How do you know when to euthanize a dog with liver failure? Making that decision can be incredibly difficult. But end-of-life care veterinarian Dr. Dawnetta Woodruff, friend of integrative veterinarian Dr. Julie Buzby, is here to help. Dr. Woodruff explains the stages of liver disease (including the symptoms of end-stage liver failure). Then she provides practical and heartfelt advice about when to euthanize a dog with liver failure.
When your cherished friend receives a diagnosis of canine liver failure, it can be incredibly scary. You may not fully understand what is happening. And the upcoming decisions about your dog’s health might feel overwhelming. You may wonder how much good quality time your dog has left. And you might be asking yourself how you will know it is time to say goodbye.
These are not simple considerations, and the answers are not always straightforward. But understanding a bit more about how liver failure affects the body can help provide some clarity.
What does the liver do?
In a normal healthy body, the liver has many important jobs, including:
- Producing and excreting bile (i.e. digestive enzymes that break down food)
- Metabolizing (i.e. breaking down) fats, proteins, carbohydrates, and medications
- Producing blood proteins and clotting factors
- Storing vitamins and minerals
- Filtering infectious agents, toxins, and other substances out of the blood
A functioning liver is critical to maintaining proper balance (or homeostasis) within the body. This means that if the liver stops working, the dog can become very sick and ultimately die.
Thankfully, the liver is an organ that has a large “reserve.” In other words, if a portion of the liver isn’t working well, the rest of the liver cells can “pick up the slack.” The liver will continue to carry out its vital functions. And the dog may seem completely normal, despite having liver disease. In fact, over 70% of your dog’s liver can be damaged or diseased before signs of liver failure in dogs begin to show up.
How will I know if my dog has early liver failure?
When your dog is in the early stages of liver failure, he or she may not have any symptoms. The only indication of liver disease in dogs may be changes on blood work such as a high ALP in dogs.
This is one reason it is important to follow your vet’s recommendations about screening blood work for your dog—even if your dog appears healthy. Routine lab work can catch liver disease in dogs early, when there are more treatment options available. Your vet will let you know how often your dog should have blood work based on your dog’s age, breed, medical conditions, and any long-term medications he or she may be taking.
Management of early liver disease
If your dog’s blood work shows mild problems with the liver, close monitoring may be sufficient at first. But if the liver values are more abnormal, your vet may suggest a liver-friendly diet. Or he or she may recommend supplements and medications that help to support the liver and keep it healthy. These diets and medications will not reverse the liver disease that is already present. But they may help slow the progression of the disease and increase life expectancy.
What are the symptoms of the middle stages of liver failure in dogs?
However, as early liver disease progresses to more severe liver damage, your dog may start showing symptoms of the middle stages of liver disease. Some of the more common signs include:
- Loss of appetite
- Fatigue, sleeping a lot, a lack of energy, or being a lethargic dog
- Nausea (and associated drooling, which can be the reason your dog keeps licking his or her lips)
- Bruising (large patches called ecchymoses or small “dots” called petechial hemorrhage)
- Itching and hair loss
These symptoms are a bit vague. And they tend to overlap with other diseases such as kidney failure in dogs, diabetes in dogs, and Cushing’s disease in dogs. That’s why visiting the veterinarian is so important anytime your dog seems “not quite himself or herself.” Your veterinarian can perform an examination and run blood work to determine if your dog’s liver—or something else—is to blame for the signs.
Management of the middle stages of liver disease
Based on the severity of the changes in your dog’s blood work and his or her symptoms, your veterinarian will make some treatment recommendations. Many dogs benefit from liver diets, medications, and supplements as previously discussed. And they may also need some symptomatic care, such as anti-nausea medications, to control the side effects of liver failure.
What are the symptoms of end-stage liver failure?
