High ALT in my 4 Year Old Cat
Hi everyone! I’m hoping to get some advice, ideally from a vet or anyone who has dealt with something similar.
* Species: Cat
* Age: 4.5
* Sex/Neuter status: neutered
* Breed: Persian
* Body weight: 4.04kg (as of yesterday)
* History: urinary issues, pancreatitis
* Clinical signs: Throwing up, lethargic, not eating. Has improved since last week
* Duration: 1 week
* Your general location: Toronto, Canada
* Link to bloodwork: https://www.dropbox.com/scl/fo/h6rhftyzpbxxre6wffbnh/ADfxS0h7cCZjn9NMuB5ymtE?rlkey=v4mvkmjpbvyapzriznwnzicwa&st=nyi32g52&dl=0
Last Thursday, I noticed my cat, Arlo, seemed to be in some pain when I picked him up. He also refused to eat dinner and ended up vomiting a little that night. He was diagnosed with pancreatitis last year, so my first thought was that he might be having another flare-up.
I took him to our regular vet first thing Friday morning. His bloodwork was normal aside from his ALT, which was elevated at 565. He had also lost some weight, going from around 4.3 kg to 3.94 kg. The vet sent us home with medication and recommended repeating his bloodwork in a few weeks to see if his ALT improved.
Two days later, he was still acting very unlike himself, so I decided to take him to the animal hospital.
The hospital vet said one possibility was some type of bacterial infection. He prescribed antibiotics and an appetite stimulant and told me to continue the Denamarin prescribed by our regular vet. They repeated his bloodwork, and his ALT had come down to 423.
The hospital vet said his biggest concern was the weight loss and recommended getting Arlo on the waitlist for their internal medicine department. The plan would be to do an ultrasound and, depending on the findings, potentially take a small liver sample for further testing.
Since coming home, Arlo has thankfully been doing much better. He’s eating again, has more energy, and seems much more like himself.
Unfortunately, the internal medicine appointment and ultrasound won’t be available for another 7 weeks. Because of the wait, the hospital vet suggested having our regular vet repeat his bloodwork in the meantime.
I took Arlo back yesterday, and his ALT has gone back up to 522.
The hospital vet had previously told me that if his levels weren’t improving, I could bring him back through the ER and they may be able to do the ultrasound sooner that way. So now I’m torn.
On one hand, Arlo seems to be doing considerably better (he’s eating, more energetic, and acting more like himself.) On the other hand, his ALT is still significantly elevated and has increased again. His weight has gone up slighly since last week, and now he is at 4.04kg.
Would you wait the 7 weeks for the internal medicine appointment since he seems to be feeling better, or would you bring him back to the ER to try to have the ultrasound done sooner?
I’m also leaving for vacation in a few weeks, which is making me extra anxious. I’m worried that if I wait, something could happen or his condition could worsen while I’m away.
I know nobody can diagnose him over the internet, but I’d really appreciate hearing from any vets or anyone who has dealt with a similar situation. I’m especially curious about how concerning the ALT trend (565 → 423 → 522) is when a cat is otherwise showing a bit of improvement.
Thank you so much!