How do you know when to euthanize a dog with liver failure? Making that decision can be incredibly difficult. But end-of-life care veterinarian Dr. Dawnetta Woodruff, friend of integrative veterinarian Dr. Julie Buzby, is here to help. Dr. Woodruff explains the stages of liver disease (including the symptoms of end-stage liver failure). Then she provides practical and heartfelt advice about when to euthanize a dog with liver failure.

When your cherished friend receives a diagnosis of canine liver failure, it can be incredibly scary. You may not fully understand what is happening. And the upcoming decisions about your dog’s health might feel overwhelming. You may wonder how much good quality time your dog has left. And you might be asking yourself how you will know it is time to say goodbye.

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These are not simple considerations, and the answers are not always straightforward. But understanding a bit more about how liver failure affects the body can help provide some clarity.

What does the liver do?

In a normal healthy body, the liver has many important jobs, including:

• Producing and excreting bile (i.e. digestive enzymes that break down food)
• Metabolizing (i.e. breaking down) fats, proteins, carbohydrates, and medications
• Producing blood proteins and clotting factors
• Storing vitamins and minerals
• Filtering infectious agents, toxins, and other substances out of the blood

A functioning liver is critical to maintaining proper balance (or homeostasis) within the body. This means that if the liver stops working, the dog can become very sick and ultimately die.

Thankfully, the liver is an organ that has a large “reserve.” In other words, if a portion of the liver isn’t working well, the rest of the liver cells can “pick up the slack.” The liver will continue to carry out its vital functions. And the dog may seem completely normal, despite having liver disease. In fact, over 70% of your dog’s liver can be damaged or diseased before signs of liver failure in dogs begin to show up.

How will I know if my dog has early liver failure?

When your dog is in the early stages of liver failure, he or she may not have any symptoms. The only indication of liver disease in dogs may be changes on blood work such as a high ALP in dogs.

This is one reason it is important to follow your vet’s recommendations about screening blood work for your dog—even if your dog appears healthy. Routine lab work can catch liver disease in dogs early, when there are more treatment options available. Your vet will let you know how often your dog should have blood work based on your dog’s age, breed, medical conditions, and any long-term medications he or she may be taking.

Management of early liver disease

If your dog’s blood work shows mild problems with the liver, close monitoring may be sufficient at first. But if the liver values are more abnormal, your vet may suggest a liver-friendly diet. Or he or she may recommend supplements and medications that help to support the liver and keep it healthy. These diets and medications will not reverse the liver disease that is already present. But they may help slow the progression of the disease and increase life expectancy.

What are the symptoms of the middle stages of liver failure in dogs?

However, as early liver disease progresses to more severe liver damage, your dog may start showing symptoms of the middle stages of liver disease. Some of the more common signs include:

• Loss of appetite
• Fatigue, sleeping a lot, a lack of energy, or being a lethargic dog
• Nausea (and associated drooling, which can be the reason your dog keeps licking his or her lips)
• Bruising (large patches called ecchymoses or small “dots” called petechial hemorrhage)
• Itching and hair loss

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These symptoms are a bit vague. And they tend to overlap with other diseases such as kidney failure in dogs, diabetes in dogs, and Cushing’s disease in dogs. That’s why visiting the veterinarian is so important anytime your dog seems “not quite himself or herself.” Your veterinarian can perform an examination and run blood work to determine if your dog’s liver—or something else—is to blame for the signs.

Management of the middle stages of liver disease

Based on the severity of the changes in your dog’s blood work and his or her symptoms, your veterinarian will make some treatment recommendations. Many dogs benefit from liver diets, medications, and supplements as previously discussed. And they may also need some symptomatic care, such as anti-nausea medications, to control the side effects of liver failure.

What are the symptoms of end-stage liver failure?

When liver disease progresses to its severe or end-stage form, the signs become much more obvious. And they may interfere with your dog’s daily functions and severely decrease quality of life. The symptoms of the final stages of liver failure include:

• Nausea and vomiting
• Confusion or disorientation
• Unexplained bruising (sometimes severe) on the dog’s body or gums
• Hemorrhage from issues with blood clotting (e.g. dog nose bleeds, blood in the vomit, or bloody diarrhea)
• Swelling of the abdomen (i.e. a pot-bellied dog appearance)
• Pitting edema (i.e. swelling where an indentation remains after pressing it) of the legs and feet
• Irritability or aggression
• Head-pressing
• Yellowish tint to the whites of the eyes, gums, and skin (i.e. jaundice)
• Dark brown urine and pale (almost grey) stool
• Seizures in dogs

Management of end-stage liver disease

Many of these end-stage symptoms of liver failure in dogs can be managed. But end-stage liver disease cannot be reversed. Your vet may prescribe anti-nausea medications like Cerenia for dogs to help control vomiting. And he or she may recommend appetite stimulants for dogs to encourage eating. Your sweet dog may also need medications to help lower the pressure in the brain, control seizures, or reduce other signs of hepatic encephalopathy (i.e. neurologic signs due to liver failure).

