Elevated ALP and ALT

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geekgirldany

geekgirldany

Member Since 2013
Catee has been doing well keeping his diabetes under control. I took him to the vet at the end of October for his 6 month checkup. Vet tech called and said he had elevated ALP and ALT. Vet told him to ask me if I could "pill" my cat. I told him no, that I had never been able to do it. It asked what the elevations meant and he said they were slightly elevated and to bring Catee back in 3 months. Never told what medicine they wanted to give. Catee was doing fine so I really did not ask anymore questions.

I looked it up later and it seems to be related to the liver or kidneys.

Well the past few days Catee seems to me not feeling well. He threw up twice, drinking more water and urinating more atleast three times. He is also getting the "parts" in his hair like when dehydrated. Of course everyone thinks I am making more of it than it really is there.

I would appreciate some input as to the elevated alp and alt. Could it be his liver or pancreatitis?
The vet must of thought it wasn't a big deal as he has NEVER had a vet tech call me. He has always called with the results of blood tests.

Thank you for any help
Dany
 
ALP and ALT are liver values.
I likely would not be concerned but would have to see all the values from the blood analysis. One has to look at the entire results.
I always get a copy of test results from my vets.
 
You will often see elevated ALP and ALT with pancreatitis as well as liver issues. If your kitty seems "off" and is throwing up, refusing food, and seems lethargic I would suggest having a pancreatic test done. The vet usually has the snap test which just gives a yes or no. You can also have the Spec fPLI test done which needs to be sent to an outside lab such as IDEXX and this one will give the actual number.
 
Thank you both for the information. I just got back from the Vet to get some food and insulin. I asked to speak to him. Catee's numbers are high that pertain to his liver but he suggested that insulin could be making it higher and need to monitor him for increased levels. He did say it was his liver. Thing that got me was the glucose was 319!!! I know it is lower at home. I do not know why it was so high. I need to start his spreadsheet again.

I got home today and Catee had threw up in his bowl... so he had tried to eat and threw up. He is staying under the table and isn't laying in the bed. He is also doing the "meatloaf" position, even on his ottoman he sits...he looks like he feels bad. Vet told me if he kept throwing up or not eating to bring him.

Is this something I should watch for overnight and take him tomorrow? Or watch him over Thanksgiving and take him Friday?

Also what can be done for him if it is his liver? The vet mentioned a medicine but I have never been able to give Catee a pill.

Thank you all for the help.
Dany
 
A combined SAM-e and milk thistle supplement can help support the liver (and may help the pancreas). It does come in tablet form IIRC. Some SAM-e/milk thistle supplements come in capsules, the contents of which can be mixed into a small amount of food (SAM-e is best given on as empty a tum as possible).

The split coat may be due to dehydration (and perhaps some physical discomfort). If Catee is hiding and meatloafing those can both be strong pointers to pain being a problem and that may feed into higher BG levels. If you're taking him to the vets I strongly recommend you get a pancreatitis test done - especially if his appetite is poor (SNAP fPL for immediate yes/no; Spec fPL sent to lab for assessment of severity of inflammation if SNAP is positive). Buperenorphine helps with pain, ondansetron is very good for nausea management (tablets - might be able to crush the dose and mix into a little food). Cerenia is also helpful for nausea and vomiting (can be injected). A course of B12 injections may help appetite and give a general boost.

Here are some helpful resources:

Nausea and appetite problems - symptoms and treatments

IDEXX pancreatitis treatment guidelines (gives info on nausea management, pain management and other treatments which might help Catee)

I think a trip to the vet ASAP is the wisest course of action. I hope Catee feels better very soon.

:bighug:


Mogs
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Thank you so much for the info.

He threw up three times yesterday. Today he has been able to eat a little bit and keep it down. He is drinking a lot of water. Not meatloafing as much and is staying in the living room with us. He still acts like he doesn't feel well. I feel like I need to take him Friday to the Vet but my friend wants to wait and see until next week. She feels that if it is his liver or pancreas there is nothing that can really be done especially since we can not pill him... I told her he could get a little pain relief and get hydrated if needed... know exactly what is happening. We are low on funds but I think the Vet would work with us. I guess people have different views on it but I feel like he needs to go sooner.
 
