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What Is ALT In A Cat's Liver...

post #1 of 24
Thread Starter 
And what does it mean?

I just took Maverick into the vet today for his retest, and the ALT level came back higher than the first time - from 300-something, to 400-something. I have no idea what ALT is, or what it indicates.

Needless to say, I am heartsick over this. I really had thought that the test results were gonna be better, b/c Mav is still eating and hasn't lost any weight. He's even been more active, and seems more like his usual self since starting his meds. The vet increased his dosage of the Prednisolone, and is keeping him on the Metronidazole & Denamarin. He wants me to bring Mav in for another retest in two weeks, and if the ALT thing hasn't improved, he recommends having an ultrasound done - which really presents a problem, b/c we've already spent a small fortune on Mav's vet visits & meds.

If anyone has any info or advice on this, I would greatly appreciate your input.

post #2 of 24
no info, here - just & for you & Mav...
post #3 of 24
ALT stands for alanine aminotransferase.

If you want a medical definition of ALT:
http://www.vet.uga.edu/VPP/clerk/figlio/index.php

And a more layman's description of liver disease with different things that vet's look for to diagnose it:
http://www.cat-world.com.au/LiverDiseaseInCats.htm

If you want a list of what all the abbreviations in a CBC are:
http://www.sniksnak.com/cathealth/labreports.html

I've not had a cat with liver problems, so have no advice other than to read as much as you can about it so that you can the vet lots of questions.

post #4 of 24
For what it's worth...

Cleo had IBD flare-ups every now and then, which require Flagyl (metronidazole) to get it back under control. Every single time she's been on the metronidazole, she runs high ALT. Once we've done the course of Flagyl, her ALT gradually returns to normal. I'm not sure if this is a common side effect or not, but you might want to run it by your vet. My vet just said that Cleo must be quite sensitive to the medication.

Cleo's ALT's were 411, 419, and 432, after each course of the metronidazole. I would get her re-checked approximately 2 weeks post Flagyl treatment, and her ALT's had dropped back down into the high side of normal. Now, a couple of years later, her ALT runs in the low normal range.

My vet prescribed Denosyl (post Flagyl) as a support for liver function. You might want to talk to your vet to see if Denosyl would be appropriate for Mavrick too.


Good luck to you and Mavrick. You are both in my prayers.
post #5 of 24
Quote:
Originally Posted by Pookie-poo View Post
For what it's worth...

Cleo had IBD flare-ups every now and then, which require Flagyl (metronidazole) to get it back under control. Every single time she's been on the metronidazole, she runs high ALT. Once we've done the course of Flagyl, her ALT gradually returns to normal. I'm not sure if this is a common side effect or not, but you might want to run it by your vet. My vet just said that Cleo must be quite sensitive to the medication.

Cleo's ALT's were 411, 419, and 432, after each course of the metronidazole. I would get her re-checked approximately 2 weeks post Flagyl treatment, and her ALT's had dropped back down into the high side of normal. Now, a couple of years later, her ALT runs in the low normal range.


Good luck to you and Mavrick. You are both in my prayers.
Flagyl is notorious for causing liver issues... it is VERY common...

I have a cushings dog with liver issues ... her alt was in the 300 s and last time alk phos was in the 3000 s due partly to a medicine she was on...

PLEASE be very careful , cats with liver issues are much harder to handle than dogs ...

Stress can also raise this enzyme according to my vet ... plus being very young or old .. I learned that when my now 20 month old s had their blood done and one was slightly out ... ie like 5 points above normal
post #6 of 24
Thread Starter 
Quote:
Originally Posted by Pookie-poo View Post
For what it's worth...

Cleo had IBD flare-ups every now and then, which require Flagyl (metronidazole) to get it back under control. Every single time she's been on the metronidazole, she runs high ALT. Once we've done the course of Flagyl, her ALT gradually returns to normal. I'm not sure if this is a common side effect or not, but you might want to run it by your vet. My vet just said that Cleo must be quite sensitive to the medication.

Cleo's ALT's were 411, 419, and 432, after each course of the metronidazole. I would get her re-checked approximately 2 weeks post Flagyl treatment, and her ALT's had dropped back down into the high side of normal. Now, a couple of years later, her ALT runs in the low normal range.

