method useful when searching for the reason for the increased liver values.
However, there is also a second, equally useful approach to organizing the causes of increased liver values in dogs. It involves separating them into problems that are directly related to the liver and/or gallbladder (i.e. hepatobiliary) or that are not a primary liver or gallbladder problem (i.e. extra-hepatic). With the extra-hepatic causes, the liver enzyme elevations are due to the secondary effects of a disease or illness in another organ system.
Using a combination of both approaches, let’s take a look at the various causes of high liver enzymes in dogs.
Causes of a hepatocellular pattern
As a review, in a hepatocellular pattern, the ALT and AST are more elevated than the ALP and GGT.
Hepatobiliary causes
Some common hepatobiliary causes (causes related to liver disease in dogs or gall bladder problems) of a hepatocellular pattern include:
- Chronic hepatitis
- Cholangiohepatitis (i.e. inflammation of the liver and biliary system)
- Copper hepatopathy
- Infectious causes
- Leptospirosis
- Infectious canine hepatitis
- Histoplasmosis
- Toxins
- Sago palm
- Blue green algae toxicity in dogs
- Amanita mushrooms
- Aflatoxins
- Xylitol toxicity in dogs
- Heavy metals
- Hepatotoxic Medications
- Ketoconazole
- Azathioprine
- Carprofen for dogs
- Acetaminophen
- Certain chemotherapy medications
- Congenital portosystemic shunts (i.e. abnormal blood vessel that connects the liver and systemic circulation)
- Microvascular dysplasia (i.e. congenital abnormality of the microscopic blood vessels in the liver)
- Liver cancer in dogs
- Systemic cancer
- Lymphoma in dogs
- Histiocytic sarcoma
- Mast cell tumors in dogs
- Any cancer that has metastasized to the liver
Extra-hepatic causes
Some common extra-hepatic causes of a hepatocellular pattern are:
- Pancreatitis in dogs
- Gastroenteritis
- Congestive heart failure
- Dental disease in dogs
- Inflammatory bowel disease (IBD in dogs)
- Anaphylaxis
- Sepsis
- Seizures in dogs
- Trauma
Causes of a cholestatic pattern
In a cholestatic pattern, remember that the GGT and ALP are more elevated than the ALT and AST.
Hepatobiliary causes
Some common hepatobiliary causes of cholestatic pattern include:
- Nodular hyperplasia (i.e. a benign condition that is common in older dogs)
- Vacuolar hepatopathy in dogs
- Cholangitis (i.e. inflammation of the bile ducts)
- Gallstones
- Gallbladder mucocele in dogs
- Liver or gallbladder cancer
Extra-hepatic causes
Common extra-hepatic causes of a cholestatic pattern are:
- Medications like steroids (i.e. prednisone for dogs) and certain anti-seizure drugs
- Pancreatitis
- Inflammatory bowel disease
- Diabetes mellitus in dogs
- Hypothyroidism in dogs
- Cushing’s disease in dogs
However, real life is often messier, and not every dog reads the textbook. So it is important to remember that these categories are not hard and fast, and that many dogs will have a mixed pattern of enzyme elevation.
How worried should you be about high liver enzymes?
When looking at this huge list of causes, it can be easy to start to worry or feel overwhelmed. However, while high liver enzymes in dogs shouldn’t be ignored, it will hopefully ease your mind to know that there are some causes, like benign nodular hyperplasia, that really are no big deal. And there are even more conditions that affect liver values, but once identified, are easy to treat with no long-term negative consequences.
Here’s are some factors to consider when you and your veterinarian are deciding how concerned you should be about elevated liver enzymes:
The magnitude and persistence of the elevations
If your dog’s liver enzymes remain consistently elevated over multiple vet visits, this is a cause for concern. And so is a “significant elevation” in the liver values. Generally, the consensus is that if the value is more than three times the high end of the reference range, this counts as a “significant elevation.”
In short, a single mild elevation may not be alarming. But ongoing or significant increases in liver enzyme levels should prompt further investigation.
Your dog’s symptoms (if any)
Often, the vet may find high liver values on routine bloodwork in dogs who are otherwise feeling fine. This is typically less concerning than if the dog is showing signs of illness.
As a point of interest, high liver enzymes themselves don’t even cause symptoms that you can observe directly. Instead, the symptoms you might notice are usually related to the underlying cause of the elevated liver enzymes.
High liver enzymes that are accompanied by the following clinical signs are concerning. And they may indicate a more serious health issue.
- Jaundice (i.e. yellowing of the eyes, gums, or skin)
- Vomiting
- Diarrhea
- Being a lethargic dog
- Loss of appetite
- Increased thirst in dogs
- Abdominal distention (i.e. a pot-bellied dog appearance)
It’s important to note that these symptoms are not specific to liver disease and can occur in various other health conditions. If you observe any of these symptoms in your dog, especially if they persist or worsen, it’s crucial to consult with a veterinarian.