If it is pancreatitis you can get injectable anti-nausea meds (cerenia) and injectable pain meds (buprenorphine) as well as SubQ fluids. If Catee is not eating or is throwing up what little he does eat then that could quickly turn into hepatic lipidosis (fatty liver disease)which can be serious. Pancreatitis can be very painful and when a kitty is showing signs of pain it is usually quite bad, since kitties tend to hide their pain very well.
 
geekgirldany said:
my friend wants to wait and see until next week. She feels that if it is his liver or pancreas there is nothing that can really be done especially since we can not pill him... I told her he could get a little pain relief and get hydrated if needed... know exactly what is happening. We are low on funds but I think the Vet would work with us. I guess people have different views on it but I feel like he needs to go sooner.
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I disagree with your friend's suggestion to wait and I think you are right to follow your own instincts and get Catee to the vet on Friday. As Mary Ann advised above it is vital to ensure that a cat keeps eating. If money is tight perhaps you could agree with your vet to skip the pancreatitis tests and treat Catee on an 'as if' basis; all of the clinical signs you describe point to pain and GI distress. If it is a pancreatitis flare then the supportive treatments (fluids, injectable anti-nausea and pain meds and also injected B12) could make Catee much more comfortable, help him to keep taking in some nutrition, and also to help the flare subside quicker.

Tip: Watch for the foods that Catee seems to manage to hold down better at the moment and stick to that for the time being. Try feeding small, very frequent meals of whichever food causes the least upset. It's great that he's taking in fluids of his own accord at the moment but, if necessary, try mixing a couple of teaspoons of water into the food to help keep him hydrated. Also try raising his food and water bowls up from the ground a few inches (e.g. stick a few paperbacks under them); it can help a lot with nausea issues if kitty doesn't have to stoop to eat.

(((Catee)))


Mogs
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Thanks so much for the support.

I took Catee to the Vet today. He kept Catee all day. Ran blood tests and called me saying his blood work was good. His BG was high 419 because I did not give him insulin this morning... he had diarrhea. Liver values are slightly elevated but not enough to cause this and his pancreas is good. Not dehydrated so Vet said he might have ate something bad. I told him about eating corn husk from a scarecrow early this month but he threw it up. He said he felt Catee's abdomen and could not feel anything. He suggested a xray... told him to do it because something is wrong.

Well xray came back clean. No tumors nothing in his stomach or intestines.

So Vet could only say that the flora in his stomach was messed up. Gave him some medicine to keep him from vomiting but said he could not pill him for the diarrhea medicine as he was so mad he would spit it out. Vet said with his age, 15, that things like this come up.

So I guess I will watch him. He said if he wasn't eating by Monday to come in and he would give me medicine for nausea in a shot so I could give it to him. :banghead:

Not sure what is wrong with him... he seem to be in pain and just did not feel good. Just don't know.
 
Catee isn't doing well at all. I know Vet trips are traumatic for him but he hasn't even been drinking water. Turns his nose up at food. Vet gave him Cerenia.

How long can he go without water??
I've read 24 hours, others say three days.
 
One day without water should be fine. Three days is pushing it but there have been cases where a cat survived longer than 3 days without food or water and fully recovered. Those case seem to be where the cat got into a shipping box and was transported unknowingly. Not a case due to illness
 
Thank you. The Vet had him all day yesterday and he did not drink any water. I don't know why he did not give him fluids... pretty sure he did not as he did not charge me for it.

Really worried... he will not drink his water and I put it up on a box for him. He starts to go for it then turns away. He turns away at food even the high carb treats I have in case of emergency. He always eats them.

Right now he is just moving from spot to spot in the house and laying. Just don't know what to do. Maybe I made it worse taking him to the Vet? He hates it so much.
 
No I do not have any SubQ fluids. According to the Vet he is not dehydrated.

He has not ate or drank anything today. Just a little while ago he got up and drank a little water. I did get him to eat some high carb treats which I hate giving him but atleast he ate some of them. I tried to sneak his food there while he was eating them and he turned away.

He goes to his bowls like he wants the food but turns away...when he gets up. He is sleeping all the time.
 
Did your vet test for for ketones in Catee's urine? You said above his pancreas was tested. That's another possible problem. Not eating for a few days also puts them in danger of developing hepatic lipidosis.
 
