dog liver failure
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How to Decide When to Euthanize a Dog with Liver Failure

KEY POINTS
Liver failure in dogs is a serious health condition with many different causes. 
Acute liver failure in dogs has a survival rate of less than 20%. End-stage chronic liver disease also has a poor prognosis.
The decision to euthanize a dog with liver failure must consider their chances for recovery and the amount of suffering they’re experiencing. 

My heart goes out to anyone who is here because a canine friend has liver failure. This disease, whether it started slowly or suddenly, can be a challenge for both dogs and their humans.

My clients are advised to consider the euthanasia of a dog who has liver failure if they have not eaten for more than 48-hours. Other signs include difficulty sleeping, seizures and constant pain. They may also be incontinent or unwilling to interact with their family.

EUTHANIZING A DOG WITH LIVER FAILURE

How can I tell if my dog has a good quality of life?

It can be hard to decide when to put down a dog who has liver failure. Even with the best of care, there is a 20% chance that your dog will recover. Consider letting your pet die peacefully rather than suffering needlessly for a few more days.

You can use a questionnaire to determine if your dog is living a healthy life. My clients are recommended to use the HHHHHMM Scale of Quality of Life. The scale focuses on the ability of your pet to eat, drink and participate in daily activities.

Answering the questions objectively is important. It’s also a good idea to ask a friend or family member for their opinion. You should carefully weigh all your options before deciding to euthanize your pet.

The decision to say goodbye

Dogs can be affected by liver failure in various ways. Some dogs may have only a poor appetite or vomiting while others are so sick they can’t move and pant in pain. Although it may be obvious that the pet in question is suffering from a serious illness, it can still be difficult to make an objective decision when your beloved pet is involved.

Many pet owners regrettably admit they delayed euthanasia until the crisis was over. However, I have rarely heard anyone say that they euthanized a pet too early.

OVERVIEW

What is the benefit of a healthy liver for dogs?

The liver is an important organ in the body that has many functions. The liver is extremely tough and can regenerate itself after damage. The liver plays a number of important roles, including:

  • Blood clotting proteins are produced
  • The production of bile acids to aid in digestion
  • Create new red blood cells
  • Metabolizing carbohydrates, fats and proteins
  • Storing essential vitamins & minerals
  • Eliminating toxic substances and drugs from bloodstream
  • Supporting your immune system

What causes liver failure in dogs

When more than 75% of an organ is damaged, it is called liver failure. (3) Liver failure can be acute or chronic. A dog suffering from chronic liver disease can experience sudden and significant symptoms worsening. This is known as acute on chronic liver failure.

Acute liver failure (ALF) can be caused from toxins, drug interactions, infectious diseases and parasites. ALF can be a bit more likely to recover in dogs than those who develop the disease slowly.

Chronic liver failure is the result of chronic liver diseases that progress and eventually lead to cirrhosis. The chronic liver disease that affects many dogs can be caused by Copper accumulation or other causes.

What is the effect of liver failure on my dog?

The liver failure can affect multiple body systems. It causes fluid accumulation, a slow blood clotting process, increased susceptibility to infection, scarring and brain damage because of high ammonia levels.

Does my dog’s liver disease hurt?

Dogs may not show any obvious signs of pain due to liver failure. You should observe your dog carefully and assess their behavior objectively.

Compare how they behaved when they were healthy and happy. Do they still eat with enthusiasm? When you return home, do they greet you? They can still relieve themselves outside.

It’s always best to consult your vet if you are unsure of your dog’s health. Even if recovery is not possible, your veterinarian can make your dog feel as comfortable as they possibly can during the remaining time.

SYMPTOMS

In 2016, a study of 49 dogs suffering from acute liver insufficiency revealed that the most common signs were vomiting, loss of appetite and neurological problems. Other symptoms included excessive thirst and increased urination. (5)

Some other common symptoms include:

SymptomDetails
Poor AppetiteNausea from blood toxins, gastritis secondary to liver failure
VomitingNausea from blood toxins, gastritis secondary to liver dysfunction
Increased thirstPhysiological attempt to balance increased fluid loss and dilute blood toxins
Increased or decreased urinationDue to changes in thirst, electrolyte abnormalities, blood sugar abnormalities
Strange behavior (wandering, circling, vocalizing)High blood ammonia levels, hepatic encephalopathy 
SeizuresFrom the buildup of toxins in the blood, low blood sugar
Bruising or spontaneous bleedingAbnormal blood clotting
Jaundice (often seen on skin, tongue/gums and white part of eyes)Excess bilirubin in the blood
Edema (noticeable fluid collection in legs, underbelly, etc)Abnormal lymph circulation or infection
ShakingReaction to toxin buildup or pain
DroolingSecondary to nausea
FeverResponse to liver inflammation or infection
Diarrhea–may be bloody, orange or yellow coloredAbnormal blood clotting, poor digestion, increased bilirubin 
Weight lossDue to poor appetite, abnormal food metabolism
Distended abdomen/ascites (fluid in the abdomen)Decreased albumin (a blood protein) production, increased pressure on liver blood vessels 
Increased pantingPhysiological attempt to balance blood gases, response to pain and nausea
Strong foul breath odorBuildup of toxins in the blood
Dark yellow or orange urine High bilirubin levels in blood
Bloody or blackish stoolAbnormal blood clotting
Increased infections Poor liver function not supporting immune system
Crusting of lips, nose, feet, elbows and around the eyes Rare-hepatocutaneous syndrome possibly due to cellular starvation and nutritional imbalances 

RISKS

Which dog breeds are more prone to liver disease?