My vet prescribed Denosyl (post Flagyl) as a support for liver function. You might want to talk to your vet to see if Denosyl would be appropriate for Mavrick too.


Good luck to you and Mavrick. You are both in my prayers.
Now I'm really confused! My vet told me that the Metronidazole was supposed to help with liver functions - not make it worse. Maybe I should contact a different vet....

Is Denosyl the same thing as Denamarin?
post #7 of 24
http://www.wedgewoodpharmacy.com/mon...ronidazole.asp

Precautions

• Metronidazole causes birth defects in laboratory animals. It should be avoided in pregnant animals, especially in the first trimester. Some metronidazole is excreted in breast milk, and it should not be used in lactating animals.

• Metronidazole should not be used in young puppies and kittens.

• Metronidazole should be avoided or used with caution, at reduced doses, in animals with kidney or liver disease.
post #8 of 24
Thread Starter 
Quote:
Originally Posted by sharky View Post
Flagyl is notorious for causing liver issues... it is VERY common...

I have a cushings dog with liver issues ... her alt last time was in the 3000 s due partly to a medicine she was on...

PLEASE be very careful , cats with liver issues are much harder to handle than dogs ...

Stress can also raise this enzyme according to my vet ... plus being very young or old .. I learned that when my now 20 month old s had their blood done and one was slightly out ... ie like 5 points above normal
^
^
See above...

When Mav was originally taken in for the urine thing and also given the blood panel which indicated the liver enzymes being high, the lady vet (there are two at the office: the female vet & the male vet) suggested that the liver enzyme elevation could be stress-related. I don't know what from - unless Mav can sense that I've been on edge lately. His environment hasn't changed too much, with the exception of Salem having her kittens. But he is getting older: he'll be 14 next month.

This just doesn't make sense to me. It seems to me that Mav should be getting worse - not better.
post #9 of 24
Thread Starter 
Quote:
Originally Posted by sharky View Post
http://www.wedgewoodpharmacy.com/mon...ronidazole.asp

Precautions

• Metronidazole causes birth defects in laboratory animals. It should be avoided in pregnant animals, especially in the first trimester. Some metronidazole is excreted in breast milk, and it should not be used in lactating animals.

• Metronidazole should not be used in young puppies and kittens.

Metronidazole should be avoided or used with caution, at reduced doses, in animals with kidney or liver disease.
Now I'm getting really nervous!

ETA: I just printed out a copy of that attached link regarding the metronidazole, and am gonna show it to my vet(s). I am also gonna contact another vet for further advice....
post #10 of 24
If you're not feeling comfortable with the diagnosis or treatment, don't hesitate to get a second opinion! It certainly can't hurt and it might help!


I did a quick Google search

Denosyl and Denamarin are both made by Nutramax Labs, and seem to be quite similar to each other.

Denosyl
http://www.medi-vet.com/Denosyl.aspx
Denosyl SD4 protects liver cells from cell death and is helpful in cell repair and healing. Denosyl SD4 elevates liver glutathione, the liver's main detoxifier, as well as supports overall liver health.
Denosyl SD4 (S-adenosylmethionine) is a nutritional supplement for use to aid in managing a variety of liver problems in dogs and cats. Possible applications of Denosyl SD4 as adjunct therapy could include dogs and cats with elevated liver enzymes and suffering from: hepatic lipidosis, breed-specific chronic hepatitis, feline liver disease, Cushing's Disease, Inflammatory Bowel Disease, Pancreatitis, etc.

Denamarin
http://www.nutramaxlabs.com/products...arin/index.asp
Denamarin is a liver supplement for dogs or cats containing S-Adenosylmethionine (SAMe) and silybin.

When liver function is compromised, the exact cause can often be difficult to determine. Supporting the liver, regardless of the cause, is essential if function is to be improved.

Administering SAMe, which is found in Denamarin, has been shown to markedly increase liver glutathione levels2,3, a potent antioxidant formed when cats and dogs metabolize SAMe. The SAMe in Denamarin has also been shown to help protect liver cells from cell death4,5 and may help cell repair and regeneration.1

Denamarin also helps support your pet’s liver through the administration of silybin. Silybin is the most active part of an extract from milk thistle known as silymarin.
post #11 of 24
Thread Starter 
Quote:
Originally Posted by Pookie-poo View Post
If you're not feeling comfortable with the diagnosis or treatment, don't hesitate to get a second opinion! It certainly can't hurt and it might help!


