Fecal proteolytic activity had been used to diagnose EPI in small animals for several decades. Many nonpancreatic diseases, such as renal, hepatic, intestinal, and neoplastic diseases, can lead to increases in serum amylase and lipase activities. This site complies with the HONcode standard for trustworthy health information: If in-clinic analysis is to be relied on for general case laboratory evaluation, meticulous attention must be paid to quality assurance. This puppy is healthy. A dedicated ion-specific electrode meter is the best way to measure these. It decreases due to the same factors as total protein, plus liver failure. Thus, rather than six tests that merely confirm or deny six possibilities, a well-chosen group of six tests can provide information pointing to a wide variety of different conditions by a process of pattern recognition. A 6-month-old, intact, male Yorkshire terrier is scheduled for a castration. Samples of known composition must be run at least daily for each analyte, in both normal and pathologic ranges; unless these are within the tolerance limits, no patient samples should be tested. Larger bucket-type centrifuges will accept almost any type or size of tube, but the rotors require careful balancing. It has a half life of 2–4 hr and rises higher than AST but recovers quicker. α-Amylase level increases in acute pancreatitis but in dogs is also increased in chronic renal dysfunction. However, in light of wide availability of tests to diagnose EPI, microscopic fecal examination is no longer justified. A dedicated reflectance meter for urea estimation is not available. Phosphate level increases due to renal failure (secondary renal hyperparathyroidism). The most common causes for an increase is raised levels of circulating steroids and biliary disease. Lipase level increases in acute pancreatitis in dogs (longer half-life than amylase) and also occasionally in chronic renal dysfunction. Congenital hypokalemia occurs in Burmese cats. In one study of 12 cats with severe forms of pancreatitis, not a single cat had serum lipase or amylase activity above the upper limit of the reference range. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. The reference range for TLI in dogs is 5.7–45.2 mcg/L with a cut-off value of ≤2.5 mcg/L considered diagnostic for EPI. ALT is present in the cytoplasm and mitochondria of liver cells and, therefore, increases due to hepatocellular damage. GGT increases in longer-term liver damage; it is particularly useful in horses and ruminants. This panel may be modified as appropriate for other species, eg, glutamate dehydrogenase (GDH) and/or gamma-glutamyl transferase (GGT) are more appropriate “liver enzymes” for horses and farm animals, or it may be more appropriate to concentrate primarily on muscle enzymes (CK and AST) in athletic animals. It is less useful to assess respiratory acid/base disturbances. Cholesterol level increases due to fatty meals, hepatic or biliary disease, protein-losing nephropathy (and other protein-losing syndromes to some extent), diabetes mellitus, hyperadrenocorticism, and hypothyroidism. However, in dogs and cats with EPI, the number of pancreatic acinar cells is severely decreased. A few (eg, insulin) require serum, whereas potassium is best measured on heparin plasma separated immediately after collection. Serum TLI concentration decreases significantly and may even be undetectable. In view of these findings, PLI assays for both dogs and cats have been optimized toward higher concentrations, and the current assays are no longer suitable for diagnosis of EPI in dogs or cats. Sodium and potassium are included to screen for hypoadrenocorticism or hypokalemia. Fluoride/oxalate samples hemolyze very readily because the cells can no longer respire, so timely separation is especially important. Analysis of other body fluids (eg, urine, ascitic fluids, CSF) is also included. Bilirubin level increases due to fasting (benign effect in horses and squirrel monkeys, may be caused by hepatic lipidosis in cats), hemolytic disease (usually mild increase), liver dysfunction, and biliary obstruction (intra- or extrahepatic). In healthy animals, serum TLI is low, but during pancreatitis an increased amount of trypsinogen leaks into the vascular space, which can lead to an increase in serum TLI concentration. If all differentials are excluded, then the list must be reevaluated. In the past, several fecal tests have been used to diagnose exocrine pancreatic insufficiency (EPI). Potassium level increases due to hypoadrenocorticism and severe renal failure (especially terminal cases). Calcium level increases due to dehydration (which is also associated with increased albumin), primary hyperparathyroidism (neoplasia of parathyroid gland), primary pseudohyperparathyroidism (neoplasms producing parathormone-related peptide [PRP], usually perianal adenocarcinoma or some form of lymphosarcoma), bone invasion of malignant neoplasms, thyrotoxicosis (uncommon), and overtreatment of parturient paresis. It decreases due to sample deterioration. The new tube must be adequately labeled. It will also increase (irregularly) in pancreatitis. We do not control or have responsibility for the content of any third-party site. Bilirubin level may also be appreciated by eye in most species. It decreases in alkalosis, vomiting (especially after eating), and in association with hyponatremia. Sorbitol dehydrogenase level increases in acute hepatocellular damage in horses but is a very labile analyte. Equine and bovine plasma is normally yellow, which makes determination problematic, but in other species, any yellow color is abnormal and indicates an increased bilirubin level. Participation in an external quality assessment program is also strongly recommended. Most of these methods, particularly the radiographic film clearance test, are unreliable. Most biochemistry tests can be performed on either serum or heparinized plasma. Bile acid levels increase when hepatic anion transport is impaired, usually during liver dysfunction (bile acids are more sensitive than bilirubin to hepatic impairment) and in the presence of a portosystemic shunt (congenital or acquired). Microscopic fecal examination for fat and/or undigested starch or muscle fibers are at best useful to suggest maldigestion. Yet more tests may be necessary until only one of the original list remains to determine the diagnosis. Clinical biochemistry refers to the analysis of the blood plasma (or serum) for a wide variety of substances—substrates, enzymes, hormones, etc—and their use in diagnosis and monitoring of disease. It is therefore of very limited value in general clinical practice. For small animals, a typical panel includes total protein, albumin, globulin (calculated as the difference between the first two analytes), urea, creatinine, ALT, and alkaline phosphatase (ALP). The link you have selected will take you to a third-party website. If there is no evidence of small-intestinal disease in such patients, a trial therapy with pancreatic enzymes and reevaluation of serum TLI concentration after 1 mo is indicated. Chloride level increases in acidosis, and in parallel with increases in sodium concentration. It decreases due to insulin overdose, insulinoma, islet cell hyperplasia (uncommon), acetonemia/pregnancy toxemia, acute febrile illness, and idiopathically (in certain dog breeds). ALP level increases due to increased bone deposition, liver damage, hyperthyroidism, biliary tract disease, intestinal damage, hyperadrenocorticism, corticosteroid administration, barbiturate administration, and generalized tissue damage (including neoplasia). Last full review/revision Jun 2015 | Content last modified Jun 2015, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, This puppy has an extrahepatic portosystemic shunt (PSS), This puppy has copper-associated hepatopathy, This puppy has microvascular dysplasia (MVD). Levels in the cat are generally much lower than in the dog, and any increase in cats is considered significant. There are no abnormalities on his physical examination. However, a small number of these dogs and cats may have EPI. Sodium level increases due to Conn syndrome (hyperaldosteronism), restricted water intake, vomiting, and most causes of dehydration. Proprietary gels or plastic beads assist with separation, and these may be incorporated into the collection tube or added before centrifugation. In turn, α2-macroglobulin-trypsin complexes are removed by the reticuloendothelial system.