Some dog breeds have more liver problems than others. Some have congenital problems like portosystemic shunts and others are suspected to lack normal liver de-toxifying processes. 

  • American Cocker Spaniel
  • Australian Cattle Dog
  • Australian Shepherd
  • Bedlington Terrier
  • Bichon Frise
  • Cairn Terrier
  • Dalmatian
  • Doberman Pinscher
  • German Shepherd Dog
  • Golden Retriever
  • Havanese
  • Irish Setter
  • Irish Wolfhound
  • Labrador Retriever
  • Maltese Terrier
  • Miniature and Toy poodles
  • Miniature Schnauzer
  • Old English Sheepdog
  • Pekingese
  • Pembroke and Cardigan Welsh Corgis
  • Pomeranian
  • Samoyed
  • Scottish Terrier
  • Shih Tzu
  • West Highland White Terrier
  • Yorkshire terrier

CAUSES

What causes liver failure in a dog?

According to one study, cancer, Leptospirosis, and disruption of the blood supply were the leading causes of liver failure in dogs. More than 900 substances, including medications, toxins and herbs, have been identified to be factors in ALF (3).

Drugs

The most common cause of liver failure among dogs is drugs (2). Some drugs directly damage hepatic cellular tissue, while others cause an unexpected adverse reaction. Idiosyncratic adverse reactions are usually caused by the liver converting the drug to a toxic substance.

Non-steroidal anti-inflammatory medications, Lysodren and ketoconazole, as well as trimethoprim sulfa are the drugs that are most likely to cause an idiosyncratic reaction.

It is impossible to know which dogs are going to have problems and which won’t. It may be safe for most dogs, but it can cause serious problems in some.

Infectious Diseases

Infectious diseases may destroy the liver tissue and function. The risk of infection is higher in young dogs and dogs that are kept outdoors.

  • Viral – Canine Adenovirus I (puppies)
  • Bacterial – Leptospira, Salmonella, Rickettsial/tick-borne
  • Fungal – Histoplasmosis, Blastomyces, Coccidioides
  • Parasitic Heartworms and protozoa

Congenital Disease

Congenital diseases are problems that exist at birth but may not manifest themselves until later in life. These can be caused by abnormal circulation, or by abnormal cellular functions.

Portosystemic Shunts (PSS),, and Portal vein Hypoplasia both cause blood to not flow through the liver. Copper Storage Hepatopathy (CSH). occurs when too much copper is stored by the liver as a result of abnormal cellular elimination.

Toxins 

Dogs often eat things they shouldn’t and the world is full of potential liver toxins. It could be a chewed plant from your yard or a fungus in their food. Sometimes we don’t even know where the toxin came from.

Some common toxins that can cause liver failure in dogs: 

ToxinDetails
AflatoxinToxins produced by certain molds. Dog food can cause liver failure if it contains high levels of aflatoxin. 
Amanita phalloides (Death Cap), Amanita virosa (Destroying Angel) & various other mushroomsWild-growing fungi contain strong toxins that affect the liver
Blue Green Algae (cyanobacteria)Type of bacteria that grows in water that is highly toxic to humans and animals
Chemicals, industrial solvents and heavy metals Lead (ammunition, batteries), zinc (pre-1982 pennies)
Pennyroyal oilPlant-derived oil used medicinally in humans and as a flea repellant in animals
Sago palmOrnamental plant
Xylitol (1)Sugar substitute used to sweeten many human foods

Cancer and Pancreatitis

Inflammation of the pancreas causes pancreatitis. In dogs with severe pancreatitis, pancreatic enzymes may leak into tissues in the abdomen. The inflammation that results can cause liver damage.

Primary cancer of the liver in dogs is very rare, and accounts for less than 1.5% all cancers. Metastatic liver cancer, or cancer that has spread from another site in the body to the liver, is more common. Cancers in older dogs, such as hypodermal haemangiosarcoma, are more likely than younger dogs to spread to the liver.

DIAGNOSIS

How can liver disease in dogs be diagnosed?

