Decoding Laboratory Tests: Insights into Blood Chemistry for Veterinary Care

Music. Really, the goal is just to use our stories to bring veterinary medicine to life for the pet caretakers of the world.

And we're doing it because we believe that educating these caretakers is the most powerful thing that we can do to improve the life quality of all of the pets that we love. Hello, Vet Tales. Hello. Dr. Natalie Keek. Dr. Josiah Vane.

And today is part two of Bloodwork. Yes. we're doing chemistry today instead of the cbc we did last time complete blood count and we did a little bit of quality yeah and that's talking about like our whole cells and knees are going to be like enzymes and electrolytes and markers and proteins indeed so we're going to go through basically we just have literally a list of the things that we see in many of our common blood panels why we're looking at

them what they mean do we care when do we care what do we do when we care and so forth and when do we do lab work yeah anytime i can yeah it gives a great window into the body allowing us because we can't ask them like what are you feeling currently well i mean and even if you could like they would just be like they'd be like thirsty i feel thirsty and you're like great so is that your kidney or is that your diabetes or like you know do you have Diabetes insipidus? What's going on? Exactly.

And so, yeah, lab work is great just on a wellness side of things too. Yearly, definitely when patients are geriatric, but then obviously we commonly do it when pets are sick. So, phony, diarrhea, TPD, which means pre-K and peeing more often. Inappetence, chronic diarrhea, or waxing amani diarrhea, like all the Addison's talks that we had not too long ago. You know, that kind of, I don't know, just all sorts of different weight loss.

Weight loss. Yeah. Classic. Thanks. Yeah. Basically, if you have a pet that isn't well, blood work is a good idea. And then also, like we like to do them at seven plus screenings to, you know, get a head start on these things. If we're running blood work annually and you're noticed that kidney value was like low last year and then it's like middle ground the next year, you start going, hmm. And then you might check it a little sooner and go, yeah, that's still climbing.

This dog's normal is elevating because it's a range. So one dog's normal might be 15 and all of a sudden it's 29. Well, that's still normal or 24, let's say.

And that's still normal, but it's not that dog's normal. And so now you're seeing this uptrend and you go okay we need to start watching this way closer because you can make easy modifications early that aren't going to cut the mustard later if you're catching this dog when it's in full-blown renal failure you can also have dogs who have slightly higher values like as normal so my personal dog comes to mind hannah who has always since a puppy ran slightly high

on and right it's free to me and i'm like assistant i'm like excuse me and y'all i'm like it's fine but now you know what her more normal is and then through the years yes it's just and just slightly abnormal on the range and that's her yeah this is well and they have that um dna test that they they if we get the marker the alt one yeah and then basically what the dna says is they have a gene that is going to make this dog's alt look

low all the time and that is normal for this patient because of the way its genetic makeup is. And so those healthy early blood tests help us understand normals. And so anyway, yes. So those are times that we're screening before pre-anesthetics, when your dog is sick, you know, that kind of thing.

So, what do you think? Do you want us to just start with A? Yeah, we'll start with A. These are... Are these an alphabet? I was like, why do they think this word? The alphabet. The alphabet as opposed to organ system. Yeah. Yeah. Yeah. All right. So, A, albumin. I love albumin. It's one of my favorites. It's a protein. It's a protein. It's the bigger protein. It is. And its main job is to keep oncotic pressure

normalized. So basically think about like, this is the way I explain it to clients, like strawberries. If you put sugar on them, all of the water leaves the strawberry and goes to the sugar. And then you have syrup. It's great. So basically the albumin is acting as the sugar, if you will, and the liquid wants to stay with it. So if you have enough albumin in your bloodstream, the liquid stays in your bloodstream.

And if you do not have enough albumin, then it leaks out into your body cavities or tissue, and that is bad. We call that hypoprovenia. We do. And then it causes edema, ascites, or effusion. Yep. And it's not fun. But we'll look at that albumin on the lab, and it's made by the liver. Yeah. So you, in end-stage liver disease, you can have a decrease of that too. We commonly evaluated for hydration status, hemorrhage.