Pre-existing conditions
Dogs with pre-existing health conditions like diabetes, Cushing’s disease, or inflammatory bowel disease may be at a higher risk of liver problems. Elevated liver enzymes in dogs with these or other underlying health conditions should be closely monitored and promptly addressed.
Changes in behavior
If liver disease progresses to liver failure, this can manifest as neurologic changes like confusion, disorientation, dull mentation, or even seizures. Therefore, you should always discuss any significant changes in your dog’s behavior with your veterinarian.
Age and breed
Your veterinarian will always consider the age and breed of your furry family member when deciding how concerned they are about elevated liver values. For example, puppies can have a mildly elevated ALP because they are growing. This isn’t a cause for concern.
Additionally, some dog breeds are more prone to certain liver conditions. For instance, Yorkies are the poster children for both portosystemic shunts and microvascular dysplasia. And Labradors are known to have both chronic hepatitis and copper hepatitis. Thus, if you have a breed with a known predisposition to liver issues, your veterinarian is likely to recommend being more proactive about working up any elevated liver values.
Follow your vet’s guidance
Your veterinarian will discuss these factors with you and make recommendations about how to proceed. Sometimes the answer might be to recheck the values in a few weeks or months. And in other situations, the vet may feel it is important to dig deeper to find the cause of the elevations right away.
What diagnostics will my vet use if my dog has elevated liver enzymes?
If your dog’s bloodwork shows high liver enzymes and the vet recommends investigating further, the good news is that despite the daunting list of different causes of liver enzyme elevation, the steps involved in the diagnostic work-up are relatively similar across the board.
Blood tests
If your vet has not already done so, he or she may recommend a chemistry panel, complete blood count (CBC), and urinalysis as the first step. The veterinarian will likely pay close attention to certain values on the chemistry panel, such as bilirubin levels, BUN, albumin, cholesterol, and glucose. All of these numbers can help assess liver function (which is not something the ALT, AST, ALP, and GGT levels can tell you about).
The vet may also recommend a bile acid test. This is another non-invasive laboratory test that checks for liver dysfunction. With this test, the vet draws a blood sample before and after the dog eats a small meal. The bile acid numbers before and after eating give the vet an idea of how well the liver is able to recycle and process bile. If the bile acids levels are high, this indicates the liver is not functioning optimally.
Additionally, if the vet suspects an infectious disease like leptospirosis, he or she may perform specific blood tests to check for antibodies or the presence of the infectious agent.
Finally, since liver disease can affect blood clotting, the vet may recommend performing a coagulation profile. This blood test can assess clotting times and ensure the liver is producing the necessary clotting factors. (However, a coagulation profile requires special tubes, handling, and a special machine, so it may only be available at certain veterinary hospitals.)
Imaging
Imaging of the liver is almost always helpful in cases of elevated liver values. An abdominal ultrasound tends to provide more diagnostic information than abdominal X-rays. Ultrasound has the advantage of being able to evaluate the size and shape of the liver and check for abnormalities like tumors, gallstones, or blockages in the bile ducts. Plus, ultrasound can reveal subtle changes that might suggest that other underlying conditions, like pancreatitis or Cushing’s disease, are at play.
Additionally, in some complex cases, for instance if the vet suspects a liver shunt, he or she may recommend a CT scan. This can be a good way to provide more detailed images of the liver, blood vessels, and surrounding structures.
Sampling the liver
Obtaining a sample of tissue from the liver can help the vet look for cancer or inflammation, or for the build-up of copper seen in dogs with copper hepatopathy. There are two possible sampling methods.
One is a fine needle aspirate (FNA), which involves using a small needle to pull some cells out of the liver under ultrasound guidance. The other is a liver biopsy, a procedure in which the vet obtains a small piece of liver tissue for evaluation.
Many veterinarians start with liver aspirates before considering liver biopsies. This is the case because the vet can often perform the FNA with only mild sedation, and it is generally considered to be a low risk procedure. FNAs are good at checking for certain cancers and are non-invasive. But they don’t provide a large enough sample to assess for inflammation or to check copper levels.
On the other hand, liver biopsies provide a larger sample of tissue and are often the best way to determine exactly what is going on in the liver. However, they are a more intensive diagnostic. A liver biopsy comes at a higher cost and has an increased risk of bleeding, as well as the need for general anesthesia.
Work with your veterinarian (and possibly a specialist)
The specific tests that your veterinarian recommends will depend on your dog’s history, physical exam, and lab work. Often the veterinarian can perform some of the preliminary testing in-house. But there may be times when your vet may refer your beloved canine companion to a veterinary specialist near you for additional testing, procedures, or follow-up.
How do you treat elevated liver enzymes in dogs?
After reaching a diagnosis, your vet will work with you to formulate a plan.
Remember that high liver enzymes are a symptom of some other problem—either within the liver or in another organ system. Thus, the treatments can vary widely depending on the suspected cause of the elevations and your dog’s situation. As discussed above, your veterinarian will take into account which values are elevated, the magnitude of the elevation, and the dog’s symptoms, age, and breed, when creating the plan.
In some cases, benign neglect and monitoring are enough. But in other cases (for example, where values are consistently and significantly elevated), finding and addressing the root cause is essential.
