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High Liver Enzyme, Low Blood Pressure
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High Liver Enzyme, Low Blood Pressure

My 13 year old Chihuahua was diagnosed with heart failure about 5 months ago. It was diagnosed as mild, and after a few scares (one big scare) she was great for several weeks, but then began to deteriorate FAST in the last few days. Meaning, on Thursday she was playful and active, on Friday she was nauseous, and by Sunday she was refusing food and could barely stand on her own.

A visit with the cardiologist today (Wednesday) didn't go so great. Her BUN levels are slightly high, but not so high that there would be any concern for her kidneys. The vet stated that her "liver enzyme" is high at around 300, but she didn't specify whether this was the ALKP level or the AST level. The X-ray showed the liver to be somewhat enlarged, and there is some fluid in her abdomen; the vet briefly suggested more testing on the liver, but was concerned that with her weakened state it might be too dangerous.

Other than that, her blood work is fine. The biggest concern is that she is dehydrated (even though she drinks a ton of water), and she has a very low blood pressure.

The cardiologist began talking about life expectancy in "maybe a day, maybe a week", so the prognosis isn't good at all. But, they said the same thing 3 months ago, and we were able to pull through, so I'm not throwing in the towel just yet.

We've taken her completely off of her high blood pressure medicine (Enalapril), and cut her diuretic dosage (Furosemide) in half, but are keeping her dosage of Spironolactone the same at 7mg 2x day. I've taken it upon myself to begin giving her Milk Thistle and Vitamin B Complex, as of a few hours ago.

For the last several months, her diet has consisted of organic turkey (to which I add dietary fiber) and spinach baby food, in addition to regular hard Rachael Ray dog food. She's not eating any hard food on her own, though, so as of today I switched her diet to a 5mL syringe of turkey/fiber + 15mL of organic sweet potatoes (baby food), 3x a day (or more if she'll take it).

Can you guys think of anything else that I can do to help increase her blood pressure a little, and possibly help decrease her liver enzyme? At this point, we're not sure how long she'll be with us, so I'm willing to try anything.
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Can you give her pedilite water? I don't know really, but wonder if with her drinking so much that she might need some potasium? I know that helps with the heart. Just something to research. I am sorry, I am only trying to think of something.
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That's a good thought; I'll run to Walgreens and pick some up. The vet didn't say anything about her blood sugar or electrolytes being low, but still, anything that might turn in to energy is a good thing.
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Dr. Osborne wrote an article on dogs with Kidney issues, it is very good, it actually sounded like what your dog is going through. Check it out on the post about Kidney's that I just wrote on. I will see if I can post it to here for you.  
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This is it....very good, read it and see if you think it might help your with your dog, this was for Kidney issues.  

by Dr. Carol Osborne, DVM, 4 hours ago
To: xxgawjuzuxx
Hello-Perhaps this article I wrote will help you. Feel free to call me directly if you'd like to discuss this further.

Pet Kidney Function: Dogs and Cats

The kidneys serve many vital pet functions.  They filter and remove toxic wastes from the body via the urine, regulate Calcium and Vitamin D levels, maintain fluid levels, and secrete the hormone responsible for red blood cell production.  

Anything that interferes with the kidneys’ ability to function properly can cause kidney disease, which is the second only to cancer as a leading cause of death in pets.  In most cases, progressive age-related deterioration is responsible, with no apparent cause.  

Other causes of kidney disease include bacterial and viral infections, nutritional factors, immune system defects, toxins, and inherited breed disorders.

“Acute” kidney disease occurs suddenly, is much less common than chronic kidney disease in pets, and with prompt treatment is generally reversible.  Long-term “chronic” kidney disease referred to as chronic renal disease is the most common form in dogs and cats.  It is usually the result of slow age-related deterioration of the kidneys.  

Signs of Pet Kidney Disease

Initially dogs and cats drink and urinate excessively.  The urine produced is dilute so dogs become dehydrated and drink a lot to try to replace the lost fluids.  No matter how much they drink; they are unable to maintain normal hydration.  

Advanced signs of Kidney Disease include weight loss, vomiting, depression and loss of appetite.  Signs are not apparent until 80 percent of kidney function is already lost.  

Routine diagnostics include blood and urine tests as well as abdominal x-rays.  A kidney biopsy is generally necessary to confirm the exact cause.  In most cases, a biopsy is not obtained and treatment is symptomatic.

What Pet Owners and Vets Can do for Kidney Disease

Fluid therapy is the single most important factor in the treatment of kidney disease.  The kidneys normally function to maintain fluid levels by concentrating the urine.  With kidney disease, excess fluids are lost into the urine so dehydration is a major problem.  

Good nutrition is also critical.  The goal is to decrease the workload on the kidneys by decreasing the amount of waste the kidneys must eliminate.  Excess dietary protein, phosphorus, calcium and salt create a lot of waste. Pet diets should therefore contain small amounts of high-quality proteins, low salt (use salt substitute), and minimal phosphorus. Home made diets are ideal and can be tailored specifically for each pet.