When liver disease progresses to its severe or end-stage form, the signs become much more obvious. And they may interfere with your dog’s daily functions and severely decrease quality of life. The symptoms of the final stages of liver failure include:
- Nausea and vomiting
- Confusion or disorientation
- Unexplained bruising (sometimes severe) on the dog’s body or gums
- Hemorrhage from issues with blood clotting (e.g. dog nose bleeds, blood in the vomit, or bloody diarrhea)
- Swelling of the abdomen (i.e. a pot-bellied dog appearance)
- Pitting edema (i.e. swelling where an indentation remains after pressing it) of the legs and feet
- Irritability or aggression
- Head-pressing
- Yellowish tint to the whites of the eyes, gums, and skin (i.e. jaundice)
- Dark brown urine and pale (almost grey) stool
- Seizures in dogs
Management of end-stage liver disease
Many of these end-stage symptoms of liver failure in dogs can be managed. But end-stage liver disease cannot be reversed. Your vet may prescribe anti-nausea medications like Cerenia for dogs to help control vomiting. And he or she may recommend appetite stimulants for dogs to encourage eating. Your sweet dog may also need medications to help lower the pressure in the brain, control seizures, or reduce other signs of hepatic encephalopathy (i.e. neurologic signs due to liver failure).
Each patient looks a little different, and there is no one-size-fits-all therapy. If symptoms are severe, your dog might need to stay in a hospital for round-the-clock care. But when caught early enough, aggressive therapy may allow your dog to feel better and go home on oral medications.
How long can a dog live with liver failure?
In addition to the fact that a dog may be diagnosed with liver failure at any of the above stages, there are also many different reasons for liver failure (e.g. toxins, infections, chronic inflammation, build-up of copper in a dog’s liver, etc.). This makes it difficult to provide a universal answer to the question of how long a dog can live with liver failure.
Some dogs have mild liver disease that progresses slowly and remains relatively stable over months, or even years. Other dogs may have a rapid progression of liver failure. And they may only live for weeks, or even days, following their diagnosis.
Since the life expectancy of dogs with liver failure is so variable, you may be wondering how you will know when to euthanize your dog. There is not one specific “end point” for every dog that indicates his or her good days have come to an end. Much of that decision depends on your dog’s and family’s particular situation.
How will I know when to euthanize my dog with slowly progressive liver failure?
When your dog’s disease is less severe, you may have weeks or months to evaluate your dog’s status. It is important to prepare for your dog’s euthanasia ahead of time as a family. And you will want to involve your veterinarian in the decision too.
In these situations, I recommend regularly using a quality-of-life scale for dogs. Or you may wish to hang a blank calendar page on the fridge. Then you can simply mark good days in green, “ok” days in yellow, and bad days in red. Having a visual representation your dog’s quality of life can help you see when the yellow and red days are becoming most frequent.
Additionally, it can be helpful to make a list of “hard limits.” These are behaviors from your dog that indicate you no longer want to push forward. You may decide that if your dog isn’t happy to see you when you get home, it is time for euthanasia. Or you may know that if most of your dog’s day is spent sleeping, you don’t want your dog to keep living like this.
It is so difficult. But establishing these limits and quality of life benchmarks can help you make better decisions when the end of life arrives and emotions are high.
How will I know when to euthanize my dog with rapidly progressing or severe liver failure?
On the other hand, if your dog requires hospitalization or care in the ICU, he or she may reach a point where the liver failure is not responding despite aggressive therapy. In that case, you will need to make a decision about euthanasia quickly.
If you and your veterinary team have tried all of the reasonable treatments, and your dog is continuing to decline, euthanasia may be the kindest option. The final stages of liver failure can be very difficult for your beloved companion to endure. And watching your sweet pup struggle can be incredibly heartbreaking too.
Choosing euthanasia in such a situation is merciful, and it allows your dog to skip over the hardest moments at the very end of the disease. You may choose to say goodbye in the hospital. Or you might want to see if your dog is stable enough to come home for an in-home dog euthanasia. Both options are kind. Your vet can help you determine which is best for your specific situation.
How does caretaker fatigue influence the decision to euthanize your dog?
As with many diseases, taking care of a dog with advanced liver disease can be mentally and physically exhausting. Medication routines, bathing, cleaning, and giving mobility assistance can be extremely time consuming. And the mental load of choosing medical therapies, worrying about your dog’s quality of life, and watching him or her struggle may become overwhelming. When considering the best time for euthanasia, it is ok (and actually essential) that you factor your own well-being into the decision as well.
One of the key components of caring for our dogs is ensuring they have love and affection from their human family. That is what gives them tremendous joy! When your caretaking duties become burdensome, the human-animal bond can begin to break down.