When it comes to treatments, some of the options that might be on the table include:
Special diet
In some cases, dietary changes can help support liver function. Your veterinarian may recommend a special prescription diet formulated to support liver health. These diets are designed to reduce the workload on the liver and provide necessary nutrients.
Medications
Medications for liver disease tend to fall into one of three categories—medications to treat the underlying cause of the disease, medications to support liver function, or medications targeted toward any unpleasant symptoms your dog is experiencing.
Some examples of the different medications in each category include:
Treating the underlying condition
- Antibiotics to treat bacterial infections
- Immunosuppressive medications to treat certain inflammatory or immune-mediated liver diseases
- Chemotherapy medications to treat cancers affecting the liver or gallbladder
Supporting the liver
- Antioxidant medications like Denamarin®, Milk Thistle, and SAM-E to help support liver function
- The medication ursodiol to improve the flow of bile
Managing symptoms
- Anti-nausea medications to treat nausea or vomiting
- Appetite stimulants for dogs to improve a poor appetite
- Pain medications for painful conditions like pancreatitis
- Fluids to improve hydration in dogs who are not eating and drinking or who are losing fluid from vomiting or having diarrhea
Management of the underlying condition
If the high liver enzymes are related to another health issue, such as diabetes, Cushing’s disease, or pancreatitis, treatments aimed at managing those underlying conditions are crucial.
Surgery
In certain situations, surgery may be necessary to address issues like liver tumors, portosystemic shunts, gallbladder mucoceles, or bile duct obstructions.
Will my dog need long term care or monitoring?
During the treatment period (and beyond), working closely with your veterinarian and following his or her recommendations is so important. Depending on the situation, this may mean giving medications or a special diet, potentially long-term. And your vet will probably instruct you to monitor your dog carefully at home and report any changes or concerns promptly.
Additionally, chances are good that your vet will want to recheck your dog periodically. This is an important way for him or her to track your dog’s liver enzymes and make changes to the plan as needed.
What is the prognosis for elevated liver enzymes in dogs?
When your veterinarian tells you that your dog has any blood work abnormality, it is normal to feel concerned. Elevated liver values don’t have to be scary, though. There are many treatable causes. And to add to the good news, the liver has some regenerative capacity. This means that even if your dog’s liver is severely damaged, there is a chance that, with appropriate treatment and time, your precious pup can regain some of the liver function he or she lost.
However, occasionally, despite prompt diagnosis and aggressive treatment, the underlying cause of a dog’s liver disease is severe enough to carry a grave prognosis.
Some of the factors that can affect prognosis include:
Underlying cause
The most crucial factor in determining the prognosis is the specific cause of the elevated liver enzymes. If the cause is something treatable, like a bacterial infection or a negative reaction to a medication, the prognosis may be very good with prompt treatment.
The degree of illness
If your dog has severe elevations in liver enzymes and is feeling extremely sick at the time of diagnosis, the prognosis may not be as favorable as in cases where the elevation is mild and caught when the dog is still asymptomatic. Plus, if there are other health issues or diseases present in addition to the high liver values, this can negatively impact the prognosis.
Work with your veterinarian
Now that you know the ABCs of high liver enzymes in dogs, you are equipped with the knowledge you need to advocate for your pup. Hopefully, you can breathe a little easier knowing that in many cases, with the right diagnosis and treatment, dogs with high liver enzymes can improve and lead long and healthy lives.
As discussed, your veterinarian will be your best source of information regarding your pup’s specific case and prognosis. He or she can work closely with you to develop a treatment plan and provide guidance on how you can best support your furry friend’s health. Together, you can help your dog keep living his or her best life, despite high liver enzymes.
What was the cause of your dog’s high liver enzymes?
Please comment below.
Suzanne Stitham says
my 5 year old dog was injuried when hit by a car. He suffered no fracture/broken bones but did bruise his lungs, and when examined his blood work, his liver enzymes were high,. He’s on carprofen and needs his C rechecked on Friday. will he have liver problems or will they return to normal.
Julie Buzby DVM says
Hi Suzanne,
I am sorry your pup has endured so much over the past few weeks. Unfortunately, there is no way to know if the liver issues will resolve or turn into a chronic problem. Did your dog have lab work prior to the car accident that showed his liver was functioning normally? The reason I ask is just because these enzymes were elevated after the accident, doesn’t mean it was necessarily caused by the accident. It is possible this liver dysfunction was present prior to your boy being hit by the car. Hoping his recheck shows an improvement in liver function and this will all be a thing of the past. If, however, his lab work has not improved, I would recommend some follow up testing (more lab work, ultrasound, etc.), adding in a liver supplement such as Denamarin, and maybe discontinue the carprofen or switch to something more liver friendly. Wishing you all the best and praying for a positive outcome.