The most important parameter with respect to dietary protein is quality rather than an absolute amount. For example human dialysis patients eat eggs. Why? … Each egg contains 7 grams of pure protein on which the kidneys do not work at all to utilize.  

Trying to determine protein levels, by reading pet labels can be quite misleading. For example, a chemical called Cyanuric Acid, used as a pool cleaner is approved as a pet food additive to artificially elevate protein levels.

In fact, the reason thousands of pets died during the 2004 and 2007 MENU pet food recall was not just because of the Melamine. The Melamine was present in the contaminated Chinese Gluten. The problem occurred when it combined with the Cyanuric acid which was also present in the pet food.

The Melamine and Cyanuric acid formed an insoluble precipitate in the kidney tubules of the dogs and cats that ate the pet food and this is what led to acute kidney failure and death for thousands of pets. The latest pet food reports available indicate that the melamine is no longer an issue but the cyanuric acid is still allowable and present in pet food.

Anemia or a low number of red blood cells is usually present in pets with Kidney Disease.  Supplementing your dog or cats diet with B-vitamins and iron stimulates red blood cell production, which helps to counteract anemia.

Today kidney therapy may include Calcitriol, which is a natural form of vitamin D and is compounded specifically for each pet.  Capsules are given by mouth once daily.  Calcitriol helps prevent further kidney deterioration, regenerates the kidneys and helps restore normal function. It was given routinely to human dialysis patients.

In pets, Calcitriol is only effective when the value of the blood calcium multiplied by the blood phosphorus level is less than 40. After over 15 years, of successful international clinical trials, Calcitriol is still considered experimental in pets.  So far the results have been excellent for both dogs and cats.  

Kidney transplants are a treatment option in extreme cases, and are available at a few veterinary facilities in the US. The College of Veterinary Medicine, in Davis, California has a top notch Kidney Transplant and pet dialysis facility.

Long-term management involves monitoring kidney functions with blood and urine tests every three to six months.  At home hydration can be monitored by pinching the skin on the back of the dog’s neck.  Hold it for five seconds, then release.  If it takes over five seconds for the skin to return to normal, your pet is dehydrated and fluids are indicated.  

Pet owners may learn to give daily subcutaneous fluids, which are given under the skin at home.  Sodium Chloride, rather than Lactated Ringers solution is preferred for fluid administration, because the Lactated Ringers solution contains both Phosphorus and Calcium neither of which are beneficial to dogs or cats in kidney failure.  

Most pets enjoy quality life for several years post diagnosis.

I hope this information is helpful.

Best Wishes,

Dr Carol Osborne, DVM
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Avatar_f_tn
Thanks for posting that, Zoe. I had actually had where you had posted it before (before I went to the vet this time, even), and I was convinced that she was in kidney failure because all of the symptoms are there. But the vet said that her kidney levels seems within reasonable levels.

The only thing the vet could find as a real life-threatening problem is her low blood pressure. Just how low it is, I don't know; all I know is that she has a hard time standing on her own, and when she tries to walk, her hind legs get twisted so she stumbles a lot. She has been sleeping or lying down for roughly 23 hours out of the last 24. And even though her heart rate is pretty fast, the pressure itself is apparently low.

If there had been a noticeable sign of deterioration, I would be able to let go a lot easier. But seriously, she was running and playing just a few days ago! So it's hard to think that she's ready to go in that short period of time.

As of right now, she's still with us. She actually ate a fair amount of sweet potatoes (organic baby food) just about an hour ago (maybe 20mL), with a little turkey (again, pureed baby food; maybe 5mL). That's an improvement over before; she doesn't have an appetite yet, of course, but she's not spitting it out, either.
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After I got off the computer last night I was reading some information that might be of use about my own dog who has UTI's often. Anyways, I came across something that I thought you should look into, read up on Cushing's disease. , weakens muscles, excessive hunger, excessive thirst, potbelly, thin hair.
You said she has low blood pressure, but I wonder if that is the result of a rebound of the high blood pressure medication?
I am also wondering about if your dog does have low blood pressure and as you stated low BUN, read up on Low Thyroid. I mention this because I have a dog that most vets thought that he had Kidney disease and wanted him on special food, will about 4-6 weeks later he had a siezure and I called several vets, none seemed that concerned except one did suggest that I get a thyroid test done, as he said often it is a low thyroid that cause this problem. He did not encourage me to get any test done right way in fact I was told to wait till the next seizure. I am so glad that I did not wait, do you know how many functions that thyroid is responsible for? Oh, my just about everything! If it is thyroid, it is easy to treat.    
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I had looked in to Cushings, but she doesn't display most of the symptoms. She has no appetite at all now, no potbelly, and her fur is normal. She's thirsty, but still dehydrated.

Also, her BUN levels were high (not low), but not unusually high considering the medication she's on. A normal high for her would be around 25, but since she began the medication, it's ranged from 35 to 60 (except for the "bad" time early in the disease, when it was in the 90s). At this visit, it was 51; still above normal, but still around her average while on medication.