Each patient looks a little different, and there is no one-size-fits-all therapy. If symptoms are severe, your dog might need to stay in a hospital for round-the-clock care. But when caught early enough, aggressive therapy may allow your dog to feel better and go home on oral medications.

How long can a dog live with liver failure?

In addition to the fact that a dog may be diagnosed with liver failure at any of the above stages, there are also many different reasons for liver failure (e.g. toxins, infections, chronic inflammation, build-up of copper in a dog’s liver, etc.). This makes it difficult to provide a universal answer to the question of how long a dog can live with liver failure.

Some dogs have mild liver disease that progresses slowly and remains relatively stable over months, or even years. Other dogs may have a rapid progression of liver failure. And they may only live for weeks, or even days, following their diagnosis.

Since the life expectancy of dogs with liver failure is so variable, you may be wondering how you will know when to euthanize your dog. There is not one specific “end point” for every dog that indicates his or her good days have come to an end. Much of that decision depends on your dog’s and family’s particular situation.

How will I know when to euthanize my dog with slowly progressive liver failure?

When your dog’s disease is less severe, you may have weeks or months to evaluate your dog’s status. It is important to prepare for your dog’s euthanasia ahead of time as a family. And you will want to involve your veterinarian in the decision too.

In these situations, I recommend regularly using a quality-of-life scale for dogs. Or you may wish to hang a blank calendar page on the fridge. Then you can simply mark good days in green, “ok” days in yellow, and bad days in red. Having a visual representation your dog’s quality of life can help you see when the yellow and red days are becoming most frequent.

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Additionally, it can be helpful to make a list of “hard limits.” These are behaviors from your dog that indicate you no longer want to push forward. You may decide that if your dog isn’t happy to see you when you get home, it is time for euthanasia. Or you may know that if most of your dog’s day is spent sleeping, you don’t want your dog to keep living like this.

It is so difficult. But establishing these limits and quality of life benchmarks can help you make better decisions when the end of life arrives and emotions are high.

How will I know when to euthanize my dog with rapidly progressing or severe liver failure?

On the other hand, if your dog requires hospitalization or care in the ICU, he or she may reach a point where the liver failure is not responding despite aggressive therapy. In that case, you will need to make a decision about euthanasia quickly.

If you and your veterinary team have tried all of the reasonable treatments, and your dog is continuing to decline, euthanasia may be the kindest option. The final stages of liver failure can be very difficult for your beloved companion to endure. And watching your sweet pup struggle can be incredibly heartbreaking too.

Choosing euthanasia in such a situation is merciful, and it allows your dog to skip over the hardest moments at the very end of the disease. You may choose to say goodbye in the hospital. Or you might want to see if your dog is stable enough to come home for an in-home dog euthanasia. Both options are kind. Your vet can help you determine which is best for your specific situation.

How does caretaker fatigue influence the decision to euthanize your dog?

As with many diseases, taking care of a dog with advanced liver disease can be mentally and physically exhausting. Medication routines, bathing, cleaning, and giving mobility assistance can be extremely time consuming. And the mental load of choosing medical therapies, worrying about your dog’s quality of life, and watching him or her struggle may become overwhelming. When considering the best time for euthanasia, it is ok (and actually essential) that you factor your own well-being into the decision as well.

One of the key components of caring for our dogs is ensuring they have love and affection from their human family. That is what gives them tremendous joy! When your caretaking duties become burdensome, the human-animal bond can begin to break down.

You and your dog don’t want to spend your final days or weeks together feeling frustrated and upset with one another. If your dog begins to resent the medications, gets angry when you try to feed him or her, or becomes upset with bathing or cleaning routines, that may be your dog’s way of telling you he or she is no longer willing to continue “pushing forward.” Likewise, if spending time with your dog is no longer enjoyable for you due to your many caretaking responsibilities, your dog may be feeling the same frustration with those interactions.

Closing words of comfort

Choosing to say goodbye is never a simple decision. Our logical brain can come to terms with the decision, knowing that it is made from a place of love and kindness. But our hearts are never ready for that moment to arrive. The decision of euthanasia can be a heavy burden to bear. It helps to consider that you are not choosing for your dog to die—the disease has already done that. Instead, you are deciding to make your dog’s inevitable death a bit easier for him or her.

It has been said that it is better to set our dogs free “a week too early rather than a day too late.” There is a lot of truth to this cliché. No matter how much extra time you have together, it will never feel like enough. Letting go before all of your dog’s joy is gone can be a very kind and brave way to show the depth of your love for him or her.

How did you know when to euthanize your dog with liver failure?

Please share your story below.

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