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Bloodwork and other Labwork
Elevated creatine values in bloodwork
Low amylase and low albumin
Increased ALT levels
Rise in white cell count
High BUN on pre surgery bloodwork panel
High levels of calcuim - Hypercalcemia
Hematocrit (HCT)
High globulin count (hyperglobulinemia), seizures, lethargy in Westie
Increased platelet count
Continued elevated lipase levels following pancreatitis
Elevated Amylase levels, pancreatitis and bladder problems
High Potassium levels with diarrhea
High cholesterol levels
also see Alkaline Phosphatase levels
also see Cancer
also see Cushing's
also see Pancreatitis
also see Ehrlichia
also see Blood parasites
also see Lymph Problems
also see Immune mediated hemolytic anemia
also see Fungal
also see von Willebrand's
also see Thrombocytopenia and platelet problems
Creatine phosphokinase (CPK) or creatinine kinase (CK) value elevations
Question: Blue, 3 years old border collie, had a blood test today and a week ago.
All his blood results were normal except the creatine enzyme which was a
little high. Urea was normal. A urine sample was taken and that was
normal.Vet thought there was nothing to worry about. She said it was probably
normal for Blue's creatine levels to be a little high because he is a
muscular dog. He eats Hill's t/d.Just thought I would let you know and ask for any comments.
Thanks, John
Answer: John-
I am assuming that this is the creatine phosphokinase (CPK) or creatinine
kinase (CK) value. If this is the case, the most common causes of rises in
CK are muscle disorders. If there is no evidence of a muscle disorder, I
don't see a reason to worry about one being present. Other possible causes
are exertional hyperthermia (technically a muscle disorder, as well),
hypothyroidism, heart disease, recent exercise prior to the blood test,
selenium/Vitamin E deficiencies and trauma to the muscles. Unless I had
some reason to suspect one of these other disorders I think that I would
tend to agree with your vet that a slight rise in CK levels is not a good
reason to go looking for an inapparent problem. You can always recheck the
levels if a problem does seem likely, or even just as a precaution at a
future time.Mike Richards, DVM
2/24/2001
Question: What are the main causes for LOW Amylase (651) and
LOW Albumin (2.55) levels?
Answer: There are no known physiologically significant causes of either low amylase or low lipase levels. If
clinical symptoms indicate that there is a lack of production of pancreatic enzymes (diarrhea, weight
loss) then testing for trypsin-like immunoreactivity (TLI test) is the best diagnostic test for pancreatic
insufficiency. If there are no clinical signs suggestive of a problem it should be safe to ignore these lab
values.
Mike Richards, DVM
1/3/2001
Question: Dr Mike
My question concerns elevated levels of ALT in my almost 6 year old male
Golden Retriever. In August of 1999, I had blood drawn for a standard
chemistry panel and blood counts so we would have a set of baseline values.
All the results were within the normal ranges for chemistry and CBC. His T4
level was 1.8 which is low normal and he ws started on 0.4mg Soloxine once a
day.
On November 29 2000, we repeated the blood chemistry and CBC. This time, the
ALT was 164, with the normal range for the test lab being 5 - 60 IU/L. The
remainder of the tests were within the normal ranges, including others that
are less specific for the liver AP =39, AST = 23, GGT = 6. The T4 level was
1.1.
The ALT was repeated on December 19 and had increased to 254. The lab ran a
bile acid assay on the same sample next day and it was normal (6.9 with 20
or less being normal).
On December 28, the blood chemisty panel and CBC were repeated, along with
ammonia and sorbitol dehydrogenase. I realize SDH is more typically used
for horses than dogs, but I asked for it and the ammonia as additional ways
to look for liver damage. The ALT was 89 which is lower but still out of the
normal range, while SDH (7.7, range 2.9 -8.2 ) and ammonia (33 range 20
-120) were both within normal range.
The dog appears healthy, and is a very energetic athletic dog. Without the
blood work there is no way you would suspect that anything was wrong with
his health. He runs hard every 2 or 3 days retrieving bumpers and birds as
part of his field training and other days goes for daily runs around our
pastures. The only thing that changed prior to the November blood test this
year was that he had been off the soloxine supplement for about 2 weeks.
Do you have any suggestions as to what would cause an increse in ALT without
affecting other liver enzymes or liver function? Are the levels high enough
to be really concerned? The thing that bothered me the most was the increase
form164 to 254 in less than 3 weeks. Could the low T4 levels be related
(either cause or effect) to the changes in ALT?
