Elevated Alt Levels?

[sbutler116]

Hi! I brought my 10 year old cat in for an annual check up a week ago. They found her to be in good health, and just slightly overweight. They did see signs of ear infection and gave us Tresaderm ear drops to use for a week. After about five days I noticed that she was drinking a lot more than normal (still had good appetite). One day she drank a whole bowl of water in one sitting. Concerned, I brought her to emergency care where they said it was probably due to the ear drops. Ears looked good, and we could stop the drops. They did blood work just as a precaution. On her blood work her ALT levels were greater than 1000 (normal 12-130). Normal bilirubin. Also, her Alk phos was high at 177 and glucose high at 173 (normal 71-159). Her platelets were low at 60 (normal 151-600). She also tested positive for a urinary tract infection and got a shot of antibiotics. They want to redo her blood test in 3-4 weeks and see if there is any change but didn't really give any suggestions as to what could be going on. Her appetite is still very good, activity level low but that's normal. This is a new vet for us and I'm not fully confident in him. Has anyone else had a cat with such high ALT levels or have any idea what could be causing it?

 

[daftcat75]

I like to call ALT, the ghost of angry elsewhere. The liver generally doesn't become inflamed on its own. Something else is inflamed and it carries over. It could be the ears or the urinary infection. Or. How's her teeth? When's the last time she had a dental under anesthesia with mouth x-rays? Dental disease can certainly cause elevated ALT. I spent thousands this year chasing ghosts trying this and that with the vet to get ALT in range. What ultimately did it was finally convincing the vet that I believed the ALT was a reflection of a problem elsewhere and that elsewhere for my Krista was her teeth. It took a few rounds of extractions and root clean up but she's eating well again and her liver numbers came back into range. I'm not saying teeth are the issue with yours but it's something to consider. Ten years old is about when cats start to have dental issues if they are going to develop them.

In the absence of any symptoms, I think the vet's approach of, "let's treat the infection and re-test the blood work in a few weeks," is a sound approach. If the ALT remains elevated in a month, you could be in for a battery of expensive diagnostics: ultrasound, needle aspirate biopsy and cytology. They use the ultrasound to guide a needle to take a sample of her liver tissue and culture it for signs of infection. She will possibly also get a course of antibiotics and maybe a bile thinner. In the absence of any symptoms, I would opt for the dental first if she hasn't had one recently. Because the liver rarely gets inflamed on its own, I would look for primary problems rather than getting too aggressive on the diagnosis and treatment for the liver itself. If the teeth are in good shape, then you go back for the ultrasound to see if the intestines or pancreas could be primary problems causing the secondary liver disease.

 

[Rosepud]

If you want to be proactive denamarin was recommended to me for my cat who had a slightly elevated ALT level about 6 above the normal which isn't even close to the same but it's supposed to support liver health and had no negative side effects as far as my vet could tell me.

 

[martymcjackson]

S sbutler116 - yes, unfortunately I had exactly this experience with my cat immediately following a round of Tresaderm. He became very lethargic, stopped eating, and his ALT tested extremely high. He was admitted for emergency hospitalization and unfortunately was dead of cholangiohepatitis within several days. I can't say 100% that it was the Tresaderm, but his liver biopsy suggested damage to his bile ducts, in turn allowing normal bacteria from the gut to migrate and infect his liver, and I've since learned (per easily located medical citations) that bile duct damage is a rare but known complication of thiabendazole (one of Tresaderm's active ingredients) in humans. I currently have a case open with the drug company out of concern that this might be an under-recognized side effect in cats. I hope all turned out OK with your kitty!

 

[dmanski]

@ S sbutler116 and @ martymcjackson - I am so sorry to hear about your troubles with Tresaderm! Yes, I have recently had the same exact issue with my Maine Coon following rounds of Tresaderm treatment. The first Tresaderm treatment was in January of 2022. Immediately following treatment my cat had severe diarrhea, became lethargic, showed no interest in eating and then began throwing up. She was hospitalized and her blood work showed extremely elevated ALT, AST, Alk Phosphatase, and CPK levels. Essentially her liver was beginning to fail. After a month of antibiotics, she was able to recover fully. However at the time no connection was made between the Tresaderm and the illness. Just 3 weeks ago, she was prescribed Tresaderm again, and the same exact pattern began to happen after finishing treatment. Luckily this time, I recognized the connection between Tresaderm and the symptoms. The blood work showed the same elevated levels, and she has begun another round of antibiotics. Unfortunately my Vet is not open to the possibility that this is related to Tresaderm. However, upon doing more research, this does seem to be a side effect (somewhat rare) that is occurring with other cats.
I have also opened up a case with the drug company, and I encourage anyone else to do the same having a similar issue. The name of the company is:
BOEHRINGER INGELHEIM ANIMAL HEALTH USA INC.
3239 SATELLITE BLVD., DULUTH, GA, 30096
And they can be reached at:
1-800-325-9167

I have also included images of the blood work, in case anyone with a similar issues would like to compare.