# Elevated ALT enzymes in bloodwork



## ladylilith (Sep 25, 2008)

Hi everyone, I adopted my cat Lilith only a few months ago (in July) and I was told she was healthy by the rescue organization, but we have been having a lot of problems. Lilith had a litter of kittens in March and was then spayed. She is a bit thin but besides this she appears healthy and is active. She is an indoors-only cat since living with me, but I'm not sure about her life prior to me adopting her.

I took her in to the vet 1-2 months ago because I noticed she had tapeworm. The vet also told me she had ear mites, fleas, and gingivitis/tooth decay. She was given medication to get rid of the worms and fleas (they are gone now - though I never noticed any fleas in the first place), and ear drops for the mites. I took her in yesterday for blood work and the vet called me back an hour ago with upsetting news.

She told me that my cat has abnormally high levels of the ALT enzyme in her liver. I had no idea what this was, so I looked it up online ASAP and found its Wikipedia entry: http://en.wikipedia.org/wiki/Alanine_transaminase

The vet told me that "normal" levels of this enzyme are around the 100s, but that my cat's level is in the THOUSANDS.

I have no idea what could have possibly caused this. She is a young cat, estimated around 1-2 years old (can't be sure because she is a rescue), she is still active and playful, and she has a high interest in food and eats regularly. I have never seen her throw up while in my care, and there are only a few house plants. The only house plants that MAY have been nibbled on (could also be normal drying out of the leaves) are a small bromeliad on the stairs and an ivy plant that sits on the coffee table. All other house plants show no signs of nibbling, and I highly doubt she would eat the house plants anyway because she ignores them. 

The vet suggested that Lilith may be ingesting something toxic such as a certain type of plant, household cleaners or tylenol (?!). All chemicals and medications are kept securely out of reach from the cat. I feed her Natural Balance canned food and she is free-fed dry food, which she generally ignores unless she's really hungry. I have noticed that she seems to pee a lot, though I figured that this is normal for her because it's been that way since I first got her, but I don't know. "A lot" is highly subjective as it is.

I would like to know if anyone else has had a similar experience with their cat. I am so worried and frustrated. I love my little baby so much and I don't want her to be sick or suffering. Please, if anyone has any advice I would really appreciate it.


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## Pinkerbelle (Jan 21, 2008)

I don't know, but I hope she feels better soon


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## ladylilith (Sep 25, 2008)

Thank you - that is the most confusing part. She is acting normal and doesn't seem distressed at all. Even the vet seemed confused by the test results, so she had the lab run it twice to make sure.

It's very troubling


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## Pinkerbelle (Jan 21, 2008)

Hmmm, well Sebastian had high liver enzymes in April, but they were ALG. They weren't super high like Lilith's though. He was also feeling fine, and I gave him some liver meds for a little while, but stopped because I decided they were probably caused by my inexpert raw feeding recipes. I stopped raw feeding and he's been fine, but you never know. These liver enzymes seem pretty confusing. Poor Lilith


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## ladylilith (Sep 25, 2008)

I read this on one site, but could the elevated ALT levels have something to do with her recently having tapeworm?

What about her feeding? Should I feed her more, less, the same amount? She is about 7 lbs. and the vet told me she has lost about half a pound.


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## ladylilith (Sep 25, 2008)

I just wanna post a little update. I called the vet back and asked for the actual ALT value today. It was 2098...

She is eating more today and is still acting quite normal. The vet recommended I start her on a round of antibiotics (amoxicillin) to get rid of a possible infection that could be affecting the test results.

I'm also taking her back to the vet on Saturday to run some more tests. Abdominal X-ray, urinalysis and a blood panel focusing on the liver. :sad


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## Kittys Mom (May 7, 2004)

I wish I knew more about liver function and values. You know? As you become familiar with one disease or another, you learn those values down pat. Ask me about specific gravity, ph, or protein values in urine or T4 levels and I know exactly what's what...but liver...I don't know.

So, are you doing the antibiotics, then waiting, then checking the ALT again, THEN doing the additional testing? Just wondering...