Colby says
My 10 year old Pomeranian recently had very dark bright yellow urine. I was concerned and called the vet immediately. Her ALT is around 4000! She had other sky high values but I cannot recall which ones! One was over 2500 and the other was 11. She is otherwise asymptomatic eating drinking etc. she came home on antibiotics anti nausea and denamarin. She is scheduled for an ultrasound this week but I’m thinking this needs to be done like today!
Julie Buzby DVM says
Hi Colby,
I understand your concern for your Pomeranian with these abnormal results on her lab work. I know it can be hard to remain patient and stay calm while waiting for testing to take place. You are doing a great job in advocating for your senior girl. Hoping a definitive diagnosis can be made and there is a clear path forward. Wishing you both all the best and praying for complete healing.
Jennifer Lowen says
My 5 year old Boston went into the vet for a limp on her front leg. Was prescribed meticam for 7 days. The vet tested her blood before giving her the meds and everything was good. Gave meticam off an on for a month but every time she came off it you could tell she was sore and had trouble going up and down stairs. Took her back to the vet a month later and she had a fever of 40.5 and her Alp was over 2400 u/l. Alt was 461 u/l ALB was low 20 g/l and TBIL was elevated 15 umol/l. Vet treated her with an antibiotic and liver diet and a liver support denamarin. We retested in a week and her levels were even higher. Also did a bile acid test which came back normal. Just had an X-ray done and vet thinks she had arthritis in her shoulder and potentially her spine has injury as you don’t see any gaps between some of bones on her spine. Had a few vets look at her blood work and nobody seems to have any ideas. She is healthy otherwise but is sore and in pain with her back and leg issues. Would meticam increase her liver enzymes?
Julie Buzby DVM says
Hi Jennifer,
I am sorry your Boston is having these issues with her liver, and I understand why you are concerned. Yes, Metacam is an NSAID which all have the potential to affect liver function. Now, without some more in-depth testing, there is no way to know if the Metacam is to blame or if there is something else contributing to this problem. It may be a good idea to talk to your vet about an abdominal ultrasound or scheduling a consultation with a specialist. Hoping you can get some answers and proceed with the recommended treatment. Wishing you and your sweet girl the best of luck and praying for a positive outcome.
SW says
My 13-year-old pup just got his teeth cleaned and got a verrrrrrrrry mildly elevated ALT value of 131 (reference range given was 10-125 U/L). We just recently changed his diet and I wonder if that might be the cause? He’s asymptomatic and I don’t know if I ought to re-check those levels in a month, three months, six months, or get all concerned now and go talk to my vet about it! He’s our baby. =)
Julie Buzby DVM says
Hi SW,
YES…. I encourage you to talk to your vet! They may be able to offer insight that would give you peace of mind. Was the elevated ALT on the pre-anesthetic lab work? If so, just having your boy’s teeth cleaned and resolving any dental disease could be enough to bring the liver enzymes back down to a normal level. Dental disease can cause issues with the liver and other internal organs. I do think rechecking lab work in a month or two is wise. This way you can take action quickly if the levels have increased further. Also, you can talk to your vet about the possibility of starting a liver supplement. Supplements such as Denamarin can be very helpful in restoring liver health and function. Your pup is lucky to have you taking such an active role in advocating for his health and well-being. Wishing you the best of luck and keep up the good work!
JENNIFER ARMISTEAD ELKS says
One year old Kirby, Cockapoo has high liver enzymes ALT OF OVER 960? The vet prescribed antibiotics which did not help. Kirby is picky about what he eats and only will eat human foods.
The AlT went from 425 to 460 and now it is over 960. The vet will order a scam to see what is going on in my young puppy. He has not signs of illness whatsoever. I am so very worried about my puppy as he is very unusual and sweet and acts like a human little boy and is very, very intelligent. The creatin was a little elaivated.. Worried to death. I pray alot and so does several friends in the neighborhood. He does not have that Lep disease however.
Jennifer A.
Julie Buzby DVM says
Dear Jennifer,
I am sorry Kriby is having issues with his liver at such a young age. The ultrasound is a good idea and I hope it will offer some definitive answers. Feel free to leave an update as new information comes to light. Praying for your strength as you navigate this hard path and healing for Kirby.
Kathleen says
We have a 9 month old wheaten terrier that just came back with 960 ALT. Very worried. She’s having an ultrasound on Wednesday. Prayers please.
Julie Buzby DVM says
Dear Kathleen,
I will be praying for your young pup! Hoping for answers and a clear path forward. Feel free to keep us updated as new information is available!
heather gasiecki says
My baby girl, Zuzu Bailey, is only 1 year and 3 months with an elevated ALT of 208. Last month she was in the normal range at 98. She has been checked several times over the past year because it fluctuates between normal and elevated. Our vet just put her on an antibiotic. Although she is asymptomatic, I am absolutely terrified that this won’t work and that something else is very wrong. We just love her with all our heart!
Julie Buzby DVM says
Hi Heather,
I understand your concern for your young pup. Has your vet discussed the possibility of trying a liver supplement? I have seen great results in my own patients with Denamarin. Also, it is ok to be honest with your vet about your worries. If you are wanting to pursue more in-depth testing, make sure they are aware of your wishes. It may be a good idea to run additional blood tests or even think about an abdominal ultrasound. Hoping you can get the answers you need to ensure your sweet girl remains happy and healthy. Wishing you and Zuzu Bailey all the best!
