It decreases due to insulin overdose, insulinoma, islet cell hyperplasia (uncommon), acetonemia/pregnancy toxemia, acute febrile illness, and idiopathically (in certain dog breeds). Sodium and potassium are included to screen for hypoadrenocorticism or hypokalemia. Ketone levels may be estimated on either urine (preferred sample) or plasma/serum. It decreases due to hypoadrenocorticism, loss of any high-sodium fluid such as some forms of renal disease, and insufficient sodium provision during IV fluid therapy. It can be measured in both blood and urine. It will also increase (irregularly) in pancreatitis. AST level increases in both muscle and liver damage but is of less value than ALT. Lipase (routine assay) is not a useful indicator of pancreatitis in cats. A test spot that is lighter in color than the reference spot suggests that pancreatitis can be excluded. Analytes that might be considered for incorporation in such expanded profiles are described below. One method, which uses pre-made tablets to pour a gelatin agar, is considered most reliable. However, trypsin, if present in the serum, is also detected by these assays. ALP and ALT levels rarely rise above 1,000 units, even in severe liver disease. Serum amylase and lipase activities have been used for several decades to diagnose pancreatitis in both people and dogs. Biochemistry tests should be accompanied by full hematology, because evaluation of both together is essential for optimal recognition of many of the most characteristic disease patterns (see Clinical Hematology). The clinical use of fecal proteolytic activity is limited to species for which more specific assays to estimate pancreatic function are not available and in areas where the more accurate and sophisticated tests are not available. In healthy animals, only a small amount of trypsinogen is present in serum. CK, the classic “muscle enzyme,” increases markedly in rhabdomyolysis and aortic thromboembolism. Similarly, the reference range for TLI in cats is 12–82 mcg/L, with a cut-off value of ≤8 mcg/L considered diagnostic. It decreases due to overhydration, severe congestive heart failure (with edema), protein-losing nephropathy, protein-losing enteropathy, hemorrhage, burns, dietary protein deficiency, malabsorption, and some viral conditions (especially in horses). However, in dogs and cats with EPI, the number of pancreatic acinar cells is severely decreased. Decreases are seen in some downer cows and as part of the stress pattern in horses and small animals. Participation in an external quality assessment program is also strongly recommended. 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.

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