I looked up hypothyroidism, but she doesn't really display most of the symptoms:

Lethargy/mental dullness
Hair loss
Weight gain/obesity
Dry hair coat/excessive shedding
Hyperpigmentation of the skin
Cold intolerance
Slow heart rate
High blood cholesterol
Anemia

She's definitely lethargic, but that's all. There's no hair loss or weight gain, her fur and skin are normal, she sleeps on top of the covers now (where she used to go under) so there's no cold intolerance, her heart rate is high (but the pressure is low), and she's not anemic. I don't know if the vet checked her cholesterol, though.

She did have a few very short seizures in September, though; 3 the first week of September, then another later in the month. No one was able to find a cause, since her heart disease prevented her from most tests.

I'm positive that the low blood pressure is a rebound of the high blood pressure medication. Honestly, ever since her first visit to the cardiologist, I've suspected that she's had too high of a dosage, but the vet insisted and I trusted her. I guess that I still do trust her; it would be easy to blame this on the medication, but I have to be realistic.

Just to update, she made it through the night! Which surprised me a lot, honestly; I figured sleeping with dangerously low blood pressure might be too much. I took her for water and to pee several times overnight, and she was thirsty each time, but could only barely stand on her own; I had to hold her legs under her to keep her from sliding. There's been no bowel movement in close to 48 hours, though, which I'm guessing is more from her inability to hunch or push than anything else.

Eating didn't go so well. She took the milk thistle (mixed in 5mL of water) and B complex first, then I tried to give her a syringe of sweet potatoes with her furosemide and spiro crushed into it. She ate about half of the syringe (2 or 3mL), but then wouldn't swallow any more, so I don't know how much of her actual diuretic she had.
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Avatar_f_tn
Could she have Bloat?

Can you call the emergency vet and ask them what they think? I have done that many times and they usually can tell me what they think it is and if I need to get to a vet right away or if it can wait to take the pet the next day, or if it is something to worry about.

My dog did not display most of the signs of low thyroid and I am not saying that is the cause of your dogs illness, but most signs are on any illness they have " some" of them. Most vets will not think to look at the thyroid after a seizure just because they have not seen this or they just stick with what they have learned. Have you posted on the " Ask a Vet"? Fourm here, I am baffled. Have you looked up the medication by actual name, not what the makers call it. Sometimes you can locate more information out that way incase your right...and you do know your pet better than anyone.

Keep posting, I hope someone knows what is going on with your dog...soon.  
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The emergency vet (cardiologist) and I have spoken several times, yeah. To be quite honest, the vet almost said that she's just surprised that Pepper is still alive, but she backed off in mid-sentence. She hasn't said as much, but she's made it clear that she thinks I should be calling to discuss euthanasia instead of medicine.

Researching online is so very frustrating. On the one hand, the vet recommended that I drop the high blood pressure medicine immediately, but then reading online finds a lot of references that state dropping it cold-turkey to lead to internal bleeding. The vet recommended cutting the diuretic dosage in half since she was dehydrated, but then how am I suppose to remove the fluid from her abdomen? The vet recommended a Vitamin B complex vitamin, but the one available has iron, which is apparently dangerous for dogs with liver disease. What it boils down to is that everything I can do is going to be wrong.

I've looked, but don't see the "Ask a Vet" forum on here. No offense to the owners of the site, but I find it to be kind of hard to navigate. Where can I find it?
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Avatar_f_tn
You can get the B-vitamins at any store, I am actually thinking of giving one of my dogs that as well.
Check out on the top right " pets", then look at " ask a veterinarian", then when you go to that area, post the question from the top box on post a question...not the one on the right side.
I know your frustrated, I did everything I could for my older dog, I did not know what else to do. She was fine one minute, then almost dead and I made the quick call to save her, but it was very costly and had I known the cost that it was going to be, I think I would have not saved her, but I would have wondered and felt bad for ever. Not knowing what is wrong is the hardest part. I agree with you, I would want to make sure there was nothing easy that I could do to help my dog.  I would post your question, but since you really need more information soon, I think I would call or fax all of your records to  Dr Carol Osborne, DVM, she really cares and can help set your mind at ease one way or the other.

Let me know what you learn,  
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I appreciate everyone's advice. Tonight at 9PM, though, my little Pepper passed away.
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I am so sorry !! I know how much you hurt right now, you tried your very best to save her and you should feel really good that you were trying to help her be in less pain. You know all the money in the world and all the test that might have been out there might not have saved her. ((hugs)).

If you need or want to talk, I am here.

I know this might seem odd to say, but what helped me feel better when I had to put down my first dog last year, was to go to the pet stores and just hug and love on some Puppies. I did get another dog a few months later, not to replace that dog but with knowledge that my older one will not live much longer.      

I know you are hurting right now and I just hope that you feel some comfort in knowing you gave the best care and love to Pepper. Btw, I had a lop ear rabbit black and white with that name...the guys at my work would often tease me about cooking up my rabbit to eat because I gave it that name :(    
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I am so sorry for your loss.  I am sure she knew she was loved and that you were doing your best for her. Take care (hugs).
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