Any light you can shed on this will be very welcome. We are going to redo
the liver enzymes in about 3 weeks to see where they are going.Noelene
Answer: Noelene-
It is not too unusual to have rises in ALT levels that are found in a blood
sample taken for reasons other than suspicion of liver disease and then for
these levels to resolve over several weeks to several months. ALT rises
when liver cells are damaged and lots of things can lead to enough damage
to liver cells to increase the ALT levels. Many of these things never cause
any clinical signs of liver disease nor measurable effect on liver function
using bile acid or other liver function testing. In most cases we never
know what happened, but drug reactions, trauma, bile stasis, blood clots
and toxins are all possible explanations. If the ALT level continues to
drop, it may not be possible to determine why it became elevated in the
first place, but it wouldn't be too important to know, either.If there continues to be a slightly elevated ALT level over time, I think
that I would be most concerned about the possibility of an idiosyncratic
(unexplained) reaction to the thyroxine supplementation leading to the rise
in ALT based on the timing of the increase in ALT. It seems reasonable to
me to stop the thyroxine supplementation because there is a strong
possibility that it is not necessary because total T4 levels are not a
reliable way to determine if hypothyroidism is present. The most accurate
test that I know of at the present time is a free T4 measurement done by
equilibrium dialysis. Even if hypothyroidism is present, it would be
unlikely to be harmful to stop thyroxine supplementation for a few weeks to
see what happens. If the ALT dropped into normal ranges, I think I'd try
for more accurate testing to see if supplementation is really necessary. If
the ALT remained elevated you could chose to supplement or not based on
clinical signs or other criteria you and your vet are comfortable with. If
your vet feels strongly that stopping the dosage of thyroxine is a bad
idea, it would probably be better to go with his or her opinion since
physical exam findings may be playing an strong role in the diagnostic
process.As long as there are no visible clinical signs of liver disease, I tend to
do nothing in these cases except for monitoring the blood until the client
and I believe that it is reasonable to stop doing that. Once in a while
rises in ALT alone are the first sign of a more serious liver problem like
chronic active hepatitis or copper storage disorders.Good luck with this. I hope the level continues to drop.
Mike Richards, DVM
1/13/2001
Question: Dear Dr. Richards,
My dog Natty is a Border Collie/McNabb, eleven years old and weighs 67
pounds. In late September I asked our Vet. to check her blood just because
she is getting older. The test showed her infection fighting cells were high
and he put her on tetracycline, 3 pills 3 times a day. At the end of that
time her blood was normal. Because a neighborhood dog, a year younger that
Natty and a constant visitor at our house, unexpectedly died, I had her blood
tested again, just for good measure. Again, the infection cells were high
and again she is on tetracycline, same dosage and same length of time, 3
weeks. I is not yet time to retest her blood. What do you think could be
causing this problem. She doesn't seem sick. She did seem to be a bit
arthritic and I just got the medicine for that which has helped. She eats
quality food and her appetite is fine.I live in a small town not close to a teaching University and I rely on my
Vet for Natty and ten cats. This has him stumped. Can you offer us a reason
and a plan of action if her test does not come back normal next week?Thank you for the invaluable help you offer all of us. Mary
Answer: Mary-
It would help a great deal in providing possible diagnoses if you could
obtain the results of the complete blood cell counts that have been done so
far. There are several types of white blood cells and the total count is
not quite as meaningful as the rises in individual cell types.If there is a rise in neutrophils and no immature neutrophils are found in
the blood, for instance, this can occur due to stress or Cushing's disease
in the absence of an infectious process. If there is a rise in neutrophils
with a concurrent rise in immature neutrophils, then an infection is much
more likely. If the total white blood cell count is high due to a rise in
neutrophils and eosinophils, then an allergic or parasitic process is most
likely. Rises in lymphocytes can indicate cancer. There are other
combinations of rises in individual cell types that can be meaningful, as
well. So knowing what cells are high, what cells are low and combining that
with the findings on a physical exam can help to determine what is happening.There are times when rises in white blood cell counts occur for no
discernible reason and it can take some real detective work to figure out
what the cause is. Even though you vet is stumped, right now, as symptoms
and lab work change over time there may be a recognizable pattern or signs
of a specific disorder may emerge. So keep working with your vet. I will be
glad to provide a list of differential diagnoses (possible diagnoses) based
on the lab work if you can send it.I am sorry for the delay in response to your question and I hope that
Natty's is still doing well.Mike Richards, DVM
1/9/2001
High BUN on pre surgery bloodwork panel
Question: Dr Richards,. My miniature schnauzer, Dublin (5 months old at the
time), was in the vet's getting spaded and when they ran tests her BUN
level was at 48. Her Bun/creatine ratio was 37, triglycerides 365,calcium
11.5 and phosphorous 6.6. All other levels were normal. The Vet was very
concerned with the high BUN at her age. They tested for kidney function
via urine tests and everything appeared fine. We had an ultrasound to look
for any abnormalities with the kidney and again everything was normal. The
vet put her on Hills KD and her BUN one month later was 20. She has gained
weight and the vet suggested we switch her to Hills GD which was less fat.