Alla Zeygerman says
Thank you so much for the article. I have a 2 year old chihuahua mix Rose. Routine blood work showed elevated ALT 158. Doctor put her on medication for a month and we repeated bloodwork. The repeat result was almost the same ALT 160. Doctor said to stop medication and now we are going for ultrasound. The doctor is puzzled as to why such a young dog would have this issue. She did not get into anything toxic. We give her fresh food. My question is what could be causing elevated ALT only? No other enzymes are elevated. The only thing I notice that GGT was not on the bloodwork panel. Would it make more sense to do the ultrasound with aspirate? I am reading a lot of these comments and ultrasound is not showing much. Rose is doing well otherwise. The only thing I notice is maybe excessive drinking?
Julie Buzby DVM says
Hi Alla,
I understand why you are concerned for your pup with this strange abnormality on her lab work. Without playing a personal role in her medical care it is hard for me to make specific conclusions and recommendations. I do think the abdominal ultrasound is a good next step. Also, I am curious about the possibility of your girl having Cushing’s disease. This could be good to discuss with your vet and get their expert opinion. Hoping you are able to get some answers and find the best way to ensure your girl remains happy and healthy for many years to come. Feel free to keep us updated as new information comes to light.
Glenda Ramson says
My little buddy is 12 1/2 years old. He is a cancer survivor, anal gland cancer, had surgery to remove gland involved, all margins were clear, and underwent 5 months of chemo, later developed heart failure, now has leukemia. I know he is slowing down. He has been having some poop problems, often times poop is very soft, but formed, and then in process of evacuation , poop is very loose and mucousy, and is often times difficult to completely empty his bowel. His poop yesterday was really off colored, a little bit gray but not still brownish. I also noticed this past week something was off, and monitored and treated his symptoms, and even took him to the vet to get, help. He had started limping and his head is tilting to one side. I did mention this to the doctor on call. Of course, I am thinking the worse, that the cancer has returned to another part of his body, as it has been 4 years since the anal gland cancer diagnosis. It is too early to tell, but the vet did say th gait that he exhibited looks more skeletal, arthritis , than perhaps a neurological issue. He was put on vetprofen, and only took one pill. After several hours he became very sick. We rushed him to the emergency vet hospital and bloodwork indicated very high liver enzyme levels. He was treated overnight with fluids and an antibiotic drip metronidazole and was sent home with pill form of med. We are praying for the best, but are not sure what to do. He doesn’t seem to be in any pain today, but is very lethargic. I will be taking him to his own doctor tomorrow for a follow-up. I guess, my question would be, when will we know it is time to make that dreaded decision to have him put down. We don’t want him suffering and do realize that having to make this decision is a great act of love. We are at a loss, as to know what to do; should we wait and see, or continue to try to keep him healthy and productive. I am not sure which liver enzyme was elevated so, we are not sure what is going on with the liver. How long would his life expectancy be if it were liver related, not cancer and not relative to other underlying organ illnesses?
Julie Buzby DVM says
Dear Glenda,
I am sorry your pup has endured so much in his lifetime and is now facing a new issue with his liver. Unfortunately, without playing a personal role in your dog’s medical care, it is hard to make specific conclusions and recommendations. As long as your boy is not suffering, it is ok to give this some time to see how his body will respond. Your vet will be able to tell you if they think he is suffering and if saying goodbye is the most loving option. Without a definitive diagnosis for this liver problem, there is no way to know what the prognosis is or what you should expect moving forward. I am hoping the visit to your vet tomorrow will offer some answers to your questions and put your mind at ease. Praying for a positive outcome and wishing you both the very best.
Tara Tolan says
Hi, I just had a blood test done on my 10 year old Husky/Heeler mix who is scheduled for her dental cleaning on Feb 6th.. The blood test shows she has a high ALP of 229. The rest of her results were all within normal range with the exception of her Cholesterol which was 370. Even tho she is 10 years old, she gets walked every day, sometime twice a day. I can say that she has slowed down which I attribute to her age. She will be going in for her Dental on the 6th which they say she will be fine. They said the high ALP might be due to her age. They are recommending maybe doing a fasting blood test to check again. Should I be concerned. Should she have an x-ray or ultrasound of the liver or is this only a minor concern since all her all other levels are fine.
Thank you.