He said there was glucose in his urine... he put it another way. But he said that was to be expected since his glucose was 416. I can't see anything on the blood results though.

Here are the high numbers and I am not sure what is what:

GLU 417mg
ALT 213 U/L
ALKP 295 U/L
CHOL 248 mg/dl
RDW 29.1%
LYM .72 K/ul
 
If your cat isn't eating and has high BG, you need to check for ketones. You can get the urine test strips at any pharmacy.
 
I think I might have a meter that tests for ketones.... but I don't know what to do if he has them. I am sure he does. I did not give him insulin this morning because he is not eating. Now it is about time to test and give insulin and he still isn't eating. He is barely drinking water and the last time he urinated was this morning. I am at a lost as to what to do.
 
geekgirldany said:
I think I might have a meter that tests for ketones.... but I don't know what to do if he has them. I am sure he does. I did not give him insulin this morning because he is not eating. Now it is about time to test and give insulin and he still isn't eating. He is barely drinking water and the last time he urinated was this morning. I am at a lost as to what to do.
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If you have a meter that tests for ketones and it's working, I strongly recommend testing now. You could also find a pharmacy that's open now and buy some ketone test strips. Any amount more than trace on a test strip requires a visit to the vet immediately. That signifies that diabetic ketoacidosis could be developing - very serious and needs veterinary intensive care.

You've said that trips to the vet are very stressful for your kitty. Unfortunately he might need to go sooner than later. Do you have a 24 hour vet or ER vet near you?
 
I have a 24 hour vet about a hour away... not a very good one. I did the ketone test on Nova max Plus and it came back 0.7
So according to this post:
http://www.felinediabetes.com/FDMB/threads/ketones-in-blood.142086/

The latest studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
In other words, about 2.5 on a blood ketone meter is about when ketones would show up as "Trace" on ketostix.

So he is okay for now is how I read it?
Just took his glucose and it is 264. I did not give a shot. He will eat the high carb treats but not cat food. When he eats the treats he is like snorting trying to get in this mouth.

He did sit and drink some water for awhile which is good. Hopefully he will get back to eating tonight?? I hope.
 
geekgirldany said:
I have a 24 hour vet about a hour away... not a very good one. I did the ketone test on Nova max Plus and it came back 0.7
So according to this post:
http://www.felinediabetes.com/FDMB/threads/ketones-in-blood.142086/

The latest studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
In other words, about 2.5 on a blood ketone meter is about when ketones would show up as "Trace" on ketostix.

So he is okay for now is how I read it?
Just took his glucose and it is 264. I did not give a shot. He will eat the high carb treats but not cat food. When he eats the treats he is like snorting trying to get in this mouth.

He did sit and drink some water for awhile which is good. Hopefully he will get back to eating tonight?? I hope.
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Based on what is said above about ketone meter readings I guess the levels are OK for now. Even if those numbers are OK (for now) I'd still be concerned if a cat doesn't eat or drink water. Not eating can cause hepatic lipidosis. If he's "snorting" or some other odd action while trying to eat treats that can be a sign of nausea. Going to the food bowl and turning away is another sign of nausea. Did your vet give you a specific diagnosis when your kitty spent the day there?
 
He has started drinking more water now and eating a little bit..Not Purina DM but Cat Chow. I know but if I can get him to eat anything I will take it and get him back over to the Purina DM.

That is what I was thinking about the snorting and turning away. For him to turn away from high carb treats previously I knew something was wrong. I believe he had a reaction to the Cerenia. Instead of helping him it made him worse.

The Vet did not give me any diagnosis. Nothing. He said he had no idea why he had been throwing up or what caused the diarrhea. He said his liver, pancreas, and kidneys were good. Only that he might have ate something that messed up the "intestinal flora". That at his age, 15, lots of things happen with their appetite. So that is all I got... I thought for sure it was his liver and/or pancreas.
 
How's Catee this AM? In this situation, Cat Chow is fine, but do try to give some insulin as it may drive his BG even higher. And of course try to get him back on the DM as soon as possible. Since he won't eat canned, have you tried the Young Again Mature Zero?
 
Hi all thanks for checking in. I am sick with the flu or a virus so I've been up most of the night/morning.