What do you recommend? She is still a bit overweight 19 lbs and I am
concerned that she is missing critical nutrients being on a Hills GD diet
at her age. Please let me know what you suggest and why such a small puppy
would have such high BUN levels.Thank you- Patty
Answer: Patty, One of the problems with doing pre-anesthetic blood tests and other routine
screening blood tests is that when an abnormality is found, there is a
tendency to ignore a lot of other evidence that a pet is normal, in favor
of either more invasive testing or therapeutic efforts to correct problems
that may or may not exist. Elevations in BUN (blood urea nitrogen) of up
to 50 mg/dl due to a recent high protein meal (according to "Small Animal
Clinical Diagnosis by Laboratory Methods" by Willard, et. al.). Puppies
often have elevated BUN levels due to high protein diets and can quickly
develop rises in BUN due to dehydration, since they are more prone to this
problem than adult dogs. Some pets just have an elevation in one lab value,
that seems to be a consistent finding, that never causes problems during
their lifetime.Since the urinalysis was normal and the creatinine normal (based on the
BUN/Creatinine ratio) the odds are really high that there was nothing wrong
with your puppy's kidneys. The use of Hill's k/d (tm) in a puppy is not
recommended by the manufacturer as a routine thing but it doesn't appear to
cause problems when it is used, based on anecdotal reports from several
vets I have spoken with who have put puppies on this diet. I would assume
that the same thing is true for g/d (tm) diet. Truthfully, I don't see much
reason to worry about using any special diet for the sake of the kidneys
with the lab values you are reporting, though. It wouldn't be a bad idea to
recheck the cholesterol and triglyceride levels, though. Lipemia (high
values of lipids like cholesterol and triglycerides in the blood) are a
problem in some schnauzers and do seem to cause problems sometimes.Last week, I had a similar situation to what you are describing, except
that I had an older cat in for a routine blood screening test in the
practice with a high BUN and normal creatinine. I started explaining
chronic renal failure and was heading down the road of initiating treatment
when my wife (also a vet) pointed out that I was probably jumping the gun,
since we had an apparently normal patient with normal creatinine and normal
urine concentration. Of course, she was right. So we are going to recheck
the lab values on the cat in a couple of weeks and then decide what to do.Hope this helps some.
Mike Richards, DVM
12/28/2000
High levels of Calcium - Hypercalcemia
Question: A few months ago, we returned to Vancouver to find our dog lethargic. I
took her to our new vet who did a bloodtest. The result was hypercalcemia.
The vet said it was most likely a cancer. I told him that my son had
overdone the excercise while we were away, and she was likely suffering with
arthritis. We changed her food to Medical geriatric formula. After
another 2 bloodtests, her calcium was back to below normal. The vet put her
onto Metacam indefinitely. Is this a good choice for arthritis?
Answer: Dawn-
It is usually best when a blood test shows hypercalcemia to test the blood
again before trying to make a diagnosis. I do not know about other labs,
but ours has more trouble with calcium levels than with most other tests.
It isn't too unusual for us to have a dog show high calcium levels on one
test and then not on others. On the other hand, the most common causes of
high calcium levels are serious illnesses, such as metastatic cancer,
kidney failure and hyperparathyroidism. It is worth considering periodic
monitoring for these problems if there is any indication of them in the
rest of the blood work, though.Meloxicam (Metacam Rx) is not available in the United States but the
information that I have seen on this medication seems to be in agreement
that it is effective and reasonable to use long term.Mike Richards, DVM
11/15/2000
Question: Hi Doctor,
I am a subscriber and we have communicated about Kenya just
recently. I just had my vet fax me the lab work and here are some
observations:The lab indicates the normal range for lipase is 100-500 iu/l and her
original level (July) was 593. Three weeks later on a restricted diet it
dropped to 516.
Your letter said the normal range is 0-160 iu/l. Needless to say, I am
confused. What do you make of this discrepancy?
Her amalyse level ("normal" = 500-1500) is 501.I was not aware previously that there were other abnormal readings. They
are as follows:
HGB 19.0 (norm=12-18)
HCT 56 (norm=37-55)
Eosinophil 1 (norm=2-10)
Absolute Lymphocyte 945 (norm = 1000-4800)
Absolute eosinophil 63 (norm=100-1250)Do you have any more ideas based on this labwork?
Kenya is not vomiting to my knowledge, and yesterday I finally saw that
two consecutive stools were without mucus. She's still a bit
uncomfortable, as is evidenced by her wanting to cut walks short lately.