I did a quick Google search

Denosyl and Denamarin are both made by Nutramax Labs, and seem to be quite similar to each other.

Denosyl
http://www.medi-vet.com/Denosyl.aspx
Denosyl SD4 protects liver cells from cell death and is helpful in cell repair and healing. Denosyl SD4 elevates liver glutathione, the liver's main detoxifier, as well as supports overall liver health.
Denosyl SD4 (S-adenosylmethionine) is a nutritional supplement for use to aid in managing a variety of liver problems in dogs and cats. Possible applications of Denosyl SD4 as adjunct therapy could include dogs and cats with elevated liver enzymes and suffering from: hepatic lipidosis, breed-specific chronic hepatitis, feline liver disease, Cushing's Disease, Inflammatory Bowel Disease, Pancreatitis, etc.

Denamarin
http://www.nutramaxlabs.com/products...arin/index.asp
Denamarin is a liver supplement for dogs or cats containing S-Adenosylmethionine (SAMe) and silybin.

When liver function is compromised, the exact cause can often be difficult to determine. Supporting the liver, regardless of the cause, is essential if function is to be improved.

Administering SAMe, which is found in Denamarin, has been shown to markedly increase liver glutathione levels2,3, a potent antioxidant formed when cats and dogs metabolize SAMe. The SAMe in Denamarin has also been shown to help protect liver cells from cell death4,5 and may help cell repair and regeneration.1

Denamarin also helps support your pet’s liver through the administration of silybin. Silybin is the most active part of an extract from milk thistle known as silymarin.
Thanks for posting that, Pookie-Poo. Every tidbit helps.

I'm definitely gonna contact another vet ASAP for a second opinion. And in the meantime, I don't think I'll continue to give Mav the Metro till I find out more about it. Maybe I shouldn't go against my vet's advice, but that link that Sharky posted really concerns me. I'm still gonna give him the Pred & Denamarin though, b/c the research I've done so far (and also the advice given) all indicate that those two drugs are common in treating liver problems. I just wish I knew exactly what's wrong with Mav's liver....
post #12 of 24
Quote:
Originally Posted by KittKatt View Post
Thanks for posting that, Pookie-Poo. Every tidbit helps.

I'm definitely gonna contact another vet ASAP for a second opinion. And in the meantime, I don't think I'll continue to give Mav the Metro till I find out more about it. Maybe I shouldn't go against my vet's advice, but that link that Sharky posted really concerns me. I'm still gonna give him the Pred & Denamarin though, b/c the research I've done so far (and also the advice given) all indicate that those two drugs are common in treating liver problems. I just wish I knew exactly what's wrong with Mav's liver....
FYI - it was pred that SKYROCKETED my dogs ALT( double the normal) and Alk phos( 3000 's way way high)


http://marvistavet.com/html/body_prednisone.html

Prednisone/Prednisolone use is likely to change liver enzyme blood testing and interfere with testing for thyroid diseases
post #13 of 24
Thread Starter 
Quote:
Originally Posted by sharky View Post
FYI - it was pred that SKYROCKETED my dogs ALT( double the normal) and Alk phos( 3000 's way way high)


http://marvistavet.com/html/body_prednisone.html

Prednisone/Prednisolone use is likely to change liver enzyme blood testing and interfere with testing for thyroid diseases
Did I misread somthing? I thought you said it was the Metro?

Would it be different in cats than dogs??
post #14 of 24
Quote:
Originally Posted by KittKatt View Post
Did I misread somthing? I thought you said it was the Metro?

Would it be different in cats than dogs??
Flagyl can cause it , I have been warned about its use with my pup by 5 vets... hence when needed she is on a LOW LOW dose

I said A drug did skyrocket my pup... we know it was pred as that was the only drug she was on at the time ... Previous round s for allergies likely caused her condition or contributed greatly to it

All the side effects seem to be multi animal so dog and cat are very alike ...

