Elevations in Alkaline-Phosphatase in Canines

What is “ALK”?

ALKaline Phosphatase is an enzyme we find in the bloodstream of a lot of dogs and cats NORMALLY

But when that number, that amount, is significantly HIGHER than the normal canine or feline patient, we want to ask why.

Does a high ALK enzyme level mean the dog is in Liver Failure?

No it does NOT.

For liver failure I like to ALSO SEE

  • Icterus (Yellow eyes, skin)
  • Low Total Protein
  • High Total Bilirubin
  • A low BUN

None, or all of these other derangements have to be present. AS a rare example: A liver “shunt” can create liver disease / illness / failure without elevations in any commonly measured enzyme or parameter.

Usually, an elevated ALK in the ABSENCE of elevations of ALT –  are related to old age, medications being taken, steroids, or Cushing’s Disease.

What would make you think of Cushing’s Disease?

A high ALKaline Phosphatase PLUS:

  • Crazy appetite
  • Thin skin
  • Crazy thirst
  • Unexplained weight gain or failure to lose weight when endeavored

Puppies OFTEN have elevations in ALK except, who’s even testing that?

SO What To Do and Think About a an Elevation in ALK?

First: If the dog is taking any medications, are they worth it?

Second: Does the dog show other signs of Cushing’s Disease?

Third: How’s the dog in general, and how is the rest of the blood panel?

Fourth: Is there any “weird” color to the pee?

More testing can be done, OF COURSE and commission based vets can wring a LOT of money out a high ALK.

An alternative in the much-older-dog is to neglect some of the untreatable causes of high ALK and see what URSO can do. Some people would also add an antibiotic. But I don’t like unnecessary antibiotics unless pushed.

What is URSO and what does it do? 

In general, I like to take HEALTHY dogs (especially with) with a known medication panel that could explain elevations in ALK (without elevations in ALT) and put them on URSO and recheck liver values in 4 to 6 weeks.

AS long as the dog is healthy, remains healthy, doesn’t lose any/much weight nor shows up with any ‘new’ symptoms of illness this is pretty safe.

Other notes:

They found out that Milk Thistle contains traces of Ursodehydrocholic Acid and so they made an entire “supplement” around it called DenaMarin. It really works if you fix the liver issues with other medications and attribute the improvements to Denamarin. Denamarin is the ‘diet coke’ of URSO.

URSO can cause a stool to be soft to even: Pasty. Especially at first. I have not encountered “diarrhea” with URSO administration.

I will use URSO in liver failure but not as a “cure” but instead as an adjunct therapy because it contributes to overall hepatobiliary health including ready and rather-complete evacuation of the gall bladder.

If the ALK remains quite high, in a dog under 20 years old, it’s probably worth assessing for Cushing’s Disease which isn’t as hard as you’d think unless you want it to be. (Like if you’re on a 15% commission in a vet franchise) Then there are literally ten tests to run:

  • Liver ultrasound
  • Pre-op bloodwork
  • Ultrasound guided Liver biopsy
  • MRI / CT of liver and bile duct imaging
  • Bile Acids testing
  • Low Dose Dex Suppression test
  • ACTH Stimulation testing
  • High Dose Dex Suppression testing
  • Ammonia testing

And there’s nothing wrong with any of that as long as you’re a Family Law attorney making enormous amounts of money fomenting discord and fighting between divorcing couples and dragging “Discovery” out into years without ever thinking about pulling a Dunn & Bradstreet or similar exhaustive audit. Or conveniently “forgetting” that there’s something called a “Motion to Compel” and even “Emergency Hearings” with the Judge when malfeasance on the part of one of the divorcing parties is causing undue stress and expense. THOSE guys make tons of money and can nod when the vet says they’d “do everything we possibly could” for their dog. Like literally everything they could possibly think of.




Author: Dr. Erik Johnson
Dr. Erik Johnson is the author of several texts on companion animal and fish health. Johnson Veterinary Services has been operating in Marietta, GA since 1996. Dr Johnson graduated from the University of Georgia College of Veterinary Medicine in 1991. Dr Johnson has lived in Marietta Georgia since 1976.