Anyone have any experience of increased liver enzymes?

Casey76

Casey76

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As part of a routine health check last year my yearling showed high liver enzymes, high muscle enzymes and low selenium.

He was treated with an injection of selenium and a hepatic natriceutical with a repeat blood test after a month. This showed improvement in both, and had another selenium injection, and another course of Heperal.

Last week I had another repeat done, at the 6 month stage. My horse is now rising 2 and in no work (obviously).

Labs show liver enzymes increased again (though GGT is decreased, but not yet normal), muscle enzymes are very high but selenium is now normal.

We are going to treat for liver parasites, specifically liver fluke, another course of Heperal and again retest in a month. But both the vet and I are stumped.

Blitz is completely asymptomatic, he is playful and cheeky, bright in himself and is in fantastic condition.
 
My MiLs horse was diagnosed with raised liver enzymes after a couple of mild colic attacks. He was scoped (showed v mild grade 2 ulcers), scanned and biopsied. The scan showed his liver was v enlarged and on the wrong side, lots of extra fluid in his gut (but he had colicked the day before & was sedated), but biopsy showed nothing significant.

He was on anti bs for about 10 days and appears to be on the mend. We are waiting for blood test #3 which will be in a week to see if the enzymes have lowered.

Tim Brazil did the scope and biopsy and he was going to see about 15 horses in Kent with similar symptoms. Our vet had 7 on the books at different stages, one was sadly PTS but the others were recovering slowly. It seems to be going round.

I'd get your vet to speak to Tim - he may be able to advise further.
 
It could be a problem with mycotoxins:o following the wet year we have had they are going to be an increasing problem for the next 12/18 months as they are in the cereal crops which go into feed as well the hay and haylage that will be fed.

Have a look at this website for more information on how they can effect horses

http://www.knowmycotoxins.com/horse.htm

They are under recognised as a problem and vets do not commonly look for them or know how to treat. You can have mycotoxin testing done - the most thorough available is from Alltech which looks for 37+ mycotoxins (the others commonly only look for about 5) They are easily treated by feeding a good PROVEN mycototoxin binder.
 
Are the reference ranges being used for adult horses or is the vet taking into account that this is a growing horse? Liver values are different in youngstock.
 
Will post more fully either later tonight or tomorrow, but off out in a few mins.

My gang have had raised muscle enzymes and raised liver enzymes over the last year. It's a bit of an ongoing saga.

What were the values for CK as the main muscle enzyme, GGT, GLDH and any other liver indicators? (together with lab reference limits)....... Just curious to compare them to my gang, and I'll give you an idea of my gang's highs/lows and timescales.

In respect of both muscle and liver problems, I'd have your forage tested for minerals (to include selenium). If the hay/grass or whatever turns out to be a problem, then at least you can do something to address it fairly easily.

Do you feed a vit/min supplement? If so, how much selenium is that providing in a daily ration?

Will be really interested to hear more, and obviously I hope your boy picks up fully.

Sarah
 
Hi FFF; I don't have the lab report for the latest blood test - I'll get it on Thursday when the vet comes back out, but from Sep last year, this is what I have:

Liver:

Total bilirubin 0.4 (0.5 - 3.5) mg/dl
Alk phos 256 (<450) u/l
GGT: 208 (<30) u/l
AST: 1029 (75 - 600) u/l
GLDH: 10 (<12) u/l
Albumin: 3.3 (2.5 - 4.4) g/dl

Muscle:

CK: 578 (<260) u/l
LDH: 715 (<400) u/l
calcium: 3.0 (2.3 - 3.4) mmol/l
Magnesium: 0.8 (0.7 - 0.9) mmol/l

HTH
 
Thanks for all the results. Will be very interested to hear what the latest ones say, and what the selenium levels are/were.