Here is what I wrote with a bit of added info
I have a cushings dog with liver issues ... her alt was in the 300 s and last time alk phos was in the 3000 s due partly to a medicine she was on...
post #15 of 24
Thread Starter 
Quote:
Originally Posted by sharky View Post
Flagyl can cause it , I have been warned about its use with my pup by 5 vets... hence when needed she is on a LOW LOW dose

I said A drug did skyrocket my pup... we know it was pred as that was the only drug she was on at the time ... Previous round s for allergies likely caused her condition or contributed greatly to it

All the side effects seem to be multi animal so dog and cat are very alike ...

Here is what I wrote with a bit of added info
I have a cushings dog with liver issues ... her alt was in the 300 s and last time alk phos was in the 3000 s due partly to a medicine she was on...
I guess I'm just too tired & burnt out right now to digest all this. It's been a rough day. I should probably reread everything tomorrow, after I've had a chance to recoup.
post #16 of 24
Quote:
Originally Posted by KittKatt View Post
I guess I'm just too tired & burnt out right now to digest all this. It's been a rough day. I should probably reread everything tomorrow, after I've had a chance to recoup.
I know it is alot to deal with
post #17 of 24
I dont have much help, other than that I am following this as i also have a cat with high ALT - his bloods in general were dire, and then a vet decided to give him a GA for a dental, so his could actually be worse now. Luckily his only symptoms are excessive drinking and weeing, although he is now showing signs of constipation. He is the third cat I have had with liver issues, and the only one that has eaten loads - if I didn't have a thyroid result for him, i would be convinced he was hyper-t.

one of my other foster cats had a 2 week steroid jab, and it meant we couldn't test his liver/kidney function as the steroid jab can raise both, I have had to wait a month after the 2 week jab to make sure that we are going to get an accurate reading, so maybe that is why his readings are higher?
post #18 of 24
Cats typically do not have as adverse reaction to pred as do dogs and people. It can cause problems in some cats, and those are more likely diabetes related than anything else, but cats seem to adjust themselves to it when they are on it long term. I've had 3 vets tell me this, as I have 2 of my cats on it long term. One has been on it for 2 years now and the other for a few months.
post #19 of 24
Whatever you do, do NOT just suddenly stop the Prednisone.....even if you fear that it may be contributing to the elevated ALT. Corticosteroids can never be stopped abruptly, the cat must be slowly weaned off the med.

So KittKatt, refresh my memory....did you ever actually get a diagnosis here?

I would be consulting with another Vet. Others are right, the Metronidazole and Pred can increase the ALT.........so my question would be, does kitty even still need these? He's been on them for a long time now. Even cats w/ hepatic lipidosis (fatty liver disease) wouldn't require meds for this long (except maybe the Denamarin, I don't see any problem with that one - it's only helping to heal the liver).

Why did the Vet even put Mav on the Metronidazole to begin with? Was Mav having diarrhea in the beginning? I'd sure be questioning why he's still on it (it's been a good 6 weeks or so, has it not?). No med should be given indefinitely.

What I would recommend is this.............request a copy of Mav's labwork from current Vet, ask them for photocopies of it. Just tell them you want to keep a record so that you can see his history. Many of us keep records of our kitty's labwork, so it's not unusual. It's your right to ask.

Then see if you can find a recommendation for a good vet in your area.....preferably see if you can find a Vet clinic that specializes just in cats............look in the Yellow Pages of your phone book under Veterinarians...scan the listings, see if there's a clinic just for cats. Then take all your labwork in with you, along with the actual meds you're giving.............and share your concerns re: the Metronidazole and (now increased) Prednisone..............ask if it might not be time to stop the Met and wean off the Pred.............you're concerned that these are elevated the ALT and it's creating a vicious cycle............because these meds are causing this elevated, current Vet thinks there's still something going on with Liver so wants you to keep on the meds............you know?
post #20 of 24
Arthur & Chester are having liver problems right now too. To save yourself some money you can buy Milk Thistle pills instead of the Denamarin. I had one pack of the Denamarin from the vet for $40 for 30 pills. I told him it was too expensive and he said it was ok to just give milk thistle (just bought a bottle of 200 pills for about $11). Also, I would ask your vet about the ALT/other medications, any questions you have they should be willing to take the time to answer for you.
post #21 of 24
Thread Starter 
Thanks for all your input everyone. I apologize for not getting back to y'all sooner. I was too burnt out yesterday from lack of sleep over worrying about Maverick, and I needed to regroup a little. All of this has got my head spinning.