She has gas as well. I got your message about the Pepcid, etc. and will
try that.Again, many thanks for your interest in this case,
Wendy
Answer: Wendy-
It is really important to use the normal values for the lab that the
samples are run at. They do sometimes vary from the "average" as much as
the difference that this lab reports. I would not worry too much about this
lipase level since it is within the range that dehydration or mild
decreases in kidney function could cause and the amylase was not
concurrently elevated but that is just my personal opinion.The hematocrit (HCT) is the percentage of the blood that is composed of red
blood cells. When the percentage rises, it means there are more red blood
cells or less liquid portion of the blood. The most common cause of rises
in hematocrit is dehydration but disorders that cause decreases in oxygen
transport can cause rises in hematocrit (like heart failure and respiratory
disease) and it can occur due to abnormalities in production of red blood
cells. But the most likely problem with this low a rise is
dehydration. That would also be true for the rise in hemoglobin.The best way to be sure that the rise in hematocrit was due to dehydration
is to retest at a time when Kenya is likely to be normally hydrated (when
she seems to feel fine). I am not sure it is worth retesting if she is
acting fine and doing fine, though.Mike Richards, DVM
9/15/2000
High globulin count (hyperglobulinemia), seizures and lethergy in Westie
Question: Dear Dr. Richards,
I have a real stumper for you.......
Last fall, our 13 year old Westie, Button, was acting lethargic so we
visited our vet. A routine blood test turned up a high globulin count
which our vet warned could be indicative of more serious problems (e.g.
multiple myeloma). We agreed to additional blood work and urine tests
all which came back suggestive of multiple myeloma. We were distraught
and sought a second opinion from an iternal medicine specialist. X-rays
were negative for bone lesions and a bone marrow sample turned out
normal. The only tests we did not agree to were a CT scan of the head
and obtaining a sample of CSF. During this time, a veterinary
ophthalmologist noted tortuous vessels in the back of his left eye and
that his pupillary response in that eye was absent. At this point we
had a lethargic dog with symptoms that did not totally match multiple
myeloma according to the internist. Feeling a sense of resignation, I
indicated that the last time Button seemed to be "his old self" was when
he was on antibiotics which were given early in the treatment of his
lethargy. Indicating it couldn't hurt, Button started the maximum daily
dose of clindamycin. Within 2 weeks, his activity returned to normal
AND so did all of his bloodwork. We began to ween him off the
clindamycin when he exhibited a "seizure" in early December. Also, his
globulin count rose again. We went back up in our dose of clindamycin
and the seizures stopped and the blood work normalized AGAIN. This
spring the seizures started to increase in frequency despite the dose of
clindamycin so phenobarbital was added to his dosing regimen. He has
responded well to the phenobarbital and guess what, his bloodwork is
abnormal again. A few more details.....the last 2 times the bloodwork
has been abnormal he has also been anemic. There were no obvious signs
of bleeding and he responded to the clindamycin. The seizures seem to
be stimulated by excitement and are indicated by short "fainting"
spells. He also pants quite a bit at rest even in an air conditioned
home.
We are told that there is no evidence of multiple myeloma symptoms
appearing and then disappearing so that diagnosis seems to be shelved.
Our vets openly admit that they are stumped. Also, an ultrasound of his
belly indicated that there was no evidence of a splenic tumor and his
ECG is normal. So....we continue with the phenobarb. and have increased
the clindamycin dose to see if again his bloodwork will normalize.
Button will be 14 in October and we have tried to maintain quality of
life but continue to wonder if there is something else that we should
consider. We would be deeply appreciative if you would comment on this
case.Thank you and God bless you for this wonderful service to pet owners,
Steve
Answer: Steve-
I can think of some disorders that would cause the symptoms you are seeing,
but I am not at all sure that they are likely or even possible.Canine monocytic ehrlichiosis causes hyperglobulinemia (high globulin
levels in the blood), lethargy, depression and bleeding tendencies. I have
not seen seizures as a listed symptom for this problem. It is treated with
doxycycline or imidocarb, usually, but might respond to other antibiotics.
Any form of ehrlichiosis could cause problems.We see a lot of older dogs with dental disease that causes lethargy,
depression and appears to be a source of high globulin levels (this is
personal observation, not documented by any studies I am aware of). This is
very responsive to antibiotic therapy but won't resolve unless the dental
problems are identified and treated. We have not associated this problem
with seizures, either, though.Systemic fungal infections will cause hyperglobulinemia but usually cause
other clinical signs, like coughing, weight loss, inappetance, lameness or
something that indicates a pretty serious problem.There is a report of anerobic bacterial infection of the central nervous
system (Dow, 88) but the dogs affected by these bacteria died quickly.
