House Rabbit Society
Alana Trauzzi  ·   ·
Potential explanation for significantly elevated ALP liver value (TLDR: plastic)
In 2023, I brought home two 1 year-old NZW sisters, Maple and Mochi. I am a big believer in getting regular bloodwork done on animals while they're healthy, to monitor for emerging health issues and have a baseline to compare to when they're no longer healthy.
April 2023, Mochi's bloodwork: beautiful. Totally normal. No concerns. Maple's bloodwork, totally normal except for JUST ONE liver value: the reference value for ALP in healthy rabbits is 20-205 U/L, and Maple's was 311 U/L. Curious, but the most common cause of isolated elevated ALP is digestive parasites and we could rule that out immediately. We shrugged and said we'd recheck next year provided she seemed healthy otherwise.
March 2024 annual birthday checkup, Mochi's bloodwork is once again disgustingly normal, Maple's bloodwork also normal except for the ALP liver value: 663 U/L. Double what it was the year prior, and TRIPLE the reference value.
PANIKKK. She couldn't be in liver failure or torsion because all the other liver values were totally normal. It couldn't be a parasite or Mochi would have it too. The vet was at a loss, there is very little literature on ALP elevation in rabbits, to the point that she was unsure if 663 U/L was even a concerning number. In dogs ALP can get quite high without any noticeable effects on their health otherwise. We took her to a specialist for an ultrasound and nothing was found, her liver looked fine, no tumours or abnormalities. Without any actual symptoms of health issues (and I am specifically trained to spot signs of illness in small animals), we decided against a liver biopsy and instead opted to recheck in 6 months.
Sept 2024, ALP 380 U/L. What the hekk Maple, you gave us all grey hairs, urgh.
March 2025 annual birthday checkup, ALP 547 U/L. WHAT THE HEKKKKK!!! Okay we're NOT going to panic this time. Recheck in 6 months, she's still healthy otherwise.
Sept 2025, ALP 480 U/L, we have a ✨pattern️✨️, maybe? It'll probably go up again in March!
March 2026 annual birthday checkup, ALP 430 U/L, pattern broken. What the hekkkkkkkkkk!!
And as I was expressing frustration to the vet about what the hell this means, it can't be environmental because they live together and Mochi's bloodwork continues to me unremarkable—I remembered. There is one particular environmental difference between them, and that difference is that Maple can't be convinced to STOP EATING PLASTIC. She chewed a giant cutout from their litter boxes, she gnaws on the slow feeder if it gets left out...
And a few months prior their plastic litterboxes were swapped out for metal. No more regularly eating plastic—we may have identified a culprit. Recheck in 6 months and we'll find out if it continues to drop.
Sept 2026: ALP 282 U/L. Maple, you FILTHY LITTLE PLASTIC EATER.
The change from plastic litterboxes to stainless steel litterboxes has been the only major husbandry change in the last year. I am therefore reasonably confident that we have found the culprit!
As the lack of literature on possible causes of isolated elevated ALP in rabbits was a big contributor to our panic in 2024, I wanted to share this with the rabbit community.
I wasn't concerned about the possibility of GI stasis because she wasn't tearing off huge chunks and eating them, she was just chewing on them and eating tiny pieces over the course of months and months... obviously eating plastic is bad no matter what, which is why I finally switched to metal litterboxes and stopped leaving the plastic slow feeders out overnight. But it feels so good to finally have an answer to this medical mystery and an actionable plan to address it. Maple's plastic consumption hasn't totally stopped—I've spotted nibble marks on the edges of the plastic shields on the new litter boxes, and she managed to get at some of the puppy pads I put under rugs in risk areas and tore a significant chunk off them. But I can at least be more vigilant and get it down enough her liver isn't being overtaxed!