Copper Storage Disease in Dogs: Common Signs, Diagnosis, and Treatment

A dog’s liver has more than 500 vital functions, from removing toxins from blood to the breakdown of fats in the digestive system. When a dog has liver disease, the liver has a harder time completing these tasks.  

One such liver disease—copper storage disease in dogs or copper-associated hepatopathy—is a unique form of liver disease that happens when too much of the mineral copper builds up in liver cells. 

What Is Copper Storage Disease in Dogs?

In a healthy dog, copper is absorbed by the small intestines and removed from the blood by the liver. Extra copper is discharged in the bile.  

In dogs with copper storage disease, there is a metabolic issue or liver disease that causes too much copper to build up in the liver cells (hepatocytes). Toxic buildup of copper causes damage to the cells. Hepatocytes are destroyed, and inflammation (swelling) and scarring of the liver may result. 

Most dogs with copper storage disease have symptoms of chronic liver disease (hepatitis) that result in a visit to their primary veterinarian. Less commonly, dogs may have acute liver failure or hemolytic anemia, which may require emergency care.  

Symptoms of Copper Storage Disease in Dogs

Dogs with copper-associated hepatopathy usually have symptoms of chronic liver disease.  

Symptoms may include: 

• Excessive urination 
• Excessive thirst 
• Lethargy 
• Vomiting 
• Bloating or distention of the abdomen 
• Neurologic signs like changed behavior, drunken gait (ataxia), disorientation, and seizures 

Less commonly, dogs may have symptoms of acute liver failure and/or hemolytic anemia. In addition to the signs listed above, the dog may also have jaundice, dark blood in the poop, blood in the urine, and spontaneous bleeding or bruising.  

Causes of Copper Storage Disease in Dogs

Most cases of copper storage disease are caused by an inherited genetic abnormality or breed predisposition.  

Dog breeds with a predisposition include: 

• Bedlington Terriers 
• Dalmatians 
• West Highland White Terriers 
• Labrador Retrievers 
• Doberman Pinschers 
• Standard Poodles 

Less commonly, excessive copper storage can be caused by conditions where bile flow through the liver is slowed or blocked (cholestatic liver disease). Liver inflammation or blockages in the bile ducts are potential causes of cholestatic liver disease.  

Too much copper in the diet can also cause copper to build up in the liver.  

How Veterinarians Diagnose Copper Storage Disease in Dogs

Copper storage disease in dogs may be suspected in pets with existing liver disease or in dogs with genetic or breed predispositions.  

The veterinarian will start with a physical exam, looking for evidence of liver disease, such as a bloated abdomen or jaundice. 

Tests done to diagnose the condition include: 

• Blood work and urine testing: These are important for checking systemic health and ruling out other causes of the pet’s symptoms. In affected dogs, blood work may show increased liver enzymes. There may also be evidence of red blood cell destruction if the dog has hemolytic anemia.  
• Bile acids: This test involves drawing a fasting blood sample, feeding the pet, and then collecting another sample two hours later. This is a test of liver function. 
• Coagulation testing: The liver is important for making blood clotting factors, so the vet may want to test if your pet can still clot their blood well. 
• Abdominal X-rays or ultrasound: These imaging techniques may show changes to the size or structure of the liver. They may also be used to rule out other causes of the pet’s symptoms. 
• Liver biopsy: Biopsies can rule out other causes of liver disease and be used to measure the amount of copper in the liver cells. 

Check with your veterinarian about whether you should fast your pet (withhold water and/or food) before their appointment.  

Fasting is required for bile acids testing and may be required if your veterinarian will want to take a liver biopsy. 

Treatment of Copper Storage Disease in Dogs

Treatment for copper storage disease in dogs involves removing extra copper from the dog’s body and not eating too much copper in the future. 

• Hospitalization: Dogs with severe illness may need to be hospitalized for stabilization. Treatments may include: 
  • Intravenous (IV) fluid therapy 
  • Medications to prevent ulceration of the stomach, like omeprazole 

• Lactulose or certain antibiotics (e.g., metronidazole) for hepatic encephalopathy 

• Blood transfusions if there are clotting abnormalities  
• Drainage of excess fluid in the abdomen if necessary 
• Chelators: A dog with copper storage disease should be started on medications that help remove copper from the body. These medications are given by mouth on an empty stomach, usually twice daily. Treatment with chelators generally lasts six to 10 months, sometimes up to a year. Dogs on long-term penicillamine may need vitamin B6 supplementation. These medications are called copper chelators and include:
  
  • Penicillamine 

• • Trientine 
• Zinc: Elemental zinc may be recommended as part of maintenance therapy to prevent intestinal copper absorption, but it should not be used with penicillamine. Zinc is given by mouth either twice daily or once daily. Some veterinarians may recommend decreasing the dose after several months. Zinc levels should be checked every two or three months and changed as necessary. 
• Antioxidant supplementation: Antioxidants are also recommended due to the oxidative stress caused by copper storage disease. These may include vitamin E and S-adenosylmethionine (SAMe), which may be in some liver supplements, such as Nutramax Denamarin.  

• Veterinary diet: Your veterinarian may also recommend a copper-restricted veterinary diet, such as Hill’s l/d Liver Care or Royal Canin Hepatic. For some dogs, dietary management alone is enough. If you want to feed a homemade diet, you should consult a board-certified veterinary nutritionist. 

Dogs who have acute liver failure have a very poor prognosis (outlook for recovery), and humane euthanasia may be recommended to prevent suffering. Dogs who have severe chronic disease or who have liver cirrhosis also have a poor prognosis.  

Dogs who have mild to moderate inflammatory disease may do well with the right therapy. 

Recovery and Management of Copper Storage Disease in Dogs

Dogs with mild to moderate disease may recover, though long-term maintenance therapy is usually needed. 

Dogs with copper-associated hepatopathy should have their liver enzymes and zinc levels checked every two to three months. Treatment with penicillamine may last up to a year, and zinc should not be started until penicillamine is stopped. 

Some veterinarians may want to repeat a liver biopsy after the dog has been treated for a certain amount of time, usually around 12 months.  

Prevention of Copper Storage Disease in Dogs

Dogs who have copper storage disease should not be bred. Pet parents looking to adopt a purebred dog from a predisposed breed should ask their breeder about family history of copper storage disease. Some breeds, like Bedlington Terriers, should be genetically tested. 

Make sure to feed a balanced and complete diet that meets the recommendations of the Association of American Feed Control Officials (AAFCO). If your dog is predisposed to this condition, such as a family history of copper storage disease, a special diet with lower copper levels may be recommended to prevent symptoms.