I'm glad y'all pointed out the fact that I shouldn't go "cold turkey" with the Pred. I didn't realize that doing so may end up hurting Mav. It seems like I'm stuck between a rock & a hard place with that one: should I or shouldn't I continue with the treatment? I don't want him to take it if it may end up causing his ALT to go higher, or if it's gonna cause more damage to his liver in the long run - that's for sure. But I also don't want him not to take it either, if it may help him.

I printed out the info on the links regarding the Pred & Metronidazole that Sharky attached, and I had my s/o give them to our pharmacist where they both work - who is also a good friend - to get his opinion. He knows his stuff, and I trust him. He's gonna contact the vet to discuss it further with him. I'm also gonna try and contact another vet (which isn't an easy task in this area, but I'm gonna try) and get another opinion.

MonaxLisa, regarding the Denamarin, the reason I decided to go that route is b/c it's supposed to be easier on a cat's stomach than just the plain milk thistle. If I remember correctly, I think the milk thistle is also supposed to be very bitter, and only comes in liquid form. It's a lot easier for me to give Mav his meds in pill form: he ends up spitting out most of the liquid stuff, and just hates it. The Denamarin costs me $32.00 for a 30 day supply, which isn't too bad. If it's gonna be easier on Mav to take it that way, I'd rather pay the extra cost.

Food Lady, I never got an actual diagnosis yet. In order to do so, the vet has to perform either an ultrasound or liver biopsy. If the next ALT test results haven't improved, I guess I'm gonna have to go that route. I've been hoping & praying that we won't have to go that route, b/c I don't want to put Mav through anymore stress than necessary. And money is an issue, too. I don't know how or where I'm gonna get it from. Just paying for Mav's med & testing has already cost an arm & a leg.

Quote:
Originally Posted by foodlady
Why did the Vet even put Mav on the Metronidazole to begin with? Was Mav having diarrhea in the beginning? I'd sure be questioning why he's still on it (it's been a good 6 weeks or so, has it not?). No med should be given indefinitely
I believe the vet put Mav on the Metronidazole in case there was a liver-related infection that was causing him to leak urine like he was (which has gone away). He's been on it since Nov. 18 - the same amount of time as the Pred. They had to special order the Denamarin: he's been on that now for a month (that was actually my idea - not the vet's. I asked about it after learning about the liver thing and doing research, and came across the Denamarin treatment online. I don't know why the vet(s) didn't prescribe that themselves. Makes me wonder..).

I'm gonna ask for Mav's test results tomorrow, and I'm also gonna get another opinion. These conflicts between the vet(s) treatment and what I've read online regarding the Pred & Metro have really got me concerned.

Thanks for all your help, peeps. I really appreciate your input.
post #22 of 24
Quote:
Originally Posted by KittKatt View Post
If I remember correctly, I think the milk thistle is also supposed to be very bitter, and only comes in liquid form.
actually, i take milk thistle, & it's in a capsule form.
post #23 of 24
Thread Starter 
Quote:
Originally Posted by laureen227 View Post
actually, i take milk thistle, & it's in a capsule form.
It must be something else I'm thinking of then. I've tried to digest so much in the past few weeks that my head is spinning.
post #24 of 24
Thread Starter 
Well, I contacted my vet's office today, and asked for Mav's test results. The receptionist said she'd mail them to me.

I also tried contacting another vet who a friend of mine swears by, but their office was closed today - so I left a message for them to call me back. It's the last decent vet that I know of in the area: the next closet option for vets is about 40 miles away - which wouldn't be as much of a problem if we had a decent car to depend on. I also called my friend to get some more info from her regarding the vet, but she wasn't home so I left a message.

I'm still waiting to hear what the pharmacist says about the Pred & Metro stuff. I asked my s/o about it last night when he got home from work, but the pharmacist had to wait till today to talk to the vet.
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