Daisy’s Case: Supporting Liver Health Through Supplementation

Sponsored by Nutramax Laboratories Veterinary Sciences, Inc.

Liver function and overall hepatic health can be impacted by numerous potential causes, including acute and chronic inflammatory causes, toxic insults, infection, biliary conditions, vascular abnormalities, genetic disorders such as copper storage disease, and chronic drug administration, such as with NSAIDs and anticonvulsants.¹

Definitively diagnosing liver disorders can be frustrating, as clinical signs are often vague or may be absent altogether in the early stages of disease, and laboratory abnormalities are often nonspecific for the underlying cause. Although some owners elect to pursue a full diagnostic investigation, there are many situations when that is not feasible, leaving monitoring for the progression of clinical signs or laboratory changes as the only available approach.

Hepatic supplements are an option that can be used to support hepatic health during the diagnostic investigation, patient monitoring, and/or recovery from an acute hepatic insult, even in cases without a definitive diagnosis.

Case Presentation

Daisy, an 8-year-old spayed female Labrador retriever, was presented for a routine annual examination and wellness testing. Daisy had been acting healthy and well at home and was not receiving any medications. Physical examination was unremarkable. CBC, serum chemistry, and electrolytes were ordered, and CBC and electrolyte results were normal.

Serum chemistry profile revealed elevation of some hepatobiliary enzymes: ALT (472 U/L [reference range, 18-121 U/L]) and AST (294 U/L [reference range, 16-55 U/L]). ALT and AST are leakage enzymes, which become elevated in the presence of hepatocyte damage. This occurs most commonly in cases of hepatitis, infectious disease, hepatotoxicity, and neoplasia.²

Daisy’s ALP (82 U/L [reference range, 5-160 U/L]) and gamma-glutamyl transferase (GGT; 0 U/L [reference range, 0-13 U/L]) remained within normal limits. ALP and GGT are inducible enzymes that increase most notably in the presence of cholestasis or other biliary conditions, endocrine disorders, benign hepatic hyperplasia, and neoplasia.²

Elevations in hepatic enzymes have high sensitivity for hepatobiliary insults but low specificity.² Numerous extrahepatic conditions, including GI disorders and endocrine imbalances, can cause elevated enzyme levels. In addition, elevations in these enzymes do not provide information about hepatic function.² On serum chemistry profiles, values such as glucose, albumin, BUN, cholesterol, and total bilirubin are nonspecific markers of liver function.³ Paired bile acids (pre- and postprandial) and ammonia levels are more specific tests for liver function.³

Upon further evaluation of Daisy’s history, similar elevations were noted 6 months prior on preanesthetic blood work for a dental cleaning; thus, testing and imaging were recommended to evaluate liver function and search for an underlying cause to the persistent enzyme elevations.

The owner declined additional testing but inquired about additional ways to support Daisy. The veterinarian advised the owner to monitor for progressive clinical signs and recommended a liver health support supplement, Denamarin® Advanced, and a plan to recheck hepatic enzymes in 6 weeks.

Supplemental Support for Hepatic Health

Denamarin® Advanced contains 2 active ingredients that support liver health: S-adenosylmethionine (SAMe) and silybin-phosphatidylcholine complex (SPC). The active ingredients have been shown to be well-tolerated by dogs and cats.⁴

SAMe supplementation has been shown to support liver health by markedly increasing liver levels of glutathione.⁵ Glutathione levels have been shown to be decreased in dogs and cats with the most common causes of liver dysfunction, making SAMe supplementation appropriate in most of these patients.⁵ In addition, SAMe plays a role in supporting hepatocyte health, may help support hepatocyte repair and regeneration, and can support cognitive function in dogs.^6-8

Denamarin® Advanced utilizes the latest SAMe innovation to provide a more bioavailable form of SAMe as compared with the original Denamarin®, allowing for lower administration levels as compared with the original as well.

Silybin is the active component of silymarin, which is extracted from milk thistle,⁶ and helps to maintain oxidative balance as a free radical scavenger to support biliary health.^6,9 The silybin in Denamarin® and Denamarin® Advanced is in a phosphatidylcholine complex, which increases bioavailability in dogs and cats.^9,10

Denamarin® Advanced should be administered on an empty stomach 1 hour prior to a meal to maximize absorption. However, it can be administered with <1 tablespoon of food if needed, offering convenience for pet owners.

Case Outcome

Daisy’s serum chemistry profile is rechecked 6 weeks later. The results showed persistent AST and ALT elevations. The veterinarian counseled the owner on options, including referral to a specialist for further diagnostics or empiric treatment for potential chronic hepatopathies. During this discussion, Daisy’s owner expressed interest in getting more information about the cost of additional diagnostics before making a definitive treatment plan decision. In the meantime, her veterinarian recommended continuing Denarmin® Advanced for its hepatoprotective benefits^4-10 and monitoring Daisy closely for any clinical signs of disease.

Conclusion

In cases of elevated hepatic enzymes, it is ideal to pursue a definitive diagnosis, which can help guide management recommendations and provide prognostic information. However, understanding the role of hepatic veterinary supplements helps ensure that, even in cases of uncategorized liver disorders, pets can receive the benefits of supportive care.