  • Physical exam: a shrunken/enlarged liver, yellowed or pale skin, abdominal pain and fluid wave/ascites.
  • Blood tests: elevated levels of liver enzymes. Especially ALT. It is concerning when the dog liver enzyme is four times or higher than the upper limit of the normal range. ALT levels above 500 U/L are a sign that the liver is in a severe state. These numbers can sometimes go down when the liver is in its final stages. Bilirubin can also be elevated above 2.9mg/dL (10). Bile acid tests liver function when the diagnosis is unclear. Blood-clotting tests can also be prolonged.
  • Radiographs
  • Ultrasound imaging
  • Biopsy can be performed without surgery

TREATMENT

What is the treatment for liver failure in dogs?

The first step is to determine the cause of liver diseases and then treat them appropriately. Not all liver diseases can be treated and it’s not always easy to determine the cause.

Dog liver disease is treated with supportive care. Anti-nausea medications, antibiotics, and liver support like ursodeoxycholic and SAM-e can be used. If your dog is still consuming food, therapeutic diets may be beneficial.

Hospitalization is required for dogs who cannot eat, or show extreme liver failure symptoms. For severe cases, IV fluid therapy and therapeutic enemas are used. Plasma transfusions may also be required.

Can dogs get liver transplants?

It is technically possible to give your dog a liver from another dog. It’s partly because it’s too expensive. Another reason is that graft reject is a big problem in dogs that’s hard to control.

Stem cell therapy is a related treatment which shows promise. A Chinese study published in 2019 showed that canine adipose-derived mesenchymal stem cells injected intravenously helped restore some level of liver function in dogs with experimentally-induced liver damage (10).

The research on stem cells in dogs is encouraging, but it still has a way to go before they can be proven to be safe and effective.

PROGNOSIS

How long can dogs live with liver failure?

Dogs with liver failure can have a bad prognosis. Most dogs only survive a few weeks. The dogs with the lowest survival rates are those that have a significantly high bilirubin level, blood clotting problems, or hepatic neuropathy.

Prognosis is poor for dogs suffering from acute liver failure. More than 80% die despite all treatment. Chronic liver disease patients have a higher chance of survival, depending on their cause and whether they can receive a specific treatment.

It is not likely that a dog will recover once it reaches the end-stage of liver disease.

Home Care

What should I give my dog with liver disease end-stage?

Consult your veterinarian before feeding a dog who has liver disease.

It is generally best to avoid eating foods that are high in protein. Nutritional protein can cause high blood ammonia due to a compromised liver that cannot properly process protein.

Hill’s l/d prescription diets are designed with limited digestible proteins to reduce ammonia production. You can reduce liver strain by feeding your dog 3-4 smaller meals per day.

SUMMARY

The quality of life questions should guide your decision. Your decision will be guided by the veterinarian’s prognosis and the underlying cause.

Euthanasia for dogs is an option when your dog refuses to eat, suffers from nausea, vomiting or diarrhea, cannot walk, and appears uncomfortable. Euthanizing your dog is a good option if he has bad days most of the time.

References

  1. Dunayer, E. K., & Gwaltney-Brant, S. M. (2006). Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. Journal of the American Veterinary Medical Association, 229(7), 1113-1117.
  2. Guilford WG, et al. In: Center SA, ed. Strombeck’s Small Animal Gastroenterology, 1996; 654.
  3. Hackett, T., DVM, MS, DACVECC. (2011). Critical Care Management of Acute Liver Failure in Dogs & Cats. In American College of Veterinary Internal Medicine (ACVIM) forum 2011: Denver, Colorado, USA, 15-18 June 2011. Lakewood, CO, CO: American College of Veterinary Internal Medicine. Retrieved March 26, 2021.
  4. Johnson, Tony, DVM, DACVECC. Acute Hepatic Failure: Yellow Is Not So Mellow. In International Veterinary Emergency and Critical Care Symposium 2014: Veterinary Information Network, Davis, CA, USA. Retrieved March 26, 2021.
  5. Lester, C., Cooper, J., Peters, R. M., & Webster, C. R. (2016). Retrospective evaluation of acute liver failure in dogs (1995-2012): 49 cases. Journal of Veterinary Emergency and Critical Care, 26(4), 559-567.
  6. Plumb, D. C. (2018). Plumb’s Veterinary Drug Handbook: Desk. John Wiley & Sons.
  7. Scherk MA, Center SA: Toxic, Metabolic, Infectious, and Neoplastic Liver Diseases. . St. Louis, Saunders Elsevier 2010 pp. 1687-1689.
  8. Twedt, David C., DVM, DACVIM.  Acute Liver Disease.  In American Board of Veterinary Practitioners (ABVP) forum 2014: Department of Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA. Retrieved March 26, 2021.
  9. Weingarten, M. A., & Sande, A. A. (2015). Acute liver failure in dogs and cats. Journal of Veterinary Emergency and Critical Care, 25(4), 455-473.
  10. Yan, Y., Fang, J., Wen, X., Teng, X., Li, B., Zhou, Z., … & Hua, J. (2019). Therapeutic applications of adipose-derived mesenchymal stem cells on acute liver injury in canines. Research in veterinary science, 126, 233-239.

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