So if you have a really low one and you have an acute hemorrhage, that might could be. Might could be. Might could be not. Might could be not. And then hydration. So it'll be high in a dehydrated dog. Yeah. And then if it's low, you have to say, okay, well, are we leaking it, losing it in the intestines or the kidneys? Are we just like flat not making it? That's less common. Usually it's leaking out through the gut or the kidney. And so then you go hunting for problems. Yeah.

But that's the reason why we see it. Next one is ALP or alkaline phosphatase. Yeah. Or we call it ALKFOS, yeah. ALKFOS, yeah. Alkaline phosphatase. Typically elevated due to hepatophtase, liver image, liver-related things. The most common reason we see it in older dogs was going to probably be Cushing's disease. So Cushing's disease, which we've talked about before and go back and listen to that podcast. That's where your body's making too much cortisol and your ALP will just skyrocket.

So these dogs are like 700 plus. Commonly like 1200, I feel like. And then they got the typical Cushing's appearance. So when I see that, I see the dog on exam, I go, great, let's go investigate Cushing's disease. When do we see an elevation that we don't get worried about though?

When they're already on like phenobarbital, is that what we're talking about? Or Pred, you know yeah they can have medically induced elimination alp that we may not be concerned about because it should resolve and that's because of the secondary prophecies that can occur yeah because the liver's just working harder and so you kind of expect that as a as a secondary finding when these dogs have to be on these medications

and you just go yeah like when you have immediate amyloidic anemia not and we're like you're on such high dose of steroids and you recheck their lab work 30 days later you're like that alp is super high but i know why it's Because I've had you on bread and we're going to get off of it soon. And yeah. And then puppies. Oh, yeah. Growing animals. Because ALP with bone growth. Because it's ALP, which is like phosphorus.

And the phosphorus will, because that's another separate thing, which we'll go over later, but it also will be high normally. Yeah. And so basically you're going to be doing your pre-labs on your puppies and you might be like, oh, there's an ALP elevation. Oh, we're a puppy. We're growing. The bone growth causes the phosphorus levels and ALP levels to be. All right. And then the next one, then I'll let you do a couple. All right.

Alamine aminotransferase, or ALT, which is also a liver value. That's the one we care most about. Commonly, people would hear me say, I care about ALT. That indicates liver damage. So those hepatocytes, those liver cells, they're getting destroyed. Yeah, and their little bitty contents are going all over the place, and the bodies happen to take it up in the bloodstream. Yeah, and that could be caused by so many things. Yeah, hepatitis, which could be like autoimmune. It could be infectious.

It could be like a secondary. Storage disease, which is just. Copper, yeah, stuff like that. Maybe hepatic lipidosis in a cat. Trauma. Oh, yeah. So dogs who get kicked in the belly by horses. Or hit by cars. Yeah, hit by cars. I'm like, recently I'm thinking of the one that got kicked by a horse. And that will cause an ALT elevation.

Have any any toxins a lot of oh yeah definitely cause an alt elevation yeah so that's super common like if they get into the bottle of aspirin or ibuprofen definitely yeah i've seen it with some mushroom ingestion you know let's see that too like they're like naturally growing ones in the backyard that is yeah and then there's with alt there is definitely a range there too where like you can the normal range i think is about 120 ish in dogs 118 120 but technically

it's not a significant elevation until you're three times up the reference interval, so closer to the 300s. Yeah, so if I see one 150 or 178, I go, meow, meow, meow. Okay. That's fine. I'll keep an eye on it. Keep an eye on it. Yeah, that's usually what I tell people.

I'm like, let's keep an eye on it. If you want to be aggressive, we can do some ultrasound, some look in, some peek in, because, you know, obviously, like, if it's a 12-year-old dog with a mild elevation, I'm like, let's just make sure there's another tumor in the liver. Although, I've seen dogs with wicked liver tumors and not one single abnormality on the blood work. It's just amazing. That's because you only really need... So much. Like 15% or something?

