Is my dog's new heart medicine causing liver problems post-surgery?

I assume when you say liver enzymes you mean ALT? There a few enzymes we look at and elevation in 1 value makes us consider different causes then elevation in another. ALT elevation is caused make liver cell injury and leakage of enzymes in to the bloodstream. As the liver sees all the blood of the body it can be quite a reactive organ. So the question is whether the liver enzyme is up because of something wrong with the liver/vessels to liver themselves (such as an infectious or inflammatory cause (hepatitis) or a shunt (more common in younger dogs)) or something the liver is responding too (toxicity, disease of over organs). Unfortunately all parts of sago palm are toxic to dogs with the seeds (nuts) being most toxic. And it can be quite challenging to know if this is the cause. If it is sago it depends on the degree of ingestion as to how severe the case is. Unfortunately the treatment for this is supportive as you have been doing. The values may continue to increase or hopefully may plateau off and remain mildly elevated or decrease again. Ultrasound will help to rule out other things going on in the abdomen, assess the liver for changes in texture (although a liver can appear normal on an ultrasound and not be functionally normal), and sometimes identify a portosystemic shunt. After the ultrasound then sampling either first by fine needle aspirate or with a biopsy (needed for many cases of hepatitis, some other issues) can be performed. Checking platelets and clotting times should be performed prior to liver sampling in patients whose livers are not normal to decrease the risk of bleeding from sampling. As shunts are more common in younger animals , if this is suspected, additional imaging may be recommended prior to sampling as ultrasound will not identify all shunts. There is also a disorder called microvascular dysplasia that can be found in the liver. This is best diagnosed by liver biopsy and the sample sent to a pathologist who specializes in liver pathology. I hope this has helped and not confused you more. It sounds like your vet has taken the appropriate steps thus far and has recommended the next best steps to try to rule out some other causes. Thank you for using Petco Pet Education Center, formerly Petcoach!

Mild increases in liver values can be seen for a number of different reasons, and sometimes it can be very difficult to determine what the underlying cause might be. Infections like leptospirosis, migrating parasites, congenital diseases like a portosystemic shunt or some toxins can cause liver values to increase. It seems like Leo is on supportive medications for the liver - it would be helpful to know if his values are increasing or decreasing since trends are most important. An abdominal ultrasound might be the next step, or you could also ask about referral to a specialist if available in your area.

The bilirubin is a bit high, as is the ALP (alkaline phosphatase) but neither of these values is super specific in terms of what the cause or the best treatment is. We can see the ALP be elevated with stress, age, and sometimes even normal cell regeneration within the liver. The bilirubin can be slightly elevated when the blood sample is what we call "hemolyzed," which can sometimes happen when blood is spun down for a blood test to be run. Therefore, if he is still showing symptoms of illness, I would echo what Dr Ana said; it may be time to consider imaging. Either X-rays or an abdominal ultrasound maybe helpful in identifying the problem and therefore identifying the best way to treat it. Take him back to the vet if he's still having troubles, as he probably is in need of some more fluids as well. Thank you for asking Petco Pet Education Center, formerly Petcoach, I hope he's feeling better.

Hello, without knowing the reason for the Pred., I cannot comment fully of this particular situation, but yes, Pred. is often associated with the elevation of liver values. I would definitely have Piluko on a liver protectant like Sam-e with milk thistle ( we have Denamarin here in the US ). As for the vomiting, your vet may recommend the metoclopramide or another medication such as Cerenia to control it. You can also try ginger root as it does have anti-nausea properties. The dose is wide, from 15-200 mg/kg every 12 hours, so start low & look to find a ginger root capsule that contains no other ingredients, especially xylitol. Make sure you tell your vet if you decide to try this. Thanks for using Petco Pet Education Center, formerly Petcoach.

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. If Pako has a deficiency of Taurine and L-carnitine, then yes, he should be on a supplement. However, that being said, most commercial dog food diets have sufficient amounts of both and most dogs do not need supplementation. If your veterinarian thinks this will help, I would look at ordering the following product, which can be found online quite easily. Liver support medications such as Hepagen C as well as a low protein, low fat diet such as Purina NF, Hills L/D diet, or Royal Canin Hepatic Support diet can help as well. These diets are formulated especially for dogs that have liver problems such as liver shunts, and they make it easier for the liver to metabolize nutrients that are provided to the body. Pako will have a decreased live span without surgical treatment of this disease. He may live a few years without many problems, but the disease can become refractory, and the neurological signs may worsen over time. I hope this helps! Please let me know if you have any other questions or concerns and I would be more than happy to help you further.

Hello, thank you for your question about Loki. ALT is a liver enzyme and elevations can be a sign of underlying liver disease (caused by infection, inflammation, etc). BUN is considered a marker of kidney function but can also be elevated for other reasons, such as GI bleeding. Depending on the severity of these elevations and Loki's history I would recommend testing him for an infection called leptospirosis, as this disease can cause liver and kidney abnormalities. Alternatively, If Loki is still feeling well and the metronidazole is improving his symptoms, you could continue with this treatment regimen and monitor him for development of any symptoms. I would recommend rechecking these values after he has finished the course of metronidazole and considering the need for other diagnostics at that time. Hope this helps, good luck!

Pardale is a non-steroidal anti-inflammatory medication that contains acetaminophen and codeine. Acetaminophen can cause liver toxicity in some dogs, especially if used inappropriately. Since he seems to be feeling better, there is a chance his liver will go back to normal with the discontinuation of the drug. Your vet could put him on a liver supplement, like Denamarin, to help his liver function better. Your vet can repeat bloodwork in a month to recheck his values. I would definitely be reluctant to put him back on a non-steroidal type medication for his arthritis or use one in very low doses. You could put him on a joint supplement, like Dasuquin and see if that help his joints.