How to Decide When to Euthanize a Dog with Liver Failure

Is having liver failure painful for my dog?

When I think of the dogs I’ve treated with liver failure, it seems there is a spectrum of disease. Some dogs only have a picky appetite and an increased incidence of vomiting. Other dogs were so sick they couldn’t do anything besides lay on their side panting and trying to get comfortable. 

It might seem obvious that the latter example would be a good candidate for euthanasia. But I know firsthand how hard it is to look at the situation objectively when it’s your furry family member. 

After it’s all said and done, I frequently hear comments from my clients that they feel they waited too long to euthanize their sick pet. I’ve rarely if ever, heard anyone say they felt they euthanized a very sick pet too soon. 

What is liver failure in dogs?

Liver failure can be defined as a state of disease when liver function has decreased enough to cause severe illness. There are two main forms of liver failure: acute and chronic. Another common scenario is “acute on chronic” in which a dog with chronic disease suddenly gets a lot worse. 

Acute Liver Failure (ALF)

Chronic Liver Failure

Many dogs live with chronic liver disease that’s not bad enough to be called liver failure. Causes include copper accumulation, idiopathic (unknown cause), infections, and immune-mediated disease. When chronic disease progresses it causes cirrhosis and  liver failure. 

How does liver failure affect my dog’s body?

When the liver fails, many body systems are affected. Fluid builds up in the abdomen as less protein is produced by the organ and liver circulation becomes congested. Blood is slower to clot, infections are more likely and scarring of hepatic tissue ensues. 

High ammonia levels build up because of decreased liver metabolism of protein. This leads to a condition that adversely affects the brain (hepatic encephalopathy). The body sometimes even tries to bypass a diseased liver with alternate blood circulation routes. 

Which dog breeds are more prone to liver disease?

Infectious diseases can set up house in the liver, destroying cellular function and tissue structure. All dogs are susceptible, but younger dogs, those that spend a lot of time outdoors have a higher risk of contracting the following infections: 

• Viral – Canine Adenovirus I (puppies)
• Bacterial – Leptospira, Salmonella, Rickettsial/tick-borne
• Fungal – Histoplasmosis, Blastomyces, Coccidioides
• Parasitic – Heartworms, protozoa

Congenital Disease 

The world is full of potential liver toxins and dogs like to eat lots of things they shouldn’t. Sometimes it’s a chewed ornamental plant from your yard or a fungal contaminant in dog food. Sometimes we never figure out where the toxin came from. 

Primary liver cancer in dogs is pretty uncommon. It accounts for less than 1.5% of all cancers in dogs (7).

Metastatic cancer of the liver is much more common. That means it has seeded to the organ from another site in the body. Metastases from cancers like hypodermal hemangiosarcoma affecting other organs are more likely to occur in senior dogs.

Dogs with liver cancer may show typical signs of liver failure or instead they may have acute internal bleeding with no signs of liver failure. Hence, the final stage of dog liver cancer before death may be sudden weakness, pale gums, fast/weak pulse, abdominal pain and swelling. 

• Physical exam- a shrunken or enlarged liver, yellowed skin, abdominal pain, abdominal fluid wave/ascites
• Blood tests: elevated liver enzymes, especially ALT (alanine aminotransferase). Concern when it is 4 times or more above the high end of the normal range–a dog liver enzyme ALT above 500 U/L is a sign of severe liver disease. But sometimes these numbers go back down in end-stage liver failure. Bilirubin is also elevated above 2.9 mg/dL (10). Bile acids testing checks liver function in less severe cases where the diagnosis is not clear. Blood clotting tests are usually prolonged, too. 
• Radiographs
• Ultrasound imaging
• Biopsy-can often be done without doing invasive surgery

Dog Liver Enzymes Normal Range Chart

Technically, it is possible to give a dog a liver transplant from a donor dog. The reason it’s not done routinely is partly that it’s cost-prohibitive. The other reason is that graft rejection is a very big problem that is hard to control in dogs.  

A related treatment that shows promise is stem cell therapy. A Chinese study published in 2019 showed that canine adipose-derived mesenchymal stem cells injected intravenously helped restore some level of liver function in dogs with experimentally-induced liver damage (10). 

This research is encouraging but stem cell therapy in dogs has a long way to go to prove it’s safe and effective. 

It’s EXTREMELY important to consult with your veterinarian about the best food to choose in this situation.

In general, owners of dogs with end-stage liver disease are advised to avoid foods high in protein. A diseased liver cannot process protein normally and nutritional protein contributes to high blood ammonia levels. 

Prescription diets like Hill’s l/d are formulated with a limited amount of highly digestible protein to minimize ammonia formation while providing enough amino acids to support normal metabolism.  

You could opt to use a homemade diet, but please, please get help from a veterinary nutritionist. Your dog will probably love eating fresh food but if you don’t use the right recipe you could make things worse. 

I recommend you and your vet work with the experts at BalanceIT.com to develop a custom recipe for your dog’s specific needs. It’s not expensive and you may even be able to get a FREE recipe, depending on your dog’s nutritional needs. The recipes are simple and use common ingredients like potatoes and eggs. 

Feeding your dog 3 to 4 times a day may help since it puts less of a load on the liver to metabolize nutrients at one time. 

If your dog is nauseous, ask your vet about anti-nausea treatments. Many drugs can cause problems for dogs with severe hepatic disease, so don’t assume you can use something left over from a past prescription or prescribed for a different pet. 

Deciding when to euthanize a dog with liver failure should be based on basic quality of life questions. The underlying cause of illness and the prognosis given by a veterinarian will help guide your decision.