Low Albumin Level And Diarrhea

[Guest JDGREYTS]

Our greyhound Dolly, who is now 10, has been having very bad diarrhea, off and on, for about a year now. Upon routine lab work, we found her albumin level to be low. Upon recommendation from the vet, we put her on Vit B 12 shots, which seemed to help. When that didnt' seem to work, we were given a special food for her. Since then, her albumin level has dropped to "serious" low level of 1.8, where the vet is concerned with the development of edema. Dolly is acting fine, but has this chronic bouts of diarrhea. She has already had kidney and liver tests which both came back normal. The vet is recommending an ultrasound to see if she is losing albumin through her intestines, but then if that comes up inconclusive, we will have to do an endoscopy. We are not sure if the diarrhea goes hand in hand with low albumin, or if something else is causing the diarrhea. Has anyone else had this issue with their grey with low albumin, and if so, what was the treatment?

 

Thanks in advance!!

[Batmom]

How is her weight? What is being done to address the diarrhea? Has she been tested for pancreatic function?

 

Low albumin is a hallmark of malnutrition/malabsorption.

 

Hoping you and your vet can get to the bottom of things.

[Burpdog]

I'd do the endoscopy and get a consult with a good internist.

[Moneypenny]

My very first greyhound had these same issues....bad diarrhea, low albumin. We did not do an ultrasound, vet said the only way to really determine what was wrong was a biopsy of the intestines, we opted to keep trying other things, he too was almost 10. What we did was change his food to Anamet (the fish and potato) and eliminated all corn from his diet and I do mean all (treats, etc). We had tried the prescription foods (ID, etc) but those still had corn and didn't make any difference. The Anamet food (had to order online, don't know if it's still made this was 13 yrs ago) and giving him hard boiled egg whites with his meals (very high in Albumin) got him better, his Albumin level got to low normal and was acceptable, we lost him about 1 year later to osteo. We opted not to do the biopsy because he had become very thin with the constant diarrhea and he also had a reaction to a dose of heartguard (neurological) and we weren't sure if he was up to the surgery. I think if the osteo hadn't reared it's ugly head, he would have continued to do well on the Anamet food and the elimination of all corn in his diet.

 

Good Luck, I know how you feel........

[tbhounds]

Your hound sounds like he may in fact have IBD.

The only true way to diagnose that is to get what they call a true cut or full thickness biopsy of the intestines. Personally, I would not waste the time

or $$ on having your hound scoped-- too many false negatives. Some folks just opt to treat as if their hound has IBD. Novel foods, B-12 injections, immune suppressant drugs like azathiprine, and a corticosteroid steroid (prefer Budesonide over pred).

Greyhounds do have lower blood proteins but, yours sounds lower than usual. The albumin is most likely leaking through the gut and passing in the diarrhea.

IBD is not to be fooled with- I would seek an Internist's opinion.

Edited to add- you really should run a bile acids test to check liver function.

Edited May 16, 2012 by tbhounds

[greyhndz]

I'm dealing with the same problem with galgo Dandi. Protein-losing enteropathy. May be one of several forms of inflammatory bowel disease, but intestinal lymphoma has to be considered. Dandi has a variant called lymphangiectasia, This may be controlled by diet alone (very low fat, plus B-12 injections, only hypoallergenic/novel food additives or treats. He did not undergo bx because his albumin was only 1.5 (critically low) and he was not a good surgical candidate. In his case, there were changes and streaking showing up on the ultrasound that were pretty diagnostic of lymphangiectasia, so my vet suggested we start empirical treatment.

 

He is on Purina HA, an ultra-low fat, hypoallergic kibble, which looks like little styrophone nuggets. I mix that with z/d canned for flavor. He is also on Tylan powder, probiotics, ranitidine and sweet potato treats (pure sweet potato). He was initially on steroids which was disastrous and did not make any difference. Our next step was cyclosporine (I couldn't afford budesonide) but we decided to ride it out to see if the dietary changes would lead to improvement after a few months, and luckily it did.