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## ladylilith (Sep 25, 2008)

I believe we are running these additional tests in addition to completing the round of antibiotics. Hopefully this will determine the problem (I'm not going to get my hopes up because I've been told liver problems are hard to pinpoint). After 2 weeks of antibiotics are complete then they'll do another test and see if there is an improvement. My vet told me that it could be a bacterial infection causing the super-high numbers, but in case it's something more serious I want to find out ASAP. I have read that ALT values this high can cause seizures or liver failure and I don't want to waste any time figuring out what's wrong.

I knew nothing about liver enzymes either until the vet told me the results. I immediately went online and researched the problematic enzyme, ALT. The normal value for cats is around 100 or less and hers is twenty times that. I am trying hard not to freak out about it, but I have anxiety so that's difficult sometimes. The fact that she's her normal sweet, playful self makes me feel somewhat at ease. I would never have known there's something wrong if it weren't for the test results. Besides being picky about her canned food earlier this week, she seems totally normal.


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## Kittys Mom (May 7, 2004)

Wow. Well, I'm keeping you guys in my thoughts. Try not to freak out too much. Sometimes, even with the worst test results/news things can work out okay.

They told me 3 years ago that Kitty had a grapefruit sized tumor that was probably cancer. Well, that's not what it turned out to be and 3 years later she's still going strong.

Be sure to keep us updated, and maybe someone else here will have some better ideas...


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## Pinkerbelle (Jan 21, 2008)

Wow, it all sounds so confusing. You poor thing  Good luck with all of that.


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## laurief (Jun 22, 2008)

I know that your girl's ALT value is alarming since it's so high out of range, but it could just be a matter of mishandling of her blood sample. ALT value can be high if the blood sample is hemolyzed (blood cells ruptured by mishandling of the sample). Here is some additional info on ALT value:

From http://www.felinecrf.org/diagnosis.htm#ALT:
"ALT (Alanine Aminotransferase) or SGPT (serum glutamic-pyruvic transferase)
This is an enzyme which is largely found in muscle, the liver and the brain. It often leaks out of damaged liver cells, so is an indicator of liver disease, although it is sometimes elevated in hyperthyroidism. Cats on methimazole for hyperthyroidism may also have elevated liver enzymes and low white blood cells. ... If a sample is haemolysed, ALT may be elevated."

More info at: http://www.diaglab.vet.cornell.edu/clin ... em/alt.htm

In addition to a more comprehensive liver blood panel, I suggest you request a thyroid test to check for hyperthyroidism. HyperT is much more common in older cats, but it can occur in youngsters like your girl, and it does typically cause significant weight loss until medically controlled or cured.

Please keep us updated on the results of Saturday's tests.

All the best,

Laurie


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## ladylilith (Sep 25, 2008)

Lily spent pretty much the whole day at the vet today, I dropped her off at 8:30 this morning and only just picked her up (it's almost 4pm).

They ran a liver panel, x-rays, urinalysis, and a bile panel or something like that to look at her liver function.

The test results should be in Monday/Tuesday, since they are closed on Sundays.

The vet told me that if the bile test came back normal then it would be very good news, because it is possible for ALT values to be elevated even in healthy cats. Supposedly the bile test is the most important when it comes to checking how her liver is doing.

I believe the x-ray was normal, because I don't recall the vet mentioning anything bad about it. I'm a little scatterbrained lately because of this. One of the receptionists told me "she's so sweet. We all love her here." haha 

Thank you for keeping my little kitty in your thoughts.


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## Loving_My_Cats (May 26, 2004)

*Sending positive thoughts for your kitty.*


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## ladylilith (Sep 25, 2008)

I just got Lily's test results back. I'm not sure what to think about it :/

Her ALT levels are down to 1201 which is still super-high but it's almost half of what it was before, which is good I suppose...

One of her other liver enzymes is also slightly elevated - AST which was 121 (normal is up to 100, I think)

The bile acid test determined that her liver isn't functioning normally. I believe in this test they take a sample, then feed her, then take another sample again after she's been fed to see how her liver deals with food. I guess it doesn't deal with the food as well as it should. They also said the liver looks slightly small on the x-ray.

