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High liver enzymes.

Species: Dog
Breed: Lhasa Apso
Age: 5-8 years
He has had major allergy problems since April 2010. He is seeing both holistic and western vets and getting acupuncture treatments, herbal meds & home cooked diet (chicken/green beans/squash/sweet potatoes/white potatoes) since last Sept. 2010. Holistic vet said he had cold phlegm in stomach and spleen was not healthy. Also he had yeast infection in stomach and all over body/ears. We did full allergy blood testing late Jan 2011 and found allergy to green beans/potatoes so replaced those with peas/carrots/oatmeal with the chicken. Holistic vet felt his digestive system was getting some better in Febr 2011 so western vet did full blood work 3/1/11 (liver ALT was 88, all other levels normal except creatinine at +0.1)before starting Ketoconazole 200mg on 3/4/11. Prednisone 5mg was added 3/11/11-initial dose 2 per day for 3 days then declining to 1 every 3 days. Appetite went way off and he lost 5 pounds (24# down to 19#) by mid-April. Western vet suspended both meds on 4/22/11 after testing SGPT at 661. She added Denosyl and re-tested SGPT 4/29/11 at 937. He is scheduled for ultrasound tomorrow. In meantime she suggested we feed him whatever he will eat. He is not allergic to beef and loves it so he has eaten plain fast food burgers, roast beef and carrots and his appetite is better altho still a little "off". He is acting pretty normal and not lethargic. Is it possible to heal his liver (if no tumor etc. is found on ultrasound tomorrow)? If he is now eating because we are offering something he wants, should the SGPT number change?

Online vet, Dr. Marie

Dr. Marie replied:

Oh, the poor little guy. And poor you for having to go through all of this!

SGPT (also known as ALT) is normally under 100 in dogs. (Some labs will say under 84 is normal). I don't get too worried about it unless it is over 300 and even then, sometimes it is not a big concern. However, if I am seeing a high ALT level in a dog who is losing weight and not eating well then I do get concerned.

At first I wondered if you were going to ask me about the ALKP level. This level is often very high in dogs taking prednisone and I don't worry about it. However, prednisone will not cause ALT to increase.

There are some dogs who can have serious liver issues because of ketoconazole. It is not common, but it can happen. However, these dogs usually have increased ALT, ALKP and AST. If only the ALT is up then this may not be due to the ketoconazole. Additionally, if it was due to the ketoconazole then we really should have seen a dramatic improvement once it was stopped and also with the Denosyl.

Cases like these are really frustrating because it is often difficult to find out what is going on. There are literally hundreds of possibilities. It sounds like your vet is doing the same things I would though. An ultrasound is the next step. They'll be looking for signs of a tumor or possibly an abscess. They may possibly want to take a biopsy of the liver which could help us get a diagnosis.

To answer your question...if there is no tumor found and if the liver is "sick" because of some sort of a toxin then yes, the liver has a great chance of healing. I have seen many dogs that had a mysteriously high ALT level that went down after a few months and we never figured out what the cause was.

I'm not sure how to answer your last question...eating food will not cause the ALT to change. However, the opposite could be true. If the ALT is decreasing then this could mean that his liver is getting healthier and he is feeling better and therefore, he would be more willing to eat.

I hope everything goes ok!

Dr. Marie.

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Customer reply:

Thank you for your help - we now feel a bit more encouraged. By the way, the only level tested on 4/22 and 4/29 was SGPT - it was done in the office rather than sending it out to the lab. Should I request they test ALKP and AST through the lab, do you believe? Or will the ultrasound give them enough information to diagnose without additional blood tests?

Online vet, Dr. Marie

Dr. Marie replied:

Interesting. It's hard to comment without knowing all of the details of the case. However, when I am wondering about liver issues like this I usually run a full liver panel. This panel includes:

  • ALT

  • ALKP

  • AST

  • Bilirubin levels

  • Bile Acids

The bile acids level can be very helpful because it can tell us a lot about how well the liver is actually functioning. If I have an animal with a high ALT but normal bile acids I don't get too freaked out. But, if there is a high ALT and really high bile acids then this tells me that there is a serious functional problem with the liver.

So, you may want to ask your vet if they would run additional blood work. One of the problems is that they will likely have to send this blood to an outside lab so it may take a day to come back.

The only reason I would say an ultrasound would tell us a lot is if there is an obvious tumor or abscess. Otherwise, the blood tests are going to be more helpful.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.