Julie Buzby DVM says
Hi Tara,
I understand your concern for your girl with this abnormal result on her lab work. While more in-depth testing may be needed at some point, for now I would not be too concerned with only the ALP being elevated. Many times, dental disease in itself can cause this mild elevation and you may see this resolve after the dental cleaning is performed. My best advice is to recheck lab work in another month or so and see if there have been any changes. Wishing your girl good luck with her dental procedure on Tuesday!
melissa casal says
Hi Dr., My pup Jet had alt of 780 when we went to ER on New years eve due to diarrea not going away (no vomit) they infused her for dehydration, x-rays and BW. i followed up with my vet the following tues days bc she hadnt pooped for 2 days. i was told the metro pill they gave her could stop her bowel movements. I then came back to vet as recommended for a new panel of bloodwork on 1/16 later and was told due to the ALT enzymes being so high and to check gallbladder. Yesterday was ultra sound and i breathes easier bc no masses were found or inflammation. My vet mentioned biopsy liver and hepatatic things, i was shaking as he spoke to me and cant remember it all. I did tell vet that at ER her ALT was 780 but the new BW they did just a little over 2 weeks later it was down to 629. He didnt know that s he said thats a great sign. the only thing changed was taking kibble out of her diet, He put her on denmarin bc i didnt want to put her back on metro as it comatosed her and made her not herself for the few days i let her be on it. Is there any foods that i can add to her food that will help then also go down. i know about milk thistle but the denmarin has that already i believe. im just wondering if theres a superfood to add. if you are able to respond, thank you .
Julie Buzby DVM says
Hi Melissa,
I am sorry Jet has been through so much over the last month. I am glad her blood work is slowly improving and nothing abnormal was seen on the ultrasound. I am not sure of any foods that are specifically beneficial for liver problems. I think Denamarin is great and glad to hear that is already part of your dog’s treatment regimen. Hoping Jet will continue to improve and praying for a full recovery. Wishing you both the best of luck and keep up the good work.
Jill says
Hi- our Border Terrier, Waffles, just passed this past Saturday. I’m struggling w/ being the one that had to make that decision and I guess I’m just hoping that it was the right decision. He’s been lethargic, sleeping, and slowing down for the past several months and stopped eating about 3 weeks ago. After 1.5 days of not eating, we took him to the vet and they did a full blood work-up and his liver enzymes were “off the chart”, well over 800. He did 2 full days of hydration IV and after 3 days of still barely eating, his liver enzymes hadn’t gone down at all. The vet did a ultrasound to check for tumors and there were none. She was baffled and started mentioning “quality of life”. We started some meds to help his nausea (what he did eat he threw up) and we just babied him and waited to see what would happen. He continued to decline. He had lost a lot of control over his bowels and his mobility was rough, hard time getting up off of the ground. We decided it was time. It was a beautiful passing at home w/ loving vets and his whole family present….but man, I’m struggling with this. Did I make the decision too quickly? Could he have recovered somehow? I just didn’t want it to become an emergency situation where we were rushing and had no control- I’ve done that w/ a kitty and it was awful. I’m really not sure why I’m writing this novel, but thank you if you happened to get to the end of it.
Julie Buzby DVM says
Dear Jill,
I am so sorry for your loss of Waffles. I know you would have done anything you could to restore his health, but I do think you made the right decision in saying goodbye and offering your boy peace and rest. What a blessing his passing was smooth and peaceful. I am certain your presence in his final moments was a comfort. May his memory live on and continue to be a source of joy in your life. Wishing you all the best as you continue life’s journey. ♥
Brent Matlock says
Our 9 year old Havanese is currently hospitalized since Monday. Hoping to bring him home today or tomorrow. He started turning away treats last week and by the weekend was eating anything and vomited twice on Sunday. We took him to the veterinarian on Monday. Blood work showed alkaline phosphate 1500, ALT 3000 and GGT 31. He’s now in the hospital on IV and meds. Doctor didn’t see any stones on gallbladder or tumors on liver on ultrasound. The doctor told me this morning he’s still not eating so she may give him an appetite stimulant and will redo labs today. No fever, vomiting or diarrhea which is good. I’m trying to figure out the case. Can a bacterial infection raise liver enzymes this much? End of December he developed a cyst on eyelid (chalazion). It got larger within a couple weeks and week before last must have ruptured as it’s gone. Then the following week (last week) is when he started to turn away food. I’m wondering if maybe he developed a bacterial infection when it ruptured? I wish we had taken him to the veterinarian when we first noticed the cyst on eyelid. He’s the most intelligent and sweetest dog I’ve ever had and the thought of losing him in very painful to my family. I pray that he starts to eat and labs some improvement.
Julie Buzby DVM says
Hi Brent,
I understand your concern for your boy and wish I had some answers. Unfortunately, without playing a personal role in your dog’s medical care it is hard to make specific conclusions. I can assure you this liver problem did not come from the eyelid cyst. In order for something like that to cause a problem with the liver it would have had to cause sepsis and also affect other internal organs or would have to be a metastasis from a primary liver cancer. If an eyelid tumor was infected to the point of causing sepsis you would see massive changes and problems to your dog’s face and eye. It may be time to think about scheduling a consultation with an internal medicine specialist. Also, has your pup been tested for tick borne diseases or other blood parasites? Any chance he got into something toxic or poisonous? These are just what come to mind as things that should be ruled out. Hoping you can get some answers and pursue the appropriate treatment. Wishing your sweet guy the best of luck and praying for a positive outcome.
