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Alkaline Phosphatase (SAP), High

The patient was presented for painful abdomen, pyrexia, vomiting, and anorexia. After 12 hours on IVF and supportive care the patient's pyrexia resolved and there was no further vomiting. A painful abdomen persisted and mild icterus was evident in both the sclera and mucous membranes. The patient was treated with Cerenia, Unasyn, Metronidazole, Gabapentin, and Famotidine. Blood chemistry found AST 70, ALT 553, ALK. Phos. 8162, GGT 46, T. Bili. 7.2, K 3.4, Chol. 720, Trig. 609, amylase 2038, PSL 697. Urine specific gravity 1.011, proteinuria 2+, bilirubinuria 3+.

12-year-old MN DSH with a history uncontrolled diabetes mellitus was presented for evaluation of ravenous appetite, shaking, and restlessness. Current therapy was 9 IU PZI SQ BID.  Urinalysis showed SG of 1.024 and glycosuria. CBC was within reference range. Abnormalities on serum biochemistry were hyperglycemia, elevated ALT and ALP activity, and hypokalemia. T4 was within reference range.

An 11-year-old MN Maltese mix was presented for evaluation of progressive elevation of liver enzyme activity. Blood work showed elevated ALT (530) and ALP (1255) activity and mildly elevated cholesterol.

The patient was presented due to panting, urinary accidents, PU/PD, +1 polyphagia, hepatomegaly on radiographs. Urinalysis revealed hematuria, pyuria, and hyposthenuria. U/A: USG 1.002, protein +2, WBCs 4-10, RBCs 11-20, rods 26-50. Blood chemistry results: ALT 283, Alk. Phos. 226.

An 11-year-old MN Yorkshire Terrier presented for a second opinion for a 4-week history of back pain; an L2 lesion is suspected. Previous treatments were Gabapentin and Tramadol, but the patient showed no improvement. The patient was still very painful, reluctant to move, and baring teeth when owner tried to pick him up. The area of L2 appeared normal on radiographs. CBC was WNL, blood chemistry found an Alk. Phos. of 187 and a PSA lipase of 528. Urinalysis showed 2+ protein. A left medial liver nodule, likely lipogranuloma or benign lesion with minor renal mineralization was seen on ultrasound. The sonographic findings were not contributing to this patient's pain and there was no evidence of visceral disease that could be contributing to the clinical signs. A CT of the spine with contrast was strongly recommended given the patient's symptoms.

A 14-year-old, MN, 13.5 lb Maltese was presented for a possible syncopal episode after going upstairs and breathing heavier. The patient was treated with enalapril 2.5 mgs PO SID and scheduled for an echocardiogram. Physical Exam: Grade 4/5 murmur. Radiograph indciated severe cardiomegaly. BP 117/74 Map 90. CBC: Normal. Chemistry: Alk. Phos 1340.

An 8-year-old, F/S, 77 lb, Pitbull terrier was presented at RDVM for decreased activity level and behavioral changes. Blood work was performed and showed an increase in ALKP. The patient also had a dental cleaning recently where they extracted multiple teeth and put her on oral Tramadol. Owner says that she was “normal” on March 20th but has slowly been declining. Repeat blood work showed an increase in ALKP. Unable to perform physical exam due to hyper response. Owner reported the patient had become very head shy and aggressive with other dogs and had drastically changed in personality. RDVM recommended a brain CT scan and it was decided to include the liver due to increased ALKP.

The patient is a 14 month old M Miniature Australian Shepherd dog who presented with an acute case of vomiting, lethargy and ataxia.  The owner was unaware of any exposure to toxins or ingestion of obstructive material. Physical exam: 10% dehydrated; mm pink but tacky; abdomen tender on palpation; weight wnl. CBC/Chem: WBC 21,120, decreased cholesterol and protein; elevated CK, ALKP, ALT, BUN and ammonia. Lepto negative.

The patient was presented for vomiting 3-4 days prior. Was recently gagging, not urinating often despite normal drinking. The patient had a decreased appetite or was not eating at all and having innappropriate defecation in the house. Blood chemistry showed liver enzyme elevation and low BUN. Bile Acids test results were high at 464.6 umol/L. An abdominal ultrasound was recommended to rule out PSS, liver disease. possible infection- Lepto? (patient from Ontario, Canada), toxin, glomerulopathy, protein starvation, chronic non-obstructive FB, Addison, glomerulopathy, other.

An 11-year-old Cavalier King Charles Spaniel was presented for poor appetite and diarrhea. CBC revealed anemia and a hematocrit of 33. Blood chemistry revealed a low total protein of 3.4, albumin of 1.4, and ALKP of 487.

 12-year-old MN Labrador mixed breed was presented for evaluation of anorexia, vomiting, and lethargy. Abnormalities on CBC and serum biochemistry were severe leukocytosis,neutrophilia, hemococentration, and elevated ALP (600).

An 8-year-old FS mixed breed dog was referred for partial anorexia and mild lethargy. Mild painful cranial abdomen was noted on physical exam. CBC and chemistry panel were unremarkable. Urinalysis revealed 3+ proteinuria with isosthenuria. Blood pressure was 220 mm Hg.