After about a dozen poo tests from 6 ponies in total, we got 1 positive for liver fluke. 1 fluke egg (Fasciola hepatica) in a 3g sample, done by Glasgow university where David Sutton is very interested in liver fluke in horses. I was reluctant to treat for fluke until we had confirmation of it (it just didn't seem right to add another toxin to an already compromised liver, unless we were sure there was fluke there), but as soon as we had that one result we treated all 5 ponies with fasinex 100 as per David Sutton's recommendation. I was petrified there would be side effects, but there was nothing. I just gave the amount in a tasty feed, and all the ponies wolfed it down. I did try intially to administer it by syringe, but it is such a watery milky fluid it just went everywhere except down the pony's throat!

Unless you are going to adopt different strategies depending on the test results, I would probably opt to leave it a few months between blood tests now. That said, I opted for monthly bloods for nearly a year, but at each stage it refocussed me on what I was feeding (and its analysis), and what we might treat for, and how much work I could reasonably expect of each pony, as they all continued to seem well throughout.

The fact your GLDH is within reference is good, because that was described to me as the enzyme which shoots up when there is a liver insult, but then comes down very quickly when the cause of the insult is removed. So that suggests that there isn't an ongoing issue, from what I understand.

I found that GGT takes a long time to come back down. My fabulous vet said that GGT can be frustrating in terms of how long it takes to come back down, and he was absolutely right. My gang went above reference with GGT in June 2012, and it's only this month, April 2013, that all but one are now within reference again. They showed the most improvement the month after the fasinex 100 was administered, but that also tied in with being 8 months after a high level selenium supplement was started (and 6 months since it stopped), so I have no idea which was the most relevant.

The worst affected pony peaked at 2,310 GGT in October 2012, and it went down to 671 in December (after Fasinex in November) and has come back down to about 89 last week (with 45 being the upper reference limit). Everyone else (4 other ponies) were normal this month for the first time since June 2012.

Their peak GGT's ranged between 213 and 2,310, but it was only the 2,310 pony who showed any reluctance to work (and this may or may not be due to the liver stuff), though I did decide to stop work with them for a few months while the worst of the liver stuff was happening.

My gang's CK levels vary between just above reference (of 225) to up to 3,800. Most of the ponies are between 250 and 800, with just one pony being up at 3,800. I initially looked at EPSM (aka PSSM) being a possible cause of the problems in one pony, but all ponies showed up negative on a hair sample for EPSM DNA, and the worst pony showed no abnormalities on a muscle biopsy (more invasive, and more expensive). Might be worth you looking into EPSM in case that's relevant.

With my gang, I felt that as they were all showing signs of work intolerance (varying degrees of reluctance and/or grinding to a halt) selenium deficiency seemed a possibility. Forage analysis confirmed that selenium was low at only 0.04mg selenium per kg of dry matter (a level associated with nutritional myopathy in animals such as sheep, cattle, pigs, camels) and so I still believe that was the cause, although blood glutathione peroxidase (GSH-px) as an indicator of blood selenium was apparently "normal" (but the reference level was not established on horses).

Most ponies showed improvement after about 5 months on a good vit/min supplement with at least 1mg selenium per day, but the worst affected pony has not improved.

If you're not feeding it already, I'd definitely feed a good vit/min supplement like Top Spec, Spillers or Dodson & Horrell at recommended levels from now on. That will also address any possible deficiency in vitamin E levels which could cause raised muscle enzymes.

Hope you find something that helps.

Sarah
 
There are 3 different formulations of Fasinex available as far as I know, with differing concentrations of the active ingredient triclabendazole. One is much more concentrated than the other two. So it's really important to work out the amount of active ingredient when working out the amount to give.

It'd be worth asking your vet to ring David Sutton at Glasgow Uni to check how much active ingredient he is suggesting now. From memory, it was just a little less than the recommendation for cattle per kg bodyweight, but please don't quote me on that.

Sarah
 
Casey,

I meant to ask you when you first posted, but could you tell me which lab was used for blood selenium testing?

I only ask because I think I'm going to ask for one of my boys to have his whole blood selenium tested, rather than relying on the results of whole blood glutathione peroxidase (which is all we've had done in the past, as an indicator of selenium, but the reference range is not well established on horses).

Think I'll start a new thread to ask this as well.

Many thanks

Sarah
 
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