ROBERTA says
Hi Brent
My dog has had the same numbers last september and was in hospital for a whole week, even had a feeding tube put in. She recovered from that, which was a relief. The vet could not tell if she had a bacterial infection or toxicity – only a liver biopsy would tell and we decided against it as it would not change the treatment course they were giving her.
Yesterday we had another blood test as she has been a bit up and down, and the enzymes are very high again. Not sure what is causing it, but I am thinking an underlying condition.
Hang in there! Its so stressful when they are sick.
All the best
Julie Buzby DVM says
Hi Roberta,
I am sorry your girl has had so many issues with her liver over the past year. Hoping you can continue to partner with your vet to find the cause and decide on the best course of action. Thank you for offering encouragement and support to others. Best wishes to you and your sweet girl. ♥
Cathrine Fortune says
My whippet bitch, 9.5 years old have got a very elevated ALT 686 U/L but is showing no signs of illness. We did an ultrasound scan to see what is going on in the liver, and found no abnormalities there. However, the vet found something on the gallbladder she is unsure of, and is going to discuss with some other vets. I am of course very worried, and is fearing cancer.
The dog is on a special diet because of kidneys ( SDMA is 22 but CREA and UREA is still showing normal levels). She gets Onsior or other antiinflammatories occasionally because of back problems, but only the prescribed dose, and not more than a few days at a time.
She has a very good appetite, drinks normal and is not bothered with diarrhoea or nausea. She looks good, no potbelly. I can see she has lost some muscle, but I guess that is normal as she is on a low protein diet, and is a lazy type.
Julie Buzby DVM says
Hi Cathrine,
I am sorry your pup has these abnormally elevated liver enzymes. I think the ultrasound was a good idea and hope your vet can get some help with the interpretation of the images. Feel free to leave an update as things progress. Praying for answers and a clear path forward.
lucy says
hello
our dog is 6 years old the past 8 months his liver enzymes is elevated it is now 334 the vet put her on DeMarini and urisdol on dec 3 we have another bloodwork in February to recheck the bloodwork for that the past couple of weeks she has vomited but she is acting good happy eating pooping doing everything normal so we are now concerned because of the vomiting that it could be the liver getting worse could it be the medication also that is causing that we are so worried we love her so much 🙁
Julie Buzby DVM says
Hi Lucy,
I understand your concern for your pup. I am glad she seems to be feeling ok despite the vomiting. Hoping the medication will help to get things stabilized and praying for good news at the recheck appointment. Best wishes!
Donna Farrell says
My dog has been diagnosed with Cushings and at first git very sick. Very high ALT readings. In veterinarian hospital for a couple of days on meds, testing, etc. She is on Denamarin fir that with no issues. Vet put her on Mitatane for Cushings and now she’s back in hospital with vomiting, etc All the signs of Cushings….pot bellied stomach, etc. Her ALT is ay about 900’s. High. They are trying to figure out what is making her go from being better to so sick. Ultrasound has been done, etc.
Could it be the Cushings med…I know it is like a chemo drug. Denamarin has not affected her but is also not keeping the liver low. More tests today. She is a 37 pound Beagle/Basset p, age 13.
Any help is appreciated. Loved your article.
Julie Buzby DVM says
Hi Donna,
I am so sorry your senior girl is not feeling well and dealing with such severe symptoms. I wish I had the answers you are looking for but unfortunately without examining your girl myself, it is hard to make specific conclusions. While I would not suspect the medicine to be causing these issues, I can’t completely rule out the possibility. This may be a good time to think about a consultation with a specialist. Your vet should be able to make the referral if that is something you would like to pursue. Hoping you can get the answers you need to ensure your pup is on the road to recovery. Wishing you both the best as you navigate this difficult path.
EB says
My dog was recently hospitalized too with an ALT of 3,600!!!(off the chart but we sent it out for further testing). I give her vetoryl for cushings normally. Started getting her an IV of fluid everyday, 2 nausea medicine, liver supplement, gallbladder supplement, appetite stimulant & 2 antibiotics. She was still yellowish on her belly and eyeballs. I had this weird gut feeling it was the Vetoryl (cushings med). I took her off the vetoryl, continued everything else, and clinically she was about 50% better about 4 days later and now she’s almost back to normal. ALT still super high (had to send out again), but assuming it’s dropping bc her other bloodwork was much better than it had been. I looked everywhere to see if there was a connection btwn the cushings meds and high ALT. I wouldn’t be surprised if it is in fact a rare negative reaction to it!
Julie Buzby DVM says
Hi EB,
I am so sorry your dog had these severe complications. Recently I have had several people write in with a similar experience. I think you may be right about a connection between an elevated ALT and a possible reaction to Vetoryl. This is sad and scary as it is the best treatment for Cushing’s that is currently available. Hoping new information will come to light and praying for continued healing for your pup.
E B says
How can we connect more? I would love to speak to you more about this as Imm convinced the vetoryl causes this. Thankfully my vet is amazing and brought her back to life but the ER vet basically told me I would have to put her down. awful. the whole experience was awful. Would love to figure out a way to make this more well known if this is in fact a thing..
