Copper Hepatopathy In A Labrador Retriever.docx

Jerome Olitin

Copper Hepatopathy in a Labrador Retriever

Case: Angel is a 3-year-old female, spayed Labrador retriever who has shown signs of copper hepatopathy, originally presenting with a history of gradual decrease in appetite. She was taken to her primary care veterinarian (Dr. Braunstein), where they took X-rays to look for an obstruction, and there were not any, but she was dehydrated. She was hospitalized overnight at an ER clinic for IVF therapy. The ER clinic ran some blood work that found elevations in her liver enzymes. Over the next few days Angel became increasingly inappetent where she would only eat a small amount of food, then refused to eat anything else. She has vomited water a couple times over the last few days. The owners have also noted that she has been drinking excessively for about one week, and has been having accidents on herself while she sleeps (this would only normally occur about every six months). The owners have noticed some weight loss, and that her activity level has decreased, but she is still bright and playful. (The owners are positive that she did not get into any toxins.) The ER clinic sent Angel home on famotidine, Carafate and Baytril. No D/C/S. Up to date on vaccinations, no flea tick or HW preventative and no travel history.

Prior Diagnostics: 12/20/12 CBC/Chem: ALP 185, ALT 998, Phos 1.0, Glu 114, cPLI – normal. Abdominal radiographs – Normal per owner 12/24/12 CBC/Chem: AST 137, ALP 241, ALT 730, GGT 22, TBili 0.5, Lack of stress leukogram

Examination: No abnormalities were noticed on physical exam.

Procedures: Abdominal ultrasound: Unremarkable Rapid lab: PCV 50%, TS, Na 146, K 3.7, Lac 2.06. SNAP Cortisol: 7.7 (normal) Chest radiographs: Mild increased interstitial pattern, skeletal structures are normal. PT/PTT : 19/70 Normal values. Labwork Pending: Bile acids – Pre-meal 27.6 umol/L, Post-meal 12.2 umol/L Laparoscopic liver biopsies: hepatitis, moderate lymphohistiocytic and plasmacytic, with individual hepatocellular necrosis and apoptosis. No evidence of infectious organisms. Copper staining: Copper deposition in a pattern consistent with grade 3 or 4 out of 5 Copper quantification: 1450 PPM

Jerome Olitin

Treatment: Angel was initially started on treatment for the chronic active hepatitis pending the copper stains and copper quantification with prednisone .4 mg/kg po q12 hrs, denamarin large dog, one tablet po q24hrs, ursodiol 11mg/g po q24hr, and Baytril 10 mg/kg q24hrs. Once the copper levels were obtained, penicillamine 9.7 mg/kg po q12 hours was added, and Angel was changed to L/D diet.

Discussion: A breed specific copper hepatopathy has been reported in Labrador retrievers. These dogs may be asymptomatic on presentation with elevated liver enzymes, or may be symptomatic. The most common presenting symptoms of copper hepatopathy include gastrointestinal signs (decreased appetite, vomiting), weight loss, and PU/PD. In Angel’s case, we chose to treat the underlying chronic active hepatitis with prednisone, ursodiol and denamarin as well as start a low copper diet (L/D) and penicillamine (a copper chelator).

Recovery: They continue to monitor Angel clinically for copper hepatopathy, as well as monitor her liver enzymes. Ideally, we will obtain another liver biopsy in six months to monitor copper levels.