Leaking Liver Enzymes

Question
Sorry that this will be long, but I need to explain. This past Tuesday, my mom brought our half poodle/half chihuahua to our vet because he has been vomitting water. Well, Tuesday he began vomitting blood and we got him in right away. She was amazed by the look of him. He was awful! He was balding and had skin that resembled "oatmeal"...it was gross. She had no clue what this was. She took some blood and that night his glucose level was 428. She gave him a unit and a half of insulin and the next morning it was down to 90. She didn't confirm, but said that it was possible that he could have diabetes. Thursday morning my mom and I left for an out-of-state concert (all awhile, worrying about the dog...but we thought he was coming home!) but our local vet ended up making a quick appointment with a specialist. My mother nor myself were with the vet when she examined him, but my father was there and the specialist said that she was going to get an ultrasound, but that all she had to do was look at him, his paws and then guessed that his gums were all red (which they were) and his diagnosis was liver failure, because of the enzymes that were leaking out of it. My father witnessed him convulsing and my mom made the decision on the phone to the vet to have him put to sleep on Friday evening.
What I'm writing to you is to ask you if you know anything about leaking enzymes in the liver. Is it bile? I'm Pre-Med (for humans) and never heard of anything like this. What causes it? Disney was eleven years old, so maybe it was old age liver failure? I just hope you can tell me anything about this problem. I would appreciate anything about it. Thank you so much for your time.

Manda

Answer
Manda,

So sorry for your loss.  A blood sugar of 428 is not normal, and I would diagnose diabetes as well.  With the skin being the way it was and the elevated liver enzymes, I would guess that the dog also had Cushing's Disease.  Cushing's disease produces excess cortisone in the blood and often dogs will develop secondary skin infections and the liver values (especially ALKP) will be elevated.  Because of all the excess cortisone, many of these dogs will also develop diabetes.  Managing both Cushing's and Diabetes is very tricky.  The seizure could have been from low blood sugar or liver failure...hard to say.  I am not aware of the term "leaking" enzymes so maybe there was some type of cholangiohepatitis?   Cushing's disease does cause the liver to have an abnormal appearance and be enlarged (steroid hepatopathy).

With Sympathy,
Dr. Fry