ALT of 744 - What to expect?

[bastjupiter]

Hello,

Last Saturday, I decided to do blood panels on my cats because I am obsessed with them. We did a SA120 through Antech. At that time, my cats were not symptomatic and I had no reason to believe they were unwell.

After receiving the results, I learned one of my cats had elevated atl at 744. I will attached a picture of the results.

My cat is a 3yo neutered male, he eats a wet food only diet and was given a BCS of 6/9 because he has mild dental disease (g1) and he is about 1lb overweight. Otherwise, a healthy boy. He eats well, plays, drinks water, and uses his litter box appropriately. He has had no potential exposure to ingested toxins.

I am so confused! I dont know what to make of these results. Has anyone ever dealt with such a massively high ALT before? What did you end up doing? Was your cat ok?

I love my cat more than anything. I have an appointment with a specialist set up, and plan to redraw the panel and also do a urinalysis. I just want to know if anyone else has been through this and made it out ok.

 

[ellen m]

I would not call that massively high, although it's high. I've had cats with higher ALT than that and were fine! It can be a temporary thing. So I would retest in a couple of months and see if there's a trend. You could ask your vet for a bile-acid test if it's still high, or higher, in a month (or, you could ask your vet for the BA test now - I myself would wait on it). Often, the cat just ate something that didn't quite agree with them and the ALT goes up temporarily. Not to panic yet! Is he symptomatic at all? Is he eating well, has he lost weight to your knowledge? Dental disease itself can raise ALT so I'd get that taken care of.

Ellen

 

[ellen m]

I just looked at the bloodwork. The HCT is high, which can indicate dehydration. That might also affect the ALT. Is he getting enough liquid? Eating wet food? Does he have a water bowl? Can you tent his skin and check for dehydration? Hopefully the vet will to that at the appointment.

Ellen

 

[mrsgreenjeens]

I agree with the above poster. Others have had similar issues. Here's one such thread: One liver value is high, maybe cancer?

 

[ellen m]

That quoted thread is unfortunately titled! There is no cause for any panic. :-)

 

[bastjupiter]

Wow thank you all so much!

Fenris has a 2 tier ceramic fountain that does bubbling, streaming, and pooling. He eats only wet food, but he was fasted the day of the appointment and because I work at the clinic, we did him between clients so he did not have food or water (he never drinks water or eats food when he is in the boarding cages) I also gave him dry treats, which could have contributed to dehydration. The same is also true for my other cat who had the same panel done who was in normal range and had fantastic bloodwork. Joji, the other cat, is slightly more overweight, and also more likely to have snacked the morning before we left. Joji also had his blood drawn before Fenris, probably an hour beforehand.

He is eating, drinking, and playing as normal. He has good elasticity when skin tented, and his gums are slick and pink. I also have been feeding him by himself since yesterday to make sure, and he is eating with his normal vigor. He received a 3 year rabies vaccine and an FVRCP vaccine at the visit as well, but he did not seem to be tender or fatigued after.

I am so grateful for these responses! I am redoing his blood panel on Friday, and seeing a specialist on Thursday, because I am quick to panic.

As far as his dental disease, he had a dental cleaning done in November, and it was recommended I wait 6-12 months from his visit last week before we put him under again for another cleaning. I brush his teeth at home as well.

His weight fluctuates between 11-13lbs, mainly because I have been trying to get him back into a healthier weight, since he is overweight. He is currently ~11lbs and some change, when the vet recommends he is closer to 10lbs. So, no sudden or surprising weight loss, and a steady fluctuation in normal ranges for him.

 

[ellen m]

He sounds great! I am wondering why he was fasted for the blood test.

 

[bastjupiter]

He sounds great! I am wondering why he was fasted for the blood test.

Mostly unintentional!! He didnt eat his breakfast before it was time to leave in the morning, and will not eat outside of home.

 

[bastjupiter]

Went to full service; we will be doing repeat bloodwork at the end of this week, and an abdominal ultrasound on the 21st

 

[ellen m]

Did your vet mention the possibility of a bile-acid test? It's often the first-call test for high liver values. An ultrasound is a great idea too.

 

[daftcat75]

That's not a massively elevated value. I call ALT the ghost of inflammation or injury elsewhere. In my experience, it's not terribly specific to the liver itself. My first question would have been about his teeth. You answered he has mild dental disease. Is this something that can be addressed? The dental disease, I mean. Does he have teeth that need to be extracted? Has he had a cleaning with x-rays recently? My gut feeling, and it's only that (with a touch of experience with one previous cat) is that once the dental disease is addressed, the ALT may come down.

But a little due diligence won't hurt either. An ultrasound and a bile acids test would be helpful to rule out anything else not yet apparent.

If he's not symptomatic for anything (other than his teeth) and those tests don't turn up anything, I would ask the vet to focus on the teeth and revisit the liver value in three to six months. If that elevated ALT value is from persistent inflammation in his mouth, then all those liver supplement horse pills aren't going to do much. Denimarin are huge pills that cannot be broken and they can take awhile to see results. If the other liver values are good, I'm suspecting the injury or inflammation is elsewhere, most obviously, his teeth.

 

[daftcat75]

I found my old thread. Krista's ALT tested at 1440. She had a broken tooth (what we originally went into the vet for) and another one that needed to go. She was also deep in the throes of tooth resorption. This was not her first dental rodeo. Over a ten day inpatient hospital stay, she got IV fluids the whole time, an antibiotic, several rounds of dental extraction, and a feeding tube. Her poor teeth had stopped her eating for several days over the Christmas to New Year's holiday and Jan 2 was the first appointment we could get. It was supposed to be a pre-clearance for a dental. It was after the ALT value came back that the vet decided she was a poor candidate for the anesthesia. Fortunately, for better or worse, Krista was a fighter at the vets and they couldn't do an ultrasound with her without sedating her. It was at that point that my favorite vet (she's changed practices and I still miss her!) decided to do her dental anyway. And when she still wasn't eating and they had to sedate her again for a feeding tube, that vet took X-rays and realized there was still some root fragments that could go. She never got any medicine specific for her liver in that stay. Though I think they may have given her ursodiol for her gallbladder. Krista was an IBD kitty who had beat pancreatitis the summer before. I called her Hat Trick because now all that inflammation got into her liver too. Near the end of the stay they re-tested her to see if she could leave, despite not getting a drop of medicine for her liver, after taking care of all that inflammation and injury in her mouth, her ALT came down from 1440 to 170.

So yeah. I have some experience here. I am a sample size of one. I have read at least one online source about interpreting blood results for dogs and cats that said dental disease could be one reason for an elevated ALT.

Let your vet run the tests to rule in or rule out other things. But at the end of the day, my gut feeling is that addressing his teeth will bring that down far more than trying to get those huge Denimarin pills into him.

 

[ellen m]

Agreed with all of the above. I've had cats with higher ALT values -MUCH higher - and have declined both ultrasound and b/a testing in favor of just retesting later. Dental disease can do it. Eating anything unusual can do it. Retesting in a few months makes a lotta sense but testing can't hurt, either.