Yeah, I don't know. 25% or 15% before your liver starts to really... Struggle with full function, which is wild to me. Crazy. And then kidneys at 66%? And when you start to see... Yeah. When you start to see some changes, but you really don't struggle until you're down below 30. Our bodies... Compensate. Are amazing. I mean, honestly, there's so much wiggle room. It's crazy. Oh, my turn. I get to hold the paper. All right. It's very exciting. Oh, BUN. I do love BUN.

We may go out of alphabetical order on this one just to hit the kidney stuff. So blood, urea, nitrogen. It's one of our favorite things to look at of the three. There's three of them that we really look at when we're talking about kidney disease. It will be high. Low BUN isn't really a thing that I can think of. Maybe. Cendaline. Yeah, and I'm like, I'm not sure what to do with that. Typically the GGT as well. Yeah, okay.

So anyway, when we have these elevations, it's technically called azotemia, where we have elevated renal enzymes. It can be kidney-related or it can be pre-kidney or pre-renal, meaning the dog is just really dehydrated or the cat. So the way we distinguish the difference is by checking urine-specific gravity. And if the urine is really concentrated, then it could just be dehydrated.

And if you rehydrate them, then the body flushes out all those extra toxins because these are breakdown products that should not be in excess in the body. And so if they are building up in excess, it's either because it's too concentrated because your blood is concentrated or because your kidney isn't getting rid of them like it's. So you could also have post-renal azotemia, which is most common in cats when they are obstructed or any animal with a urinary obstruction,

but it's just really common in cats. And they're little b-men will skyrocket. And sometimes they have concentrated urine. Sometimes it just depends. Yeah, and it really doesn't. You just got to go off a little. Yeah, yeah. And then you unblock them and you give them fluids and 90% of them are fine in terms of their renal values within three days. If not, 12 hours. I mean, it's not, yeah.

Really quickly, depending on how long they've been blocked and how much true trauma there was to the kidney. So I'm going to go to alphabetical order and just go ahead with the creatinine is the other one. Creatinine is a little bit less finicky.

BUN can go up and down. It'll change wildly by 20 or 30 points in a day and can be much more sensitive to things like diet changes, like GI bleeds, increased protein in the diet dehydration creatinine is more even keel if it's elevated you should be more concerned i mean you still get elevated creatinine with just dehydration but it doesn't it's just not as we can blame that one more on the kidney than the u.n absolutely

and have a little bit more things from other things absolutely and then phosphorus is the third one we look at it can also go up with like hyperthyroidism bleeding disorders i don't really know much about that, but that's what the paper actually says here. Oh, I guess because you're digesting the blood product. Yeah. And then panting can cause a falsely elevated phosphorous to ibogum. Interesting. It does change the phosphorus, like excessive panting. Uh-huh.

I think I vaguely recall that when we used to have those. It has to do with blood gas. Yes. And asynosis. Exactly. Things like that. So I believe it causes an increase. I know that y'all probably. Yeah, you maybe don't care. If you do care, fact check us and let us know because we're just going off of memory up here in this alphabetized list. Okay, I'll do one more and then I'll hand it back to you. Calcium.

Tell me what you think of. cancer cancer above 13 I immediately think cancer yeah mild elevation I'm like is our machine wrong right we've talked about yes on this podcast that we you know calcium is finicky but slight elevations can be kidney related really high elevations like I said 13 is when I start my alarm bells start to go off that's when I'm like oh yeah cancer and there's two types of cancers I think I think of lymphoma and I think of Haggisaka or anal gland

I had no person yeah but in school we call it agusaka we did not so every time he says that i'm like i'm sorry.

What is this a japanese alcohol sorry sake yeah sake no is that yeah we just called him adenocarcinomas so agusaka i think richie taught me that i mean he might have i don't know maybe i ignored it i was just like maybe i was like no i'm not saying that i'm not saying agusaka anal gland carcinomas are number one that you're thinking of and then also you can have hyper parathyroidism is the other reason but then you got to get your ionized calcium and it's

a whole nother can of worms yes which if you have elevated calcium disease typically there's a malignancy slash ionized calcium panel that can help you differentiate between cancers and the parathyroid disease and i have i've had a couple parathyroid disease dogs in dallas when i worked there yeah i've had one and that's been probably six years ago it was uh we did not do surgery on her we just managed her with prednisone because that it does help tremendously anyway okay

so calcium yeah tumors hyperthyroidism you can see changes with kidney disease as well uh especially in cats okay your turn all right so back to a amylase oh did i skip one oops i did it okay so am it's fine because i started on bu it's oh my gosh you guys the alphabet amylase amylase is something that we don't evaluate, I feel like, too often. Like if it's elevated and the animal is clinically normal, I will not really care.

