High Liver Enzymes: Alk Phosphatase 1,500 (Reference Range 5-131)

[ivegrgas]

Darby, male dog mixed breed (Chihuahua, Terrier and Datsun)

Age: 8 years, adopted by current guardians about 2 years ago

Weight: 11-12 lbs, at the time of adoption he was overweight but the weight is within normal range now

Appearance: Coat is shiny, no discharge from the eyes or nose

Coughing: He sneezes a bit (lives in Northern CA)

Itching: Licks his front paws a lot but he also has two nails that tend to bleed often after even a short walk

Current Environment: Only pet living in a home with two small children. Adopted from the Milo Foundation 2 years ago.

Past environment: We only know that he had older owners that died and he lived with another dog. He was probably found after a few days of their death.

Current diet: mix of commercial canned (liver prescription diet) food supplemented by home prepared foods such as brown rice with turmeric

Current medicines: taking Denmarin for liver

Past medications/vaccines: “current” on all vaccinations, had medication for eyes as he had a corneal ulcer, anesthesia for removal of 12 teeth, followed by antibiotics about 1.5 years ago

Other health issues - one nail in both rare paws is bleeding and not healing. Since adoption after a long walk his 2 nails bleed- noticed it in the month of September. Then in the winter time it was less noticeable. Then again this summer, it happened many times so I was not sure if its the hot pavement or something to do with his disease. I put on little boots and that helps. Seems some sort of a chronic wound on the nail that opens up in the heat and on a walk.

Behaviour - unchanged

Energy - not able to jump on to the couch any longer. He can jump down very easily but does not jump up anymore.

Mood - good/unchanged

Appetite - has always been a hungry dog and will eat anytime, anything. But that has not changed ever , if anything- I think he is hungrier on the liver diet.

 

[Dr. Jeff]

Hey Ive-

Thanks for posting more information about Darby.

As we discussed briefly during the EH!, the elevated SAP (serum alkaline phosphatase) of 1,500 can have many physiologic meanings in addition to liver dis-ease.

SAP is an enzyme that can come from multiple sources and from use of steroids. It also comes from the pancreas, bone, intestines, etc.

Since it's relatively non-specific, the first question would be to find out what else is going on?

Any recent drug use (including heartworm meds), flea/tick chemicals, etc?

Then on to differentiating whether this elevation is indicative of a liver dis-ease at all.

For example, as you might have seen in the endocrine course, elevated SAP is an uber-sensitive indicator of early Cushing's dis-ease.

Were there other tests run?

You've also mentioned a few great individual characteristics like his bleeding nails.

Internal symptoms, like SAP, are also individual characteristics.

And as such even "abnormal" test results can be normal for the individual.

This is less likely in this case (because of the high value) but it would be interesting to find out if any other recent tests are available.

Even any preop screening before the dental could be useful.

Lastly, if these guardians want further physiologic (vs. energetic and Vitalty-related) answers, the follow-up tests are not invasive (tho also not inexpensive).

Things like an x-ray, ultrasound, urine cortisol:creatinine, and pre and post prandial bile acids will help characterize the symptom.

<a href="http://veterinarycalendar.dvm360.com/diagnostic-approach-dogs-with-increased-alp-activity-proceedings" target="_blank" rel="noopener">Click/tap here</a> for a comprehensive (though conventional) vet article about characterizing elevated SAP.