However, the signs seen in them did match what you are seeing -- lethargy,
depression, seizures, as well as other symptoms, including paralysis and
other severe CNS signs.Cancers sometimes cause increases in globulin levels and may cause almost
any clinical symptom, depending on where they are located and what they
effect. Finding cancers can be really difficult. It would be a little odd
for antibiotic therapy to make a difference if cancer is the cause of the
symptoms but sometimes antibiotics help for reasons other than their
antibiotic actions.Heartworm disease will sometimes cause inceases in globulin levels in the
serum and can cause the symptoms seen, although coughing is usually present
by the time fainting spells that resemble seizures occur with this disease.Bacterial endocarditis might cause the depression, lethargy, seizure like
activity and hyperglobulinemia and would be responsive to antibiotics. A
heart murmur is often present with this problem. There are usually ECG
signs associated with bacterial endocarditis but cardiac ultrasound is a
better way to look for this problem.Chronic infections almost anywhere can cause increases in globulin levels
and would respond to antibiotics. It seems like it would be easy to find an
infection but there are lots of reports of infections in the urinary
system, liver, gallbladder, spinal column and other areas of the body that
didn't surface until extremely serious signs finally showed up or were
found incidentally on post mortem exams.I don't know if any of these possible differentials will help. I wouldn't
be at all worried about using clindamycin long term if it seemed to
help. This is a fairly common approach to persistent periodontal disease
in dogs so there is a lot of evidence to suggest it doesn't cause problems
very often.Your vets probably thought of these and appear to have been working to rule
most of them out. Keep working with them and hopefully some clinical sign
that points the way to a diagnosis will appear soon.Mike Richards, DVM
7/14/2000
Question: Dear Dr. Mike,
I have a question regarding a High platelet count. I've seen several questions regarding low
count but my Bichon Frise has the opposite problem. I adopted "George" from an animal
rescue on July 5. Other than being a little shy he seemed OK. A vet in TX has just given him
a physical and he was deemed healthy, free of disease and able to fly. On July 11, I took him
to our local animal hospital here in Illinois. They also examined him, we've determined that
he's about 7 years old, and at one time probably broke his shoulder blade. I took him back
the next day, July 12, to get his teeth cleaned, major tartar. When they did the blood test, his
white cell count was 33,000. The Dr. me said that it should be around 12,000. A couple of
other "things" didn't look quite right so they did a full blood panel. George's platelet count
came back extremely high. It registered at 3 million. The Dr. said it should be about 300K -
510K. A urinalysis did show that George has a UTI. He's currently on antibiotics, twice a
day. They also put him on dewormer, even though blood and stool samples tested negative
for worms/parasites. The white cell count could be attributed to the UTI, but not the platelet
count according to the Dr. A pathologist looked at the results and thought maybe there was
internal bleeding at one time. His potassium level, liver, kidney levels appeared to be normal,
not alarming. George appears to be fine, he has a huge appetite and loves to go for walks
twice a day. His red cell count has not changed from day to day, so it doesn't look like they
are being destroyed. There is some speculation as to whether or not the marrow is releasing
immature red cells. They did see some in a second blood test. I'm supposed to wait until this
Friday, July 21, and take him back for another blood test. The Dr's at the clinic said they've
never seen a platelet count this high. Do you have any idea what could be causing this, is it life
threating? I look forward to your answer. Thanks, Susan
Answer: Susan-
These are reported causes of increased platelet counts:
hypothyroidism (usually fairly mild increases)
essential thrombocythemia (reported in the Feb 99/March 99 Compendium of Continuing
Education) - signs were lethargy, weight loss, depression This condition is also likely to cause
an increased white blood cell count due to neutrophilia and anemia.myeloproliferative disorders (like excessive bone marrow stimulation, cancers of the bone
marrow, metastatic cancers stimulating the bone marrow)platelet function abnormalities sometimes lead to increased platelet numbers as the body tries to
compensate for the fact that the platelets don't work well (usually mild increases, though)iron deficiency and chronic blood loss (from any source - urinary tract, gastrointestinal tract) can
lead to thrombocythemiaWith the great elevation in these values, essential thrombocythemia seems likely, even though
George doesn't seem to have the clinical signs expected with that problem. Bone marrow
analysis is helpful in differentiating among the causes of increased platelet counts.Your vets may have access to the Compendium article since a lot of vets subscribe to this
journal.Mike Richards, DVM
7/19/2000
Continued evaluate lipase levels following pancreatitis
Question: Hi Dr. Mike,
I have seen your site numerous times and only recently have had the occasion
to subscribe and ask a question. My situation is addressed on the site, but
I need more specific information/recommendations. Here's the situation:My 11 year old German Shep. mix has been diagnosed with Pancreatitis;
however, he really is just on the fringe of the condition. He's not in any
pain, has no abdominal bloat, etc. but five weeks ago started with diarrhea,
which had small flecks of blood in it. Then, he had one instance of
vomiting. We tried to regulate his condition through diet (fasting,
initially), fluids, and Gastriplex, which is made by Thorne Research and not
a "white man drug". The Gastriplex seemed to upset his stomach - he was
very, very restless. For the first couple of weeks, we were unable to
control the diarrhea, but the vomiting stopped. Bloodwork and x-rays
revealed nothing remarkable, except an elevated lipase level. I began
feeding him brown rice with a little garlic butter and eventually added a few
veggies. The diarrhea was coming under control, but not the lipase level.