Catee is sleeping and seems more comfortable. He has ate a little Cat Chow, not enough to really help him. I do have Young Again Mature Zero Carb... unfortunately he won't eat it. Super picky eater. I will be taking his glucose soon.

Tuxedo Mom, these are the tests he said was for the pancreas:

AMYL 909 U/L Range 500-1500
LIPA 796 U/L Range 100-1400

He said that showed his pancreas was good.
 
geekgirldany said:
Hi all thanks for checking in. I am sick with the flu or a virus so I've been up most of the night/morning.

Catee is sleeping and seems more comfortable. He has ate a little Cat Chow, not enough to really help him. I do have Young Again Mature Zero Carb... unfortunately he won't eat it. Super picky eater. I will be taking his glucose soon.

Tuxedo Mom, these are the tests he said was for the pancreas:

AMYL 909 U/L Range 500-1500
LIPA 796 U/L Range 100-1400

He said that showed his pancreas was good.
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OK those are not specifically pancreas tests rather they measure pancreatic enzymes, Often the amyl and lipase will be elevated with pancreatitis nut not always. The actual test for pancreatitis is either the snap test that can be done at the vets...it gives just a YES or a NO. The fPLI test needs to be sent to an outside lab such as IDEXX and will give an actual number reading so if it is positive you can tell how high it is.

One of my kitties has chronic pnacreatitis (largely due to other health issues) and has the occasional flare up. His numbers are consistently high on the fPLI test. Last bloodwork a couple of weeks ago his AMYL was normal 1037, but his Lipase was high 4275. These numbers can be up or down at any given time. The symptoms you are describing are very similar to what my kitty gets when he has a flare up.
 
I replied on your other thread with info on Cerenia side effects and also tips for how to try to coax an inappetent kitty to eat. I feel so much for yourself and Catee right now because I've been where you are and it's very distressing and scary. :bighug::bighug::bighug:

I'm on the same page as Mary Ann; so much of what you describe of Catee's clinical signs sound like a pancreas flare and acceptable amylase/lipase assays are not enough to rule out pancreatic inflammation. I agree with Mary Ann's recommendation to go back to the vet and ask for SNAP fPL test for an immediate yes/no for pancreas inflammation. If he doesn't offer the SNAP test perhaps you could ask for a Spec fPL. It needs to be sent to an external lab so results may take a few days (but it has the advantage of providing a numeric result indicative of severity of any inflammation present. Even though the test results may take a few days you could ask your vet to treat 'as if' it were pancreatitis in the meantime. I see from your other thread that Cerenia made things worse for Catee. As I posted on your other thread, ondansetron is another anti-nausea med that most cats tolerate very well and it may be worth trying that for Catee. (Worked MUCH better than Cerenia for Saoirse.) Pain relief (buprenorphine) is another important supportive measure if pancreatitis is the problem. Some clinical signs of pain in pancreatitis kitties may include (but are not necessarily limited to):

- crouching in a tense, meatloafed position.

- hiding behaviour (e.g. retreating under furniture).

- lying on cooler surfaces (e.g. stone floors instead of carpeted floors).

- lethargy / low mood.

The abdomen may be sensitive to touch but also pancreatitis can cause back pain. Pain signs may be more evident just after the cat has eaten something.

If it is pancreatitis and you can get the right supportive meds in place for Catee all going well it would make him feel a great deal more comfortable. At minimum you need to address the inappetence. BTW in addition to nausea meds cyproheptadine can help stimulate the appetite.

geekgirldany said:
When he eats the treats he is like snorting trying to get in this mouth.
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Brainstorming here: did the vet examine Catee's teeth and gums? If a cat is reluctant to eat due to oral discomfort the longer the cat fasts it may start getting nauseated due to excess stomach acid building up (sometimes a clinical sign of this is vomiting liquid - no food or hairballs in the vomitus). Famotidine can help with excess stomach acid issues.

Also, can Catee actually smell his food properly? A cat won't eat something if it can't smell it properly. Try warming the food a little to increase its aroma or perhaps check if he will eat more strong-smelling food? Hand feeding can also increase the aroma due to the food being warmer.