You and your dog don’t want to spend your final days or weeks together feeling frustrated and upset with one another. If your dog begins to resent the medications, gets angry when you try to feed him or her, or becomes upset with bathing or cleaning routines, that may be your dog’s way of telling you he or she is no longer willing to continue “pushing forward.” Likewise, if spending time with your dog is no longer enjoyable for you due to your many caretaking responsibilities, your dog may be feeling the same frustration with those interactions.
Closing words of comfort
Choosing to say goodbye is never a simple decision. Our logical brain can come to terms with the decision, knowing that it is made from a place of love and kindness. But our hearts are never ready for that moment to arrive. The decision of euthanasia can be a heavy burden to bear. It helps to consider that you are not choosing for your dog to die—the disease has already done that. Instead, you are deciding to make your dog’s inevitable death a bit easier for him or her.
It has been said that it is better to set our dogs free “a week too early rather than a day too late.” There is a lot of truth to this cliché. No matter how much extra time you have together, it will never feel like enough. Letting go before all of your dog’s joy is gone can be a very kind and brave way to show the depth of your love for him or her.
How did you know when to euthanize your dog with liver failure?
Please share your story below.
Dianne says
This is one of the most comforting articles about euthanasia I have ever read, especially the section about caregiver fatigue. Thank you so much!
Julie Buzby DVM says
Dear Dianne,
Thank you for the kind words! I am glad you found the article informative and comforting. Best wishes to you and yours. ♥
Sandy Huebner says
My vet called saying my 9 1/2 to American Cocker has elevated liver readings. He recommends treatment. However, we can not afford the meds. What should we do? As if now he does drink a lot of water. His appetite is good. Thanks for your response.
Julie Buzby DVM says
Dear Sandy,
I am sorry your Cocker Spaniel is having issues with his liver. Please make sure your vet is aware of your financial concerns. Many times, we will offer what we think is best, but do have other treatments or medications available as a secondary option. If you cannot afford the medication, there may be a generic form or at least some supplements that could be used to help with your boy’s liver health. Hoping you can find a clear path forward and praying for a positive outcome for your sweet boy.
Emily says
It’s heartbreaking to read these comments.
I have a lot of guilt for not having detected my dogs liver disease sooner. She was only 3 yrs and 6 mo when she passed away. She received annual check ups which included blood work and it was completely undetected. In October I took her in because I noticed she lost a few pounds (otherwise normal and always had been picky with dry food) took her to the vet just to make sure she was ok;. They ran a blood test, fecal matter, everything came back fine they said probably just a picky eater.After changing up her diet she was fine Up until a two weeks ago I noticed the slightest distinction of her abdomen so took her to the ER. The vet even explained at first glance she looked fine and maybe was putting weight on and her physical exam presented no problem. After ultrasound, MRI, and blood work (blood work came back normal) they said she had fluid in her abdomen and thought it was a leak in bladder, the following day, I took her to a specialty clinic with referral for emergency surgery, where the vet said she believed it was not likely pyometra but the only way to confirm was with an exploratory surgery and they would operate accordingly. They drained her fluid in stomach. And this is when I discovered she had a very fibrous liver. I didn’t get the biopsy results until after she passed where I discovered she was born with congenital liver disease and connecting parts must’ve been underdeveloped in the mother pups womb, even if I had known when she was a puppy the course of action would have been to make her as comfortable as possible.
She passed a week later very peacefully and I’m blessed she didn’t suffer or atleast show the signs or the complications that liver disease can present.
I’m just so devastated that I didn’t know she was sick for her whole life. She was perfectly happy, and fun we went hiking, to the lake for Christmas we went to the beach and just this new years we spent it in west Texas and visiting marfa and big bend. I miss her so much.
Julie Buzby DVM says
Dear Emily,
My heart aches for you with the loss of your beloved pup. I know you would have done anything to give her more time, but it is clear she lived a happy and joy filled life by your side. May the memories of all the good times you shared bring you comfort. Praying for healing for your heart and brighter days ahead as you continue life’s journey.
Lydia Roll says
Hey Sondra, I forgot that I also give him organic ground turkey. Also got him an organic sirloin steak. I saw the little carnivore in him. Asparagus is on the menu too. but he doesn’t like it. I forgot to add Spinach and Kale. Be well, take care. Lydia
Alexander says
I can see the love in your words.