We added some very small amounts of cooked chicken to the rice and the
diarrhea started again. So, off food, on fluids we went and again, the
lipase shot up. It had come down to within normal range only once and after
going on chicken, it shot up again. I started feeding him again and two
weeks ago began feeding him chicken baby food with the rice. His poops
hardened up and were formed within several days and his lipase was on
directly on the line dividing "normal" and "high". For two weeks we did this
and my vet (another vet in the practice put him on the baby food because my
vet was on vacation) didn't like the consistency of his stool - oatmealy and
orange. He took him off the baby food and put him on rice and small amounts
of turkey and veggies late last week and put him on Gastrigen (another Thorne
product). Friday night, Storm (the dog) was up ALL NIGHT, panting, pacing,
etc. and did not settle down Saturday morning. I called Dr. Strong, we went
in and put him on fluids and took another blood sample. His lipase was in
the middle range of the "high" level. So, we started the fast again and I
took him in for fluids on Sunday. Today he had an ultrasound, which revealed
a slightly swollen pancreas, nothing alarming to my vet, but of more concern
were the "spots" on one side of his liver. Not of tumor size, but obviously
a concern. He's still fasting and we go in tomorrow for fluids. Then,
another lipase test on Wednesday.My vet is getting more concerned now because we can't get the lipase to
within normal range. My vet and I both agree Storm is on the fringe of
pancreatitis - not really displaying hard and fast symptoms, but the lipase
and spotty liver is obviously an issue. He is happy, eating well (when he's
allowed!), and generally seems to be fine on the outside. I've had him 9.5
years and I know he's feeling fine. Dr. Strong feels he's a ticking time
bomb, unless we get this lipase level regulated. Certainly, we would like to
fix this before it becomes a crisis.Do you have any thoughts, suggestions, experience, etc. with elevated and
stubborn lipase levels? I would greatly appreciate your input and am very
happy to compensate you for your time and expertise above the subscription
fee. Thank you so very much in advance for your feedback.Regards, Robyn
Answer: Robyn-
Lipase becomes elevated most commonly due to pancreatitis or a decrease in
kidney function. The decreases in kidney function can occur due to causes
other than the kidney itself. The kidney is dependent on adequate blood
flow and blood pressure to work, so dehydration and low blood pressure can
cause a decrease in kidney function. Kidney diseases or obstructions to
urine outflow from the kidney are the other conditions that can lead to
increases in lipase or amylase levels due to kidney disease. It is also
possible for intestinal conditions such as inflammatory bowel disease (IBD)
to cause rises in lipase or amylase levels sometimes. Pancreatitis can
cause rises in lipase and amylase to three or more times the normal level,
with increases as much as ten to fifteen times normal occurring in some
cases. Kidney disease usually causes rises to about fifty percent of normal
and smaller rises tend to occur with IBD.It is usually best to try to evaluate lipase and amylase levels together,
since they should both rise when pancreatitis is present. Unfortunately,
both may rise with the other conditions listed above, as well.At this point, it doesn't seem to me that there is enough evidence to be
sure of what is going on. Pancreatitis is definitely a condition that
should be in the list of differentials and it may be the problem, but it
doesn't seem that this is a certainty to me, yet.I would probably want to look for evidence of a decrease in pancreatic
function by checking for trypsin-like immunoreactivity (TLI) in the serum
(this is a test many commercial labs can arrange for) as a way of checking
on pancreatic function. A decrease in pancreatic function could produce the
clinical signs that you are seeing, although it would be a little unusual
to have increases in lipase levels and decreases in TLI levels.It may be worthwhile to ask your vet to refer you to an internal medicine
specialist for a second opinion. One thing that bothers me, though, is
that you are worried about a lab value when the clinical signs of illness
do not seem to be present at this time. It is important to place more
emphasis on the patient's signs than the lab values when a conflict like
this occurs, in most cases. The lab values are important and if it is
possible to clarify their meaning without endangering the patient it is a
good idea to do that but keep your shepherds' overall condition in mind and
try to remember to diagnose and treat based on the whole patient and the
whole clinical picture, not just one lab value.Hope this helps some.
Mike Richards, DVM
6/30/2000
Elevated Amylase levels, Pancreatitis and bladder problems in Schipperke
Question: Dear Dr. Richards-
I have an eight year old schipperke. He had a urethrostomy for urolithiasis
about one year ago. He has been on the C/D diet (carrots for treats) and
doing quite well except for the occasional need for antibiotics to treat
blood in the urine. I was told he would be prone to these infections now.