But if they're vomiting and they have GI pain, like when I'm pushing on their belly, and I look at the lipase, which is also on our chem panel, and both are elevated, I immediately get concerned about pingree titus. So those are my go-tos for that. Amylase can be elevated in kidney disease because it is also cleaned out by the kidneys.

And I have seen dogs in casks with elevated amylases that are in chronic, terrible kidney disease currently in a patient who has some really hot amylase because of kidney disease, not because of pancreatitis. So, yeah, when I have a vomiting dog and I'm worried about pancreatitis, I look at white face, I look at amylase, and I look at ALP because when vomiting dogs, you can get mild elevations of ALT. Well, if the pancreas is mad, it makes everybody around it mad,

including the liver. Yeah, everybody. Yeah, specifically the duodenum and the liver. And so your liver values will go up on those guys. The leakage sometimes will. Fancy words, triaditis. Oh, I love triaditis. It's such a great wording. It's fun to say. It is. Not great for your patient. No, but they get over it. Yeah, you just treat them, make it over it.

And then retitus reference that. Yeah. And then some other like GI related values that we look at are going to be our, so I have lead-based amylase with the cholesterol. We'll look at triglycerides and cholesterol sometimes, which will play into some of our liver disease dogs, GI dogs, type of thyroid dogs can have elevated cholesterol. Cushing's disease will commonly have cholesterol issues. They definitely do. Diabetes will commonly have cholesterol issues.

And then we'll circle to... Not that we really treat cholesterol issues in dogs directly. You manage the primary condition and usually cholesterol gets better. But we don't have issues in dogs with plaque. What is it? I'm not a human doctor. You know, when you're in your vessels. Coronary artery.

Plaques yeah something and there's like some other word someone with heart is the heart problems in their family is like screaming at us right now as i listen to this um gorillas anyway yeah they definitely whatever it is it builds up in our veins because of high cholesterol does not happen in dogs it the biggest issue is it makes it really hard for our blood machines to breed the blood word what's the breed that schnauzer yes so schnauzers can have a primary hyper cholesterol,

hypertrigalcystinemia, which sometimes you need to treat, depending on if they have like chronic GI signs and they're negative for their thyroid and stuff. And they've got pancreatitis every five seconds. You may do a low-fat diet, which you're already going to do because of pancreatitis. So sometimes. And then there is a medication that you can put them on to how to do once. Most of the time they respond well to a low-fat diet. Okay. Wow. Look at us go. We're just cruising. Yeah.

Let's go to the electrolytes. Oh, gosh. yeah oh god i like potassium potassium i find to be quite helpful, all right so like guys we're looking at sodium we're looking at chlorine we're looking at potassium and yeah it goes through yeah you are but i can't think what it is sodium no you already said that oh potassium sodium chloride potassium and do they count calcium that's what's in our panel. Yeah, isn't it? No. That's not right? Oh my gosh. Okay, you keep talking. I'll Google it.

So wildly important, sodium and potassium. I look at them every single day and go, does this patient have abs? Every day. Every day. Or are they obstructed? Or are they obstructed? It is. No, you're right. This is so dumb. It's called, yes, because it's called light for clip, but it's just sodium, potassium, and chloride. Why is it not the light for clip? They have one of them as the ionized version. Okay. Yeah. I'll give you the complete value. That's just, yes Lucy.

So the two values that I look at most importantly are sodium and potassium. For blocked cats, I'm definitely looking at potassium because if it's elevated, a high potassium is typically because you have a blocked urinary tract. So that is in variable humps and everything like that. You tend to unblock them. They tend to resolve really rapidly.

