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Fatty liver (hepatic lipidosis) in cats: blood work and recovery

When a cat stops eating for several days, especially an overweight cat, fat floods the liver faster than it can be used. The liver swells and stops working properly. Hepatic lipidosis is serious, but most cats recover if they are fed early, often through a feeding tube.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

Hepatic lipidosis follows days to weeks of poor appetite, either on its own or because of another disease such as pancreatitis. The blood work typically shows a markedly high ALP and bilirubin with a GGT that stays relatively low, a pattern unusual in other feline liver diseases. Ultrasound and a fine-needle aspirate of the liver confirm it. Potassium and phosphate are watched closely, especially when feeding restarts. With nutritional support, about 60% of cats survive.

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How it starts

The classic picture is an overweight cat that stops eating for days to weeks [1]. Lipidosis can be primary, triggered by a stressful event, or secondary to another disease: in one study of 71 cats, 28% had no identified cause, while 44% had a digestive disease, pancreatitis or cholangiohepatitis [2]. See pancreatitis in cats.

What the blood work shows

  • ALP: rises early and often markedly; in 48 cats, the median ALP was 471 U/L [3, 4]. In cats, ALP has a short half-life, so even small rises matter [5].
  • GGT: in most feline liver diseases GGT rises more than ALP, but hepatic lipidosis is a notable exception, with GGT rising late [4].
  • Bilirubin: often high, causing jaundice; mean 9.9 mg/dL in one study [3, 6].
  • ALT: raised, but usually less than ALP [3].
  • Potassium and phosphate: can be low, and fall further when feeding restarts [3, 7].

See high liver enzymes in cats.

How to read the ALP line

Here is an example line from an overweight cat that stopped eating a week ago.

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
ALP Alkaline phosphatase480U/L0–45H
  1. Abbreviation ALP or ALKP.
  2. Result 480 U/L in this illustrative line: markedly high.
  3. Unit U/L or IU/L.
  4. Laboratory interval An illustrative cat interval; each laboratory sets its own.
  5. Flag H: above the interval. With a high bilirubin and a GGT that is normal or only mildly raised, this pattern points to hepatic lipidosis [4].

Confirming the diagnosis

Ultrasound shows a bright (hyperechoic) liver, and a fine-needle aspirate shows fat in most liver cells [3]. Ultrasound also helps find an underlying disease such as pancreatitis [1].

Refeeding and the electrolytes

Feeding is the treatment, but restarting food can shift potassium and phosphate into the cells (refeeding syndrome). In 11 starved cats with this syndrome, all became low in potassium and 8 low in phosphate [7]. A very low phosphate can destroy red cells within 24 to 48 hours [8]. This is why these values are rechecked often in the first days. See potassium in dogs and cats.

Outlook

Cats that do not receive nutritional support are unlikely to survive, while about 60% of cats that do receive it recover; in a 2024 study, 63% of 48 cats were alive 3 months after diagnosis [3]. Older age and fluid in the belly were linked to a poorer outlook [3].

Related articles

En français : la lipidose hépatique du chat.

Questions to ask your veterinarian

  1. Is the ALP much higher than the GGT?
  2. How high is the bilirubin?
  3. Is there an underlying disease such as pancreatitis?
  4. Are the potassium and phosphate normal, and how often will they be rechecked?
  5. Does my cat need a feeding tube?
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Frequently asked questions

What does hepatic lipidosis mean?

Fat builds up in the liver cells after a period of poor appetite, so the liver works less well. It is also called fatty liver [1].

Can a cat recover from fatty liver?

Yes, often: with early nutritional support, about 60% of cats survive, and the prognosis is good when it is recognised and treated early [1, 3].

How long does hepatic lipidosis last in cats?

It depends on the cat and on any underlying disease. Assisted feeding continues until the cat eats well on its own, while the vet follows the bilirubin, liver enzymes and electrolytes [1, 3].

Why is ALP high but not GGT?

In most cat liver diseases GGT rises more than ALP; hepatic lipidosis is a notable exception, which makes the pattern a useful clue [4].

How much does a cat need to eat to avoid fatty liver?

Any cat that eats little or nothing for more than a day or two should be seen by a vet, especially if overweight [1].

Sources

  1. Webb CB. Hepatic lipidosis: clinical review drawn from collective effort. J Feline Med Surg. 2018;20(3):217-227. doi.org/10.1177/1098612X18758591
  2. Kuzi S et al. Prognostic markers in feline hepatic lipidosis: a retrospective study of 71 cats. Vet Rec. 2017;181(19):512. doi.org/10.1136/vr.104252
  3. Wallace OP et al. Association of time to start of enteral nutrition and outcome in cats with hepatic lipidosis. J Vet Intern Med. 2024;38(6):3144-3152. doi.org/10.1111/jvim.17200
  4. eClinPath, Cornell University College of Veterinary Medicine. Gamma-glutamyl transferase. eclinpath.com/chemistry/liver/cholestasis/gamma-glutamyl-transferase
  5. eClinPath, Cornell University College of Veterinary Medicine. Alkaline phosphatase. eclinpath.com/chemistry/liver/cholestasis/alkaline-phosphatase
  6. eClinPath, Cornell University College of Veterinary Medicine. Bilirubin. eclinpath.com/chemistry/liver/cholestasis/bilirubin
  7. Cook S et al. Retrospective evaluation of refeeding syndrome in cats: 11 cases (2013-2019). J Feline Med Surg. 2021;23(10):883-891. doi.org/10.1177/1098612X20979706
  8. Adams LG et al. Hypophosphatemia and hemolytic anemia associated with diabetes mellitus and hepatic lipidosis in cats. J Vet Intern Med. 1993;7(5):266-271. doi.org/10.1111/j.1939-1676.1993.tb01018.x

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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