About two weeks ago he was put on another round of antibiotics and the S/D
diet because there was blood and crystals in the urine.Last Wednesday (5/3) he suddenly became very ill. He was vomiting, hunching
his back in pain, and looked bloated. I took him to the emergency room and
he was diagnosed with pancreatitis. They kept him overnight to start IV
fluids and when I picked him up the next day he appeared much better. My
regular vet kept him until Saturday. When he went to the emergency room his
amylase was almost 16,000 and it was still over 13,000 when my vet checked
him a couple days later. He never had a fever and all his other lab work
including WBC have been normal. When he was staying at the vet he did not
vomit but when I got him home he vomited bile about 12 hours apart, each time
it happened about 6 hours after eating (I/D). Each day he appears to be
getting better. except for sleeping a liitle more, he has been quite lively.My questions:
1. When I started reading information from your sight on pancreatitis I
noticed that some of the dogs seemed pretty sick compared to the symptoms my
dog had (fevers, vomiting, other abnormal lab work). Why would my dog be
feeling better, but have such a high amylase and no other abnormal labs? I
know this is a serious condition, but my vet feels that my dog will be ok.
Do you have any thoughts for me?2. Do you know of anything that helps prevent bladder infections in dogs
that have had a history of stones? I read an article that a daily serving of
blueberries can help prevent infections in women. My vet said I could try
it, but I'm afraid I was not very consistent to see if it worked.Thanks for your help. I think your site is a great resource.
Answer:
An amylase level in this range is very very likely to indicate pancreatitis
and the clinical signs also do fit the disorder. The rise in amylase levels
does not correlate directly with the severity of the pancreatitis. Some
dogs with relatively mild pancreatitis, which does not last long, have very
high amylase levels. Some dogs with severe disease have amylase levels in
the normal range. So I would tend to trust your vet's judgment on this one.I did think a little about whether you might have meant that the amylase
levels were 1600 and 1300, instead of 16,000 and 13,000. If this were the
case, I'd worry about a urinary blockage having lead to the amylase level
increase, as this can occur. The amylase levels are elevated over normal
(usually the high end of normal is around 880 U/l at most labs) but usually
not greater than twice normal. If there was a stone in the ureters or
urethra leading to a blockage and it passed, that would explain the pain
and the amylase levels, if the values reported are off by an order of 10.I think that you may be thinking of cranberries instead of
blueberries. Cranberries cause acidic urine production, which helps to
prevent bacteria growth and which inhibits the formation of struvite
crystals in the urine. It would be best to avoid foods that acidify the
urine while using s/d diet, as it already has this effect and the
combination of s/d and a food that acidifies urine may be harmful. Feeding
dogs cranberries has not worked all that well for prevention of bladder
infections and bladder stones, probably because it is hard to keep the
urine acidic all day using these in the diet.Was there an analysis of the stones removed from the urethra last
year? Knowing the composition of the stones can be helpful in devising
preventative measures.Mike Richards, DVM
5/11/2000
High Potassium levels with diarrheaQuestion: Dear Dr Mike,
ANY help would be very gratefully received, even if only a few words.I apologise for the detail, but am
unsure what is significant.
We
have a 14 year old retriever/springer spaniel cross who is dearly loved.
For
some time now he has been suffering from diarrhoea, but in the last couple
of
weeks,he has urgently needed to get up 2 or 3 times a night and blood has
started to appear in his stools. He has been very thirsty, panting a lot,
with no
heat rise or exertion.Just before going out he seems to sort of yawn 2
or 3
times, his mouth waters, he swallows a lot and licks his lips.His normal
diet is
chicken, sprinkled with a mixture of plant extract and minerals called
Digestor.
We've
taken him to the vet who took a blood sample, please see bottom of
message for results.
His
opinion was that the high level of AST , in view of his age and the fact
that
there were no white cells fighting off infection, was significant and pointed
to the
likely existence of a pancreatic tumour. If this was the case, then there
was
nothing we could do, except manage his diet and make him as comfortable
as
possible. He did not feel a need to take a stool sample. He gave him a
shot of
antibiotics, and also some vitamins and minerals. We have now changed his
diet
from chicken to rabbit.
In,
the last week, his stools have become solid, the blood doesn't seem to
be
appearing any more, and he hasn't got up in the middle of the night, although
he
did wet his bed on the first night. We are not sure whether he is rallying,
or
whether the vet's diagnosis is incorrect.
(a)
Is a pancreatic tumour the most likely diagnosis, or would the AST level
and
other readings possibly point to something else ?
(b) Is the antibiotic shot significant here ?
Is there anything else we can do ?
Any
suggestions anybody could give would be so much appreciated. The dog
belonged to my girlfriend's father, who died last year, so there is a lot
of
sentimental attachment.