Eric Graham says
My 2 year old frenchie had an ALT of 1.51 which the vet told me was slightly elevated. We did a blood recheck six weeks later and the ALT has risen to 1.68. With that, the vet has us using Denamerin Advantage and an ultra sound in two weeks. We have no idea what he could have ingested that would cause a problem other than a possible food change that we made. Of course we are very concerned as to what could be causing the ALT to rise.
Julie Buzby DVM says
Hi Eric,
I understand your concern for your pup. I am glad your vet is taking such a proactive stance and is moving forward with ultrasound. Hoping you get some answers and can find a clear path forward. Praying for a positive outcome and many happy years ahead for your sweet boy.
Kathy Burgess says
Thank you so much for this detailed article!! I always research issues and found this to be very helpful and full of great detail. I will work with my vet on my aging dogs very high liver enzymes. I feel better equipped now to be able to understand any tests or treatments.
Thank you again – this has been amazingly helpful.
Julie Buzby DVM says
Hi Kathy,
Thank you for the kind words! I am glad to hear the article was informative and will help to empower you to continue to advocate for your dog’s health and well-being. Keep up the good work and I wish you nothing but the best!
Lynn P. says
This article is so helpful! My senior Maltese had ALT 1,077 with AST 380 and ALP 3,000. I was very worried to say the least. While his vet explained things well, he understandably couldn’t go into this depth of detail. Reading this really gave me a way to plan for various scenarios and prepare myself, mentally and financially.
For now, he is on Denamarin and Urisodol with a blood panel recheck in one month. He is much improved but not out of the woods, and I suspect Cushing’s as underlying cause.
Thank you for this excellent article, it really helped me understand and plan, and know what questions to ask going forward. Much appreciated!!
Dr. Julie Buzby says
Hi Lynn,
Thanks so much for your kind words about the article! I’m so thankful that it was able to help supplement what your vet told you and prepare you for whatever the future may hold. It sounds like your vet has a great plan for your pup, and I hope that he is back to his old self soon!
Dottie Hampton says
Our 8.5 year old CKCS was diagnosed with Cushing Disease. He has had two ACL surgeries (one on each hind leg). He has been on Galliprant and other steroids for this issue. He has been Vetoryl for Cushings for around 3 weeks. We can see a remarkable improvement in Winston’s condition. He has more energy and muscles are stronger., not panting as much, etc. Do you have any recommendations?
Julie Buzby DVM says
Hi Dottie,
I am glad to hear your pup is responding well to the Vetoryl and you are seeing an improvement in his symptoms. I am not sure I understand what sort of recommendations you are looking for. Feel free to leave a follow up comment with any questions. I’ll do my best to address them or point you in the right direction to the information you need.
Victor Davis says
A very much by chance enzyme diagnosis…
Within a week of adopting a one year old Great Pyrenees/Lab mix puppy (90 lbs and full of energy), he found his way into a compost bag. There was mold and while he didn’t ingest much while tearing the bag apart, he did have a reaction to a toxin in the mold which was discovered through bloodwork. His enzymes levels were slightly elevated. He presented with head shaking/tremors which, over the course of three hours occurred four times with a duration of approximately twenty seconds each time. The symptoms completely disappeared over the next six hours waiting my turn in veterinary ER. Had I not been home, I may never have even known about his toxic encounter except for the torn bag mess in my side yard.
I do not have the lab results in hand.
We were sent home with S-ADENOSYL-225 SAMeLQ as “liver support”.
He has had no apparent lasting issues and will have bloodwork repeated at his next exam. He is happy, healthy and rambunctious as any pup I’ve ever encountered, gets daily long walks and a healthy variety of food.
My questions : Is this a common complaint? Does this minimal treatment seem appropriate?
I truly appreciate and look forward to your email/informative columns having first finding toe grips for a dog I had several years ago (she had a slightly torn bicep).
Thank you for all you do!
Julie Buzby DVM says
Hi Victor,
It sounds like your pup experienced an acute liver injury due to a toxin that was ingested in the mold. It is common to offer supportive care in these instances and give the liver a chance to recover. The supplement you mentioned is wonderful and is exactly what I would have prescribed in this case. I think the decision to recheck lab work at the next appointment sounds perfect. This will let you know if the liver has healed or if there will be ongoing issues. If ongoing issues are suspected, then the next step in treatment can be discussed with your vet at the recheck. Hoping you receive good results and wishing your sweet boy the best for a long happy life.
Robin Franklin says
my Airedale, 10, is on Galiprant for his arthritis. it has been 2 years, and he recently did blood work that shows liver enzymes up. I am giving him Hepaticlear Pro. the vet gave me. His legs still shake, and he has much trouble getting up. His skin is itchy and he has little warts all over, even one growing over his eye that needs to be removed..ugh
Julie Buzby DVM says
Hi Robin,
It can be very hard when a senior pup starts dealing with multiple issues at the same time. I am glad you are working with your vet to find ways to keep your sweet boy feeling his best. Thank you for sharing your experience with us. Best wishes to you both.