title: Retrospective evaluation of acute liver failure in dogs (1995-2012): 49 cases.
abstract: OBJECTIVE
  To characterize the clinical presentation and outcome of dogs with acute liver failure (ALF).
  
  
  METHODS
  Retrospective case series from January 1995 to December 2012.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Forty-nine dogs were diagnosed with ALF defined as the acute onset of clinical signs accompanied by serum hyperbilirubinemia and coagulopathy (prothrombin time >1.5 times the upper limit of the reference interval) with or without signs of hepatic encephalopathy.
  
  
  METHODS
  Medical records were retrospectively analyzed for clinical presentation, history, physical examination findings, clinicopathologic data, diagnostic imaging findings, hepatic histopathology, treatment, and outcome.
  
  
  RESULTS
  Presenting signs included anorexia (28/49, 57%), vomiting (25/49, 51%), neurologic abnormalities (17/49, 35%), and polydipsia/polyuria (10/49, 20%). Neurologic impairment compatible with hepatic encephalopathy occurred at some point during hospitalization in 28/49 (57%) of dogs. Common clinicopathologic abnormalities on presentation other than hyperbilirubinemia and increased serum liver enzyme activity included thrombocytopenia (25/49, 51%), hypoalbuminemia (23/49, 46%), leukocytosis (17/49, 34%), anemia (14/49, 29%), hypokalemia (13/49, 27%), and hypoglycemia (10/49, 20%). The causes of ALF included neoplasia (13/49, 27%), presumptive leptosporosis (4/49, 8%), and ischemia (1/49, 2%). The remaining cases were idiopathic although 15 of these dogs had exposure to possible hepatotoxins. Common lesions in the 35/49 (71%) dogs that had hepatic histopathology were necrosis (19/39, 48%), lipidosis (16/39, 41%), vacuolar change (7/49, 14%), and inflammation (4/49, 8%). Complications included ascites (20/49, 41%), bleeding tendencies (14/49, 29%), pancreatitis (12/49, 24%), and acute tubular necrosis (11/49, 22%). Seven (14%) dogs survived to discharge. Survivors had higher alanine aminotransferase activity, and were more likely to maintain normal albumin concentrations and not develop clinical bleeding or ascites during hospitalization.
  
  
  CONCLUSIONS
  Canine ALF is associated with multiple etiologies and a high mortality rate. Strategies to increase survival are urgently required.
authors.affiliation: Departments of Clinical, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, 01536.
authors.forename: Carrie
authors.initials: C
authors.lastname: Lester
authors.affiliation: Departments of Clinical, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, 01536.
authors.forename: Johanna
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Biomedical Science, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, 01536.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Peters
authors.affiliation: Departments of Clinical, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, 01536.
authors.forename: Cynthia R L
authors.initials: CR
authors.lastname: Webster
mesh_terms: D000818:Animals; D004283:Dog Diseases / Q000453:epidemiology* / Q000401:mortality; D004285:Dogs; D005260:Female; D006760:Hospitalization; D007003:Hypoglycemia / Q000453:epidemiology / Q000662:veterinary; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000662:veterinary*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008499:Medical Records; D010195:Pancreatitis / Q000453:epidemiology / Q000662:veterinary; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014839:Vomiting / Q000662:veterinary
keywords: canine; coagulopathy; encephalopathy; hepatopathy