Many many thanks
David
BLOOD RESULTS
This table, all in normal range
Normal range
Result
HCT
37 to 55
42.2%
HGB
12 to 18
14.3g/dl
MCHC
30 to 36.9
33.9g/dl
WBC
6 to 16.9
7.5 x 10 to
power 9/L
GRANS
3.3 to 12
4.7 x 10 to
power 9/L
%GRANS
63
NEUT
2.8 to 10.5
3.7 x 10 to
power 9/L
EOS
0.5 1.5
1.0 x 10 to
power 9/L
L/M
1.1 6.3
2.8 x 10 to
power 9/L
%L/M
37
PLT
175 500
348 x 10 to
power 9/L
=============================================================
AST
just into high
GGT low edge of normal
CRE high edge of normal
Na
is low
K appears to be high, presumably off scale
Normal range
ALB
27 to 38
34g/l
ALKP
23 to 212
86U/L
ALT
10 to 100
54U/L
AMYL
500 to 1500
937U/L
AST
0 to 50
53U/L
ASPARTATE AMINO TRANSFERAZE
UREA
2.50 to 9.64
6.84mmol/l
Ca
1.98 to 3.00
2.47mmol/l
CHOL
2.84 to 8.27
4.10mmol/l
CREA
44 to 159
152umol/l
GGT
0 to 7
0
U/L
GAMMA GLUTAMYL TRANSFERAZE
GLU
4.28 to 6.94
5.66 mmol/l
LDH
40 to 400
170U/L
LIPA
200 to 1800
1087U/L
PHOS
0.81 to 2.19
1.35mmol/l
TBIL
0 to 15
4umol/l
TP
52 to 82
66 g/l
TRIG
0.11 to 1.13
0.75mmol/l
GLOB
25 to 45
32g/l
Na
144.0 to 160
131.7mmol/l
K
3.50 to 5.80
High
Cl
109 to 122
112.5mmol/l
BUFFY COTE PROFILE hard to describe !
Answer: David-
I am not sure why your vet was worried about a pancreatic tumor, based on the lab work. The most
worrisome lab value in this report is the potassium level. Potassium levels above 7 can cause heart
problems and can even cause sudden death. I would really want to know if this value had corrected
itself, in a patient I was monitoring. High potassium levels are most commonly caused by severe
kidney problems and by hypoadrenocorticism. Kidney failure seems unlikely based on the lab work
and hypoadrenocorticism that is acquired as dogs age often does not affect the potassium level.
Despite this, I would want to know the potassium and sodium levels had returned to normal or run an
ACTH response test to rule out hypoadrenocorticism if the potassium remained elevated and the
sodium remained low. Administration of saline intravenously helps to reduce the potassium levels and
medications are available to control hypoadrenocorticism if it is present.The AST test is not specific enough to be really useful in small animals, but it can indicate liver damage
when other liver enzyme levels are elevated, too. In this case, I would have a hard time making a case
for liver disease based on the minor elevation of this enzyme with other liver enzymes being normal.
GGT has the same problems in dogs (it is more specific for liver disease in cats, though).It would be better to feed a more balanced diet, if possible. I do not think that there is likely to be a
link between the diet and the current problems but there may be long term problems with calcium and
phosphorous balance with a predominantly meat diet (unless this is a commercial dog food made with
rabbit that is a complete nutrient source).I tend to think that a recheck of the lab work will show a return to normal of the abnormal values in
the lab work you sent. However, it is important to recheck it.The antibiotic injection may have helped a great deal if there was an infectious problem as the
underlying cause of the symptoms seen.There is a good chance that there are other symptoms or physical exam findings that have suggested a
more serious problem exists. If your vet continues to feel this way it is often possible to identify
pancreatic tumors with ultrasound exam. We send our patients who need ultrasound examination to a
specialist in our area.Hope this helps some.
Mike Richards, DVM
4/10/2000
High cholesterol levels in dog serum
Q: Hi Dr. Richards,
Can you shed some light on cholesterol levels in dogs? Recent lab results
on our 7yr old JR terrier came back with elevated cholesterol levels and it
was suggested that we have her thyroid tested. How are these tests done,
and what do they mean when they are elevated? What effects do dogs suffer
when cholesterol is elevated? As a quick hx, Charlotte is the one with
hydrocehpalus and microvasc. liver shunt. She is on Kbr, lasix and
prednisone for these conditions, and has done pretty well for close to a
year now. Lab results are good except for the cholesterol levels. Thanks
for your great service, it is so educational.
Maureen
A: Maureen-
High cholesterol levels in dog serum can be associated with drawing the
blood too close to a meal, hypothyroidism, Cushing's disease and
hyperlipidemia (high fat levels, usually a problem primarily in
Schnauzers). Most of the time, high cholesterol levels can be safely
ignored in dogs, though.There was a method of detecting hypothyroidism that advocated comparing the
total thyroxine level and cholesterol levels and making a ratio from them.
If the cholesterol level was over about 350 the ratio always indicated
hypothyroidism. There are more accurate ways of assessing thyroid function
now. It is hard to argue against thyroid testing when the cholesterol
levels are that high, though.Dogs do not typically develop the atherosclerosis seen in humans (except
for Dobermans) so there is less risk of higher cholesterol levels in dogs
than in humans.In all honesty, I don't know how cholesterol testing actually works so I
can't help with that part of the question.Mike Richards, DVM
05/25/99
Last edited 01/30/05