Oluwasegun Sekoni says
I got took over care for Lucy, a 6-year old boerboel in September 2023after her caregiver, my friend passed on. Sometime in November 2023, she came on heat and I had her bred. when she didn’t put to bed at 66 days from last breeding date, we diceded to go for a c-section: she has slightly distended breasts with what seemed like colostrum.
At the clinic, we discovered her blood was light and vet mentioned she wad severely jaundiced. We found out she was at end stage liver cancer and had to put her down immediately. It is still a rude shock because I thought all the while she was pregnant.
Julie Buzby DVM says
Dear Oluwasegun,
I am so sorry for your loss of Lucy and your dear friend. Hoping that with time your heart will begin to heal from all you have been through. Wishing you peace as you continue life’s journey.
Brent Matlock says
We had to euthanize our 9 year old Havanese on Saturday. It was such a difficult decision. Middle of January he started not eating his treats. The next weekend he started acting different. He walked slowly and just wanted to be to himself. He wouldn’t eat all day but drank a lot of water. My wife got him to eat a few pieces of chicken that next. The next day he threw up nice and would not eat. We took him to the veterinarian Monday morning and blood work was done which showed ALT 3000 and ALP 1500. Urine very dark , dehydrated and jaundice. He was hospitalized 2 days on IV and meds. ALT came back to normal after 2 days of IV and meds. ALP was 1700. X-rays and ultrasound done. Doctor said the liver looked enlarged and dense. He was not eating so the doctor sent him home with us Wednesday evening thinking he might eat at home. He was sent home on 5 medications. 2 antibiotics, appetite stimulant, nausea med and denamarin. We had to crush up the pills and force feed him which was tough. He looked sad, lethargic, getting weaker and breathing sounded different. He drank water excessively and urine still very dark. He would not eat anything. No interest in being social or playing with his toys. I took him back on Friday and the doctor gave him a steroid shot hoping this along with the appetite stimulate would help him eat. We tried everything but he would no longer eat. On Saturday after watching him go down hill so fast and now 6 days without eating we decided to have him euthanized. Doctor suspected bile duct or liver cancer based on all the findings and without having an MRI to confirm. Doctor said many times with cancer in dogs they don’t show any symptoms until it’s advanced. We wanted to do an MRI but he was too weak after refusal to eat for so long. He was the best dog and this decision was so hard but we couldn’t bare to see him suffer any longer.
Julie Buzby DVM says
Dear Brent,
My heart goes out to you with the recent loss of your beloved pup. I know you would have done anything to give him more time, but I agree it was best to offer him peace and freedom from his struggles. It is clear your boy was dearly loved, and I am certain he knew. May his memory live on and continue to be a blessing in your life. Wishing you the best for happiness as you continue life’s journey.
Connie Hagberg says
Hi, Thank you for all your important information. My 12 year old “rescue” Chiihuahua, Rosie, has a heart murmur, liver disease, and now seizures. We have been to our long-time vet who has precribed the appropriate meds. Rosie is not herself now.. She was horribly abused/neglected when we adopted her about 3 years ago. We have taken great care of her, including all medical/vet check ups. She eats Hill Liver Health Diet and also takes milk thistle. We know the time is probably near and thinking about euthanasia. What are your thoughts? We are absolutely heart broken about Rosie’s conditions. Thank you. Connie
Julie Buzby DVM says
Dear Connie,
I am sorry Rosie’s health is declining and you are facing this difficult decision about her quality of life. Without examining her myself, it is hard to know if she is at the point where saying goodbye is the best option. I do think it is better to let go one day too early rather than one day too late and allow unnecessary suffering. Your vet can help you navigate this unknown path and help you with the timing of things. Ultimately, I encourage you to trust your intuition. You know Rosie better than anyone. Praying for your comfort and strength. Bless you and your sweet girl. ♥
Melissa says
Hi, Thanks for sharing my dog is going to be 12 and a week ago she started vomiting and stopped eating. She has not vomited since last Thursday but still wont eat. On Monday I took her to the vet and got blood work done and her liver levels are very high. The doctor gave her some injection treatments and bolus of fluids ever day since. On Tuesday I brought her back for her second bolus and the Doctor said she was worse as her eye and in her ears are now yellow. He said to keep an eye on her and if her eye become more yellow on Wednesday morning then the treatment is not working. If her eyes are the same or better then to bring her back for another bolus of fluids. Tuesday evening she had a full sweet potato and was playing with her toys more, so this morning I looked in her eyes and they didn’t get worse they stayed the same. The doctor said to if she stays the same or the color gets better Thursday to bring her back for another bolus of fluid so we can flush the toxins from her liver. She is also on 2 medication at home that he gave she for the next 10 days.