Of course, you may have to have some intervention if things are really out of whack, but medical dimension to like lower the potassium very commonly though you just have to unblock them yeah and the body will fix it yes and same with sodium so sodium i'm sorry yeah so we're studying chloride yeah yeah yeah with sodium we tend to look at that when we're trying to diagnose addison's because there's a sodium potassium ratio that's really out of whack,

but with sodium if you have like a dog that's at the beach so we don't see this very often but if have a dog that's like at the beach and it's feeding or drinking the water constantly at the beach and then it gets sodium toxicity. Well, the other thing is like salt rocks in the winter. Yeah. But anyway, got it. Yeah. It really, you have to correct that, but depending on how quickly they got the salt toxicity or how quickly the sodium got to where it is, you have to like... Titrate it down.

Titrate it down. It's tear-frested. it's really scary because they get brain swelling, essentially. And so if it changed quickly, you can fix it quickly. If it changed slowly, you have to fix it slowly and vice versa. So. It's tough. Yeah. My other most terrifying is when we have the TKAs and you're trying to fix it. You're trying to fix the diabetes issue and your potassium is just tanking on you.

And you're like having to add in potassium chloride and you're like having heart palpitations of your own because it's so scary. But you have to do it. I think they just scared us in school. Yeah. But yes, TKAs are a common order. or you end up, because you're giving so much insulin, you end up taking the potassium. So then you have to supplement the potassium in the bag of fluids. And potassium chloride wouldn't give it to you. It gives you a heart attack.

It could. Literally. It will give you a heart attack. It definitely will. We, you know, do all of our calculations. Double check it. All the technicians, I'm like, label that bag like crazy so that. We mix the bag thoroughly. Yes. There's a paper that says mix the bag up and down seven times. And that's completely mixed. And I saw it with the technicians and like seven times. And then an extra one for good measure.

And then just a bunch more. And some more. So that it doesn't pull at one spot and then go all in. So that's the electrolytes. And then really, we have just gone through this. Which is great because we're at like 23 minutes, which is our norm. Beautiful. The other ones, and I'll leave the last one for you, but the other ones that I wanted to bring up, how beamin was a protein that we talked about. And then we have globulins on our panel, which is another protein.

This will elevate due to certain disease states. So one that comes to mind is take-borne illnesses will cause a really high globulin count. Chronic diseases will cause it. Cancer. Cancer. Cancer. Yeah. Cancer. I feel like. They love to. Cancer. And I'm stuck. I'm really worried about cancer. And then you can actually get. The monoclonal. Yes. You can get a group of globulins that are all the same origin.

And so, you have to do a test called protein analysis, phyletrophoresis, and they find out, oh, all of these globulins are exactly the same. Yeah, it's one little globulin guy just going nuts. And that's cancer. And that's cancer. And then if it's a bunch of different ones, then you're like, oh, take a... Chronic inflammation. So that's something we look at, but it can also be elevated in dehydration. Yeah. So decrease in hemorrhage. And then total protein, bam,

you're just looking at all. Albumin plus globulin, yeah. Yeah, and if it's high, then you need to, like, if you just run a total protein and it's high, then that's when you've really got to go back and sort out albumin from globulin because that tells you.

The story. The story, yeah. Okay. Glucose. Aw, glucose. How exciting for me. So, so funny. I know. Glucose. Boy, we could write a book on this. I had one today. This is kind of random, but this little doxin came in because she has some mammary tumors and has some bad teeth. And the owner was worried because it was a new patient to us. And she was like, yeah, you know, my other vet had said these were probably cancer.

And I'm just getting really worried because now she's losing weight and drinking and peeing all the time. And I was like, oh.

So we're in some blood work. And guess what? She's diabetic. her glucose was like 400 yeah anyway so she has bad teeth memory cancer and now diabetes god love her she's happy as a clam happy as a clam but glucose so it has you know obviously the high and the low side of things if we have hypoglycemia we can think about several things one would be like little puppies that just cannot manage their blood sugar yet because their liver and their fat metabolism just aren't

at capacity yet especially small breeds kittens yeah little kittens who have please yep so that's why it's so important in little kittens and little especially small breed puppies to have access to food at least every four hours during the day and every six hours at night so their blood sugar doesn't drop if they do drop they'll get really lethargic and you can give them like honey or sugar to you know spike them back up yeah so there's that other reasons for.

