# ALT liver enzyme



## Nova&Uschi'sMom (Mar 22, 2013)

Hi folks, our big boy just turned 9 years old. About 1.5 years ago we started monitoring his blood work. In 2017, his ALT liver enzyme was above normal range at 382 (we were told regular range is 18-121). He seemed healthy and happy, so we decided not to do anything about it. One year later in 2018, his ALT liver enzyme was up to 403. So we started him on the liver medication hepatosyl. Since then (July 2018) his ALT has been fluctuating between 300-350. Has anyone had similar experiences or know much about the ALT liver enzyme and hepatosyl? Since the med hasn't improved his liver enzyme level much, we're thinking of taking him back off the med. We just don't know if it's likely that this high ALT level might just be normal for him? Or if we should be more concerned that there is some underlying liver issue? Thanks!


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## Jax08 (Feb 13, 2009)

Why do you say it didn't help? It was 403 and has maintained 300-350? Have you done any diagnostics to look at his liver?


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## Magwart (Jul 8, 2012)

You really ought to try to get to the bottom of this. If your vet is stumped, maybe he or she can refer you to a board-certified veterinary internal medicine specialist?

From the little I've read, 3x normal typically is the line where they start trying to investigate to find a cause, or persistently 2x normal. There are a LOT of potential causes of liver injury/liver disease though, so it's a detective exercise to get to the root cause. Your vet may need to hear that you want to find answers as to cause, even though it's going to cost some money to do that.

Exposure to toxins is apparently a big one to look into -- and the list of things that are hepatoxins is large, but that's a task you can work on for your vet. It apparently includes landscaping (esp. sago palm), blue green algae (common in warm, stagnant water in some parts of the US), _Amanita_ mushrooms, aflatoxins (common in grains, and sometimes found in some kibble), heavy metals, xylitol or chlorinated compounds (pool water would be a suspect here). The list of suspects also includes some RX veterinary drugs (ketoconazole, azathioprine, carprofen, lomustine, acetaminophen, mitotane, phenobarbital and more). You also have supplements and herbal remedies implicated as suspects (with herbal teas, pennyroyal oil and comfrey being the biggest suspects). My list here is just copied from an article mentioning "common" liver toxins -- but you might haven an uncommon one. The ASPCA has a list of poisonous landscaping plants for dogs, so I would go through and, check off what plants you know are around that might be problems:
https://www.aspca.org/pet-care/animal-poison-control/toxic-and-non-toxic-plants

I would then evaluate home, lifestyle, and everything the dog could ingest -- literally walking the property where the dog hangs out, looking for things that might be getting nibbled regularly on that are on the poisonous plant list. 

Lepto and canine adenovirus-1 can also be root causes of liver injury. Then there are major disease states of other organs that show up with elevated liver enzymes -- diabetes mellitus, hyperadrenocorticism, hypothyroidism or hyperadrenocorticis are all possibilities. You might be getting an "early warning" about some other treatable disease state, and you don't want to ignore that early warning, right?

So...lots to investigate. Some imaging is probably in your future, and maybe cytology. 

This vet-oriented article goes into a lot of detail -- it's long, but it will help you be a well-informed consumer with your vet for discussing next steps:
http://veterinarymedicine.dvm360.com/canine-liver-enzymes-so-many-questions?pageID=1


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## Nova&Uschi'sMom (Mar 22, 2013)

Thanks everyone! We're just really baffled - this enzyme count has been high for 1.5 years now but he's still been acting like his regular self. We never would have known if we hadn't had his blood work done. He's eating/drinking normally. And for a 95 lb, 9 year old, he's ripping around and playing like he's always done. Our 6 year old female still has all regular liver enzyme levels. We're definitely going to do more investigating.

The only other thing that's crossed our minds is possible stress factors? We started having kids ~ 3 years ago. He's quite fond of them, but our lifestyle and home environment has changed significantly.

Thanks again for the insight. We thought the hepatosyl was going to bring his enzymes back down into the normal range again, but it hasn't. Which has us thinking about what the underlying issue might be.


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## hollykatew (May 10, 2011)

Hey Nova&Uschi'sMom

Have you looked into a holistic vet?

I second the previous reply that you need to look into the cause of the problem. This is obviously a while ago now (how did everything go?). Did you find out what was the cause and did you undertake further diagnostics like ultrasound? 

My dog has had elevated liver enzymes (just ALT). It has likely been like this for a year, although her test results from 1.5 yrs ago are normal. She's 11. 

We did an ultrasound which found her liver tissue is not normal. It has a 'diffuse abnormality' (darker spots across it, with a greater amount of this abnormality in one particular lobe). I always insist to see a specialist when things get complicated (therefore that's who we saw when we undertook the ultrasound). Ultrasounds are great as they don't emit the same radiation as a CT scan or xray.

Our specialist has now recommended something I feel is a bit extreme in our circumstance (like you, my dog's ALT is not elevated substantially, although is still cause for concern. Dogs with severe liver disease can have enzymes reaching in the thousands. My dog's is about 300 (norm is 150). She has a great appetite and is playing and walking although substantially less - however she's a senior. 

Our spec has recommended we do open abdominal surgery to obtain a liver biopsy (I've spoken to three specialists so far extensively to get multiple opinions, including one who does laprascopy (key hole). Unfortunately there's no other way to obtain a reliable sample for diagnosis of the problem. Even fine needle aspirate (no surgery required!) has only a 30-50% agreement according to literature (I checked this also) with biopsy diagnosis taken from actual surgery because of the depth of tissue changes. Possible things that have been mentioned include malignant cancers, but also benign hyperplasia. 

So I'm on here to hear others' stories of similar liver enzymes. My approach, after also discussing this extensively with my natural holistic vet (our go to vet for the past 7 years), is to support my dog's overall health but particularly the liver with natural support which my dog is very responsive to. We will maintain close eye on the issue through a follow up blood test and possible ultrasound in another few months or so. Doing open surgery on an 11 year old dog could be very rough in terms of recovery. They also request a CT scan (lots of radiation, MRI is not pracitcal/available) which uses contrast dye (needs to be processed by the internal organs once again, more strain on the system). 

Anyway, would really appreciate hearing anything you or others have come across. If you haven't continued to investigate why the ALT is high at least you have some of my insight for future reference if you unfortunately need it. 

Thanks, all the best!


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