I strongly recommend you get help with insulin dosing (from your vet and also ask for help on the Prozinc/FH forums); 0.7 on a blood beta ketone (BBK)meter shows there is some tendency toward build-up of ketones at the moment (cat with enough insulin and eating well would be around 0.1-0.3) so you need to keep a very close eye on BBK levels for the time being. (A BBK meter at times like this is a godsend!) With the inappetence due to currently-unknown cause and high BG levels it's vital that Catee gets at least some insulin. The last thing either of you need is DKA.

I'm glad that Catee is drinking again. Try to get fluids into him as best you can as it helps to flush ketones out of the system. Add a little water to his food if you can get him to eat (not enough to make it taste watery!) Keeping Catee properly hydrated will also help him feel better.

If in any doubt get Catee to the emergency vet.

Sending prayers for you both.

:bighug:


Mogs
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I would consider slippery elm bark and / or ondnsetron..... both have made a huge difference for us-
If you vet will give you a script for fluids it is good to have "just in case":bighug:
 
Thank you all for following up.

I am pretty sick with some virus so I had to go to bed to get some rest. Posting late. I appreciate you all, I really do.

Catee ate about 2 ounces of Cat Chow yesterday of course his blood glucose was high this morning 364. So I went ahead and gave him 1 unit of Prozinc. He seemed to be doing some better. But today when I got up he had only ate a little bit of food and drank some water.

This evening he is sleeping a lot. He was laying on the floor Thursday/Friday but is now sleeping in his bed. He wakes up and goes to his water/food bowls like he always does but will turn around majority of the time. I was able to get high carb treats in him about 3 of them. He acted like he did not want them. He just ate a little more Cat Chow and drank water a few minutes ago.

I should have told the Vet about the Snap test Friday... I was so sick I did not think of it. I guess I thought he would know to do it. He does Idexx blood tests in house... does that mean he could do the Spec fPL?

I will be testing him again soon. I am pretty sick... if I can make it I will take him to the vet in the morning. I was talking to my parents today about it to see if they would take him since I am sick. They feel like he should not be taken because the vet didn't do much for him Friday and you can not go in telling the Vet what to give Catee that he should know. They feel like he could have done more and charged $250 for not doing much.
 
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geekgirldany said:
He does Idexx blood tests in house... does that mean he could do the Spec fPL?
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Yep.
geekgirldany said:
I was talking to my parents today about it and they feel like I should not take him because the vet didn't do much for him Friday and I should not go in telling the Vet what to give Catee that he should know. They feel like he could have done more and charged $250 for not doing much.
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When cats have complex health issues they typically aren't solved by throwing a steroid or a course of antibiotics at the problem. As caregivers we develop great knowledge and experience from observing our kitties, recording important, sometimes subtle, aspects of their general day-to-day behaviours and their responses - good and bad - to their treatments and by sharing this info with a good vet who is keen to work in prtnership with the caregiver that generally tends to foster a more collegiate and co-operative strategy for managing the patient more successfully. Below are two relevant, well-researched resources I brought to my vets to use as a basis for discussion about Saoirse's treatment strategy; both myself and our vets found them very helpful in this respect.

Nausea symptoms and treatments

IDEXX pancreatitis treatment guidelines

I hope the above info may be helpful to you and Catee.

:bighug:


Mogs
.
 
Just wanted to do a update on Catee. First thank you all for your help. It has been awhile since I have written because I have been sick myself. I've had a pretty bad flu and it has taken me about two weeks to get better.

Catee is back to eating. I did not take him back to the Vet. I thought it might just be his time. Poor thing, yesterday I got up earlier than I usually do and he thought I was going to take him to the Vet. :) He was hiding just knowing that I was going to take him.

He went about 1 week not eating what he should. One day he would eat the next he wouldn't. On the days he wouldn't I would give him treats, just anything that he would eat. He is drinking water... really too much. His glucose has been high of course during this as I could not give him insulin or could give very little. So he drinks a lot and urinates a lot. I've got to get that under control.

Now that he has got back to eating regular, I am having a hard time regulating his glucose. I had been giving him 2 units twice a day. Now when I do it his BG will be around 300 AMPS down to around 250 PMPS then goes down to 158 AMPS the next day. So I am not sure why he is doing this. He is eating what he should so it should go back up into the 200s. Not sure what to do.
 
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