I am not sure how to make the decision on when to say she has had enough. Her symptoms are not eating anything but sweet potato’s or turkey lunch meat but I can’t give her that anymore the doctor said no meat as the liver can process it only clean food and she is jaundice and she shivers periodically through the day.
Julie Buzby DVM says
Dear Melissa,
I am sorry your girl is not doing well, and you may be facing some very difficult decisions over the next few days. I wish I could tell you what is best, but without examining her myself it is hard to make specific recommendations. From what you describe, it does sound like saying goodbye could be the most loving option. It is ok to let go before all joy is lost and the only thing remaining is pain and suffering. Praying for clarity and comfort as you navigate this tough path. Bless you and your senior girl.
Dottie says
So sorry to hear about your Rosie. I, too, have a Chihuahua named Rosie who was rescued at age 4 and was neglected and abused at a puppy mill. She is now 16 and has similar illnesses, heart murmur, enlarged liver and perhaps Cushing disease which vet says will require testing to be sure. I feel her time is getting close. Will be a difficult decision.
Thank you for sharing.
Julie Buzby DVM says
Dear Dottie,
I am sorry you are facing this difficult situation with Rosie. I am praying for your strength and for clarity when tough decisions have to be made. Wishing you and your sweet girl comfort and peace.
Stacey says
My beautiful 17 year old shihtzu honey has battled on, but bloods today have shown she is in liver failure and the neurological deterioration is so apparent. She has seizures from a suspected brain tumour she was diagnosed with 18 months ago and these are becoming more frequent. We have taken the decision to let her be at peace in the coming week, and this articles kind words have given me a little comfort. You’re right, my heart will never be ready but she deserves to rest, she’s done more than enough.
Julie Buzby DVM says
Dear Stacey,
My heart aches for you as you face this emotional decision for Honey. I think you have made a loving choice to offer her freedom from her suffering. Praying her passing will be smooth and peaceful. Wishing you comfort and healing for your heart. Bless you and your sweet girl.
Melissa says
Hi my little girl was diagnosed with liver failure. My vet did ultrasound and blood work and there is nothing they can do but give her some medication to help her liver and medication to make her feel hungry. She is still playful and drink the only symptom she has are like of wanting food and jaundice. I know the day will come very soon but it to now when?
Julie Buzby DVM says
Dear Melissa,
I am sorry your pup is living with liver failure. There is just no way to know the specific amount of time she has left. My best advice is to keep doing what you can to maintain her quality of life and make the most of each day you are gifted. Offer comfort and love and let her find joy in these final days. Praying for your strength and peace. Bless you and your little girl.
M A Wilson says
Thank you so much for your clear explanations and sensible advice. We foster an older dog for a working friend and have been aware for some time that his behaviour has changed and he has lost weight ( he welcomes the affectionate touch rather than trying to bite my hand off !!) but last week an ultrasound scan revealed changes in his liver structure. Urine sample collection (hysterical) and blood tests followed, not got the results yet but together with his massively increased water drinking, increased urination and total lethargy, we know what to expect. Not killed a toy in weeks, one of his favourite activities!
Our friend has unfortunately bought a Westie pup who terrorises her old boy. He’s with us however right to his last breath, if necessary with the help of our very compassionate vet .