 

As tbhounds recommended, an internal med vet who is experienced with IBG/protein-losing enteropathy is essential at this point to proceed with the diagnostics, and recommend an appropriate elimination diet. With a low protein, as in your dog's case, they may recommend IV infustion of hetastarch to prevent leaking of albumin from the gut. Some dogs need steroids, some go on to an immune modulating drug, such as imuran or cyclosporine, or budesonide, which releases steroids directly into the gut

 

But first off should be an internal medicine vet to manage her care.

Best of luck and let us know how she's doing!

[MP_the4pack]

If you have a protein losing enteropathy, have a liver function test done. Not the standard liver enzyme which you get with a chem panel. Liver function is by request only.

All the doctors were focusing on my girls intestines when all along it was her liver.

[tbhounds]

If you have a protein losing enteropathy, have a liver function test done. Not the standard liver enzyme which you get with a chem panel. Liver function is by request only.

All the doctors were focusing on my girls intestines when all along it was her liver.

Bile acid test

[MP_the4pack]

If you have a protein losing enteropathy, have a liver function test done. Not the standard liver enzyme which you get with a chem panel. Liver function is by request only.

All the doctors were focusing on my girls intestines when all along it was her liver.

Bile acid test

 

Of course if I read your post to the very last line I would simply have done this:

[greyhead]

One of our greys developed IBD after an extended period of diarrhea due to a bacterial overgrowth in the intestines. If the vet hadn't resisted doing a fecal culture & sensitivity until I finally just ordered it to be done, it might not have come to that. After treating that helped immensely but didn't completely resolve the situation, we did an ultrasound, which showed the lymphangiectasia and structural changes consistent with IBD. An ultrasound can give you a pretty good picture of the whole situation -- ALL the internal organs if you like. Unlike biopsy, it can visually show exactly where the problem(s) is(are). In our grey's case, it was at and near the place where the small intestine meets the large. A surgical biopsy could have gotten to it, but an endoscopy could not have gotten there from either end. If we had done the surgical biopsy the first time it was mentioned, that was before the bacterial overgrowth was discovered, and cutting into that area without knowing that might have allowed that infection to have spread farther than it already was.

 

Lastly, I want to mention that we decided, with the support of our vet, that the biopsy results wouldn't really change the treatment plan but would put an older and already depleted hound at greater risk. But most internists will not work on an IBD case without a diagnosis obtained through biopsy. We looked carefully and finally did find one that would supervise the excellent treatment plan our vet had already put in place. (Yes, it took that long to find the internist.) Personally, I don't care for an approach to medicine that is one-size-fits-all, but oftentimes with internists that's what you get. You get the textbook (advanced though it may be) answer to diagnosis and treatment. Internists have their place certainly, but we've learned we have to be willing to thank them for their input and make up our own minds with the help of that information and the judgment of our vet and ourselves.

 

We also had all the other tests performed that have been mentioned here, by the way. Apart from them, when you get to looking for IBD, I'd start with the ultrasound. It's relatively inexpensive, non-invasive, gives lots of information about the whole GI system, and will let you know if endoscopy is even doable and where the incision of a surgical biopsy should most productively be made.

 

Oh, and those B-12 injections are hugely helpful but they don't cure anything. They do need to be continued for life, as I understand it, and we give them at home. Which reminds me of another thing I've learned through this process of caring for my greys: just because a brief treatment with something doesn't solve the whole problem, that doesn't mean that the treatment isn't doing something important. It may mean that the treatment needs to be given longer, and/or at a higher dose, and/or that there are more problems that haven't been detected yet but need to be.

 

Wishing you all good things as you work through these issues.

[greyhead]

Oh, and I'd be completely remiss if I didn't mention that treating older greys like ours with prednisone is almost certainly not the way to go. Budesonide is the way to go, IMO and the opinion of most others on this board who have experience with IBD. If you need more info about that, just ask.

Edited May 17, 2012 by greyhead

[Guest JDGREYTS]

Thank you to everyone who has written in to help with this issue! Comforting to know that others are going through or have gone through the same thing! We will definitely look at ALL options to a diagnosis as well as a treatment! Thanks again!!! And please feel free to keep posting advice/helpful ideas!!!

Edited May 17, 2012 by JDGREYTS