Because she is young, they suggested she could have a shunt which I personally think is unlikely because she has never vomited or had seizures which are 2 big symptoms of a shunt kitty... they gave me the option of referring me to a specialist to do further testing (ultrasounds, dye tests and a bunch of other ridiculous things), or waiting it out for a few weeks and re-testing her to see if she improves. 

I'm a full-time student and I work part-time for minimum wage, and I'm trying to save up for my own apartment. I can't afford much more vet expenses right now (this has already cost me upwards of $500). I asked the vet if she thought Lily was in any immediate danger, and she said "no" based upon the way she eats normally, acts normal and hasn't been suffering seizures or vomiting. I have decided to take the conservative approach and start Lily on a special diet for pets with liver disease, and have her re-tested in a few weeks to see if the special diet helps lower her levels any.

If the special diet doesn't help, I guess I have to go to the specialist. I feel better hearing that she isn't in any immediate danger, though.


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## judec (Oct 3, 2008)

I'm curious how ithings are going with Lily?

One of our cats, Bella, also has elevated ALT. She has no symptoms, at least not yet. The ALT was checked in routine bloodwork before a dental cleaning. First it was 210, six weeks later it is now 369, so definitely going in the wrong direction. She was on antibiotics (for gingivitis) before the first test, and again after her teeth were cleaned. I suppose this could confuse things... I even wondered if the antibiotics could cause the problem, but she has been off of them for about 4 weeks.

How is the special diet going?


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## ladylilith (Sep 25, 2008)

Hi! Well, I'm pleased to say that she eats the Hill's Prescription Diet l/d canned food and kibble.

At first she wasn't eating the canned food, but I microwaved it for about 40 seconds or until it was warm. Then I stayed next to her the entire time she was eating, and when she got distracted and walked away from the food bowl I'd remind her about it and coax her into eating more. She will also take food from my fingers very well and I can get her to eat that way sometimes.

I mixed the new l/d dry food in with her old kibble so it's about 50/50 and she munches on that when she's hungry enough :S 

As for her levels I am not sure yet, but we are going to have her re-tested in a few weeks to see if the new diet helps. Besides the occasional lack of interest in food, she tends to drink a bit more water than normal (I think), but she hasn't shown any severe symptoms of liver disease / liver failure (vomiting, seizures, etc.) thank goodness. I also found out that one of the house plants my mom had downstairs was Devil's Ivy, which is poisonous if eaten. I highly doubt she ever tried to eat it, but it could explain the weird test results. In any case, the plant has been relocated for her safety.

I am so happy she has been eating lately. It's a huge relief. Unfortunately, I can't seem to get her to take the "Hepato support" supplement. It seems to really turn her off the canned food when I sprinkle it on there. I'm really just glad that she's been eating normally, though!


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## ladylilith (Sep 25, 2008)

Just wanted to post an update for anyone who may be reading this and has the same problem 

I have great news... I had suspicions that my vet was ripping me off, so I took Lilith to a new vet and her liver panel came back 100% normal. All of her values are within normal range. Yay!!

The new vet said it was probably a toxin that worked its way out of her system... I went back to the old vet and returned all of that crappy stuff they made me buy. Except they wouldn't take back the $30 bottle of Hepato Support supplements (only 2 are missing, comes with 90 capsules)... if anyone has a kitty with liver problems I would be happy to give it to them, as I don't want it to go to waste.


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## Crawt (Apr 14, 2009)

Hi,

Is there any more information on elevated liver enzymes available?

:?:


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## bluemilk (Oct 3, 2005)

Has your home been tested for Radon?


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## ladylilith (Sep 25, 2008)

Hello - the problem was resolved several months ago. Her liver function is now back to normal and the ALT value is within normal range.

Sorry but I don't know of any more information... the vet suggested that she may have consumed something toxic (such as a human pill), even prior to me adopting her in July, which could have taken months to get out of her system.

Thank you though


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