Julie Buzby DVM says
Dear M A,
Bless you for giving a senior pup a loving place to live out his last days. Thank you for sharing your story with us. My thoughts are with you and wishing you both comfort and peace. ♥
Lydia Roll says
This is such a lovely and gentle article. My dog is 14 and he was diagnosed with Liver Disease in June. He is getting his blood work every month and I have a super wonderful vet. She euthanized my 18-year-old cat not long ago, and she is so dear to my dog Pan.. Right now, Pan’s liver values have dropped from 175 to 145. My vet noticed how happy I was to hear that, and she somehow knew that I was thinking he would have a full recovery. Reading this article made me feel so informed and secure in my treatment of Pan; he gets homemade for all his meals and it gives me pleasure to do this for him.
Julie Buzby DVM says
Dear Lydia,
Thank you for the kind words and positive feedback about the article. I am so glad it offered some comfort and peace of mind as you continue on this difficult journey with Pan. It sounds like you have an amazing partnership with your vet and you both are working hard to ensure your sweet boy has as many happy days ahead as possible. Wishing you all the best and give Pan a hug for me!
Sondra Edwards says
I am going through this right now with my 14 year old girl. May I ask what meds Pan took and what foods have helped him? I would greatly appreciate any information.
Lydia Roll says
Dear sondra, I hope your sweet girl is still with you.Beginning yesterday, Pan appears to be on the decline. He is a bit more disoriented and lethargic. His gums look normal. But when I lifted him up he cried. This alarmed me. However he did eatmoat of his breakfast. Keep in mind that whatever you feed your sweet girl, it should all be organic. These are the meats I make for him: Beef Liver, slow cook chicken, Planet Earth tuna or salmon, chicken livers, you can give white fish too. The vegetables: broccoli ….I don’t use the stems. I simply cut the little florets and put then in the microwave for 45 seconds or more, cooked carrots, a medly of squash & broccolli. I also give egg yolks on the main dish.I puree the meat and veggies together for easier digestion. I also give cottage cheese, liver treats and salmom treats by Dr. Marty. Vitamin E (you can pierce it with a safety pin & sqeee it on his food, with Mil thistle ( I open the capsule and give 1/2 At Breakfast,Also Omega-3 Pet soft gels, do the same piercing of the capsule. And this is the Liver med Denamarin given every 24 hrs, apoquel for itching (he has lesions) Galliprant for arthritis and Zeniquin for anxiety wihich he sometimes has when I have to leave him at home. One of his symptoms I’m seeing more of is what looks like shivering. I think he could be at the middle of the final stages. I’ll see how he does in this coming week. He is my heart. I hope ypur little girl is doing well. Much love to you. Lydia Roll
Julie Buzby DVM says
Hi Lydia,
I am glad to hear Pan is still doing well with treatment. Thank you for offering advice and encouragement to others. Wishing you both the best for continued success and happiness. Bless you!
Teri Henderson says
my 10 year old doberman was diagnosed with liver disease a few years ago. we have been giving her denamarin and I added Milk Thistle to her diet. some days she beats really well and other days babe does not eat anything. today is another bad day. she vomited one and has diarrhea today. she is extremely thirsty today, but she is incontinent, so I have been giving her a little water often. she has gotten extremely picky with her food so I give her ground hamburger. that is really all she’ll eat when she does eat. she likes greek yogurt sometimes as well. I have thrown away more food in the last month than I care to think of. We have made the decision to not undergo any extreme treatments. Any advice on how to keep her comfortable and ease her upset stomach?
Julie Buzby DVM says
Dear Teri,
I am sorry your senior girl is nearing the end of her days. It may be a good idea to contact a hospice vet in your area to help offer guidance as you navigate this tough road ahead. I do think your girl may benefit from a probiotic supplement. I have had great success with Purina FortiFlora. Not only does it help to promote gut health but has also worked as an appetite stimulant for some patients and can help to resolve diarrhea and vomiting (depending on the cause). If you are looking for other healthy options of foods to offer your girl, here are links to other articles with more ideas and information pertaining to your situation:
1. 14 Vegetables Dogs Can Eat (And May Just Love)
2. Thanksgiving Food For Dogs: 10 Dogs Can Eat & 10 to Avoid
3. How an Appetite Stimulant for Dogs Can Help Your Pup
4. Dog Hospice Care Can Bring Peace and Dignity to Your Dog’s Final Days
Hoping you can find the best way to ensure your girl can maintain her quality of life for as long as possible. Make the most of the time you are gifted, and I wish you both happiness and peace.