Hypoglycemia. One of them is, sorry, my phone was ringing. It totally pulled me off track. Insulinomas. Insulinomas. I hate those. Which I thought a couple. Yep. So the pancreas will just crank out insulin all of a sudden. Timers. Yeah. I think we did talk on it. We did do a talk on insulin. And then we have also ingestion of fake sugars. Xylitol. Xylitol specifically will cause the dog's body to think it's sugar,

but it isn't. So it kicks out insulin, drops all the blood sugar down. There's not any sugar. It's a problem. And then we actually can see that in Addison's disease. Woo! That one burned me once. Dang it. I hate Addison's. Anyway, so that's the low blood sugar spiel. A high blood sugar is basically either you just recently ate a whole lot of sugar and it's transient.

Cats will get a transient stress hyperglycemia so they come to the vet clinic and their blood sugar just skyrockets to like you know 250 and you're like is it diabetic i don't know wait 30 minutes to four days and it'll be normal again and so you just watch those guys and then you can also have a really acute stress event like a dog that goes into cardiac arrest for some reason will their blood sugar will just boom like 600 and then if you get them back it'll normalize very quickly.

But of course, the thing we most commonly think about is diabetes mellitus, which is where the blood sugar is chronically elevated because the body is not secreting a proper amount of insulin to manage the amount of sugar that the body is requiring to do its job. And then we have to treat them for diabetes, which we probably have a podcast on. Yeah. Surely. And then if it's like the stress hyperglycerin, we'll check the urine.

Typically, there's no glucose in the urine. And then we say, okay, you're not that it can stress.

Distress yes or if it's syntax sometimes everything nothing nothing yeah yeah like or and then sometimes this or hats can technically like like a little bit of glucose in the urine distress so we would then do a couple other tests be that follow up and check recheck or we can send out special handles that basically tell us the past three weeks of glucose yeah yeah and you know sometimes i just wait for a minute and see how yeah that i had one cat that it took me and because i think she was

just like pre-diabetic so it was probably two months before we were finally like yes this is diabetes because she would like look like it and then she wouldn't and then she would and then she wouldn't and then finally it was like okay this is yeah this is for real and so now she's doing great and then you have one of our receptionist cats who's always comes in at a weirdly high glucose and then you check the year and you're like okay well there's no diabetes but it's

like weirdly high it's higher than what stress is supposed to go up to. She's just crazy yeah yeah i mean yeah some of them will just it's bananas in the 300s like what are you doing she is yeah i was like she's like no she does that and i'm like are we sure and she's like oh yeah oh yeah i was like well i'm gonna double check i was like okay you're I don't understand it. If either, she's just very sensitive on her glucose style.

Or, I don't know. That's it, though. Yeah, that's it. I feel really good about it.

T4 we didn't touch on, but we have an episode on hyper and hypothyroidism, so reference that one. But those are all the things that we're really looking at on a routine panel, why we do them, and then reference the other podcast episodes for what we do when we find problems with them, because that's literally 87 podcasts later. How many are we at? I don't know. I'm going to count. I don't know. I'm guessing 60.

I'm just guessing, though. We were really good about every week for a better part of a year, probably. And then after the tornado, it was just like, we've been so busy. Our schedules are so weird. We would always have emergencies come in and cut off the time. Plus, it's hard enough to find topic. Yeah. So that's why we're always like, hey, guys, if you have any requests. I'm not just standing apart. He's holding it like a pop star. He's got the stand in one hand.

Oh guys this is why this is why we have this is why we should be doing facetimes don't try to screw it back in i ruined everything i hope we all great he broke the chair when he sat down send us your podcast requests until next time we'll probably talk about um rat poisons rat poisons and then maybe the bird flu if we get brave guys yes if you're yeah you need to be paying attention. Yeah, a little bit. Yeah, okay. Music.