You might want to have the ammonia level done.
 

It's not expensive, and it would give you more to go on. If they're building up ammonia in the blood, it's an indication that they aren't processing proteins the way they should be.

Ammonia tests do not help in determining if a dog has MVD (which is a real possibility here since the BAT results are under 100) because many times in dogs that actually have MVD, the ammonia tests come back normal...

I didn't say they did.

I was reading up since you all said that a low protein diet could be harmful to Mayme if she didn't absolutely need it.

I found this:
Although low protein diets were recommended in the past for dogs with liver disease, recent research has found that protein is required for a healthy liver and a low protein diet can be harmful to dogs with liver disease. The only time that protein needs to be restricted is when hepatic encephalopathy (neurological problems caused by excess ammonia) is present.

Since Mayme shows no neurological signs, should I just stick with a mid-range protein level?

Any food that is AAFCO approved probably has enough protein for a dog to survive on. Prescription diets that aren't AAFCO approved could have less.

If your pup isn't having neurologic symptoms, I wouldn't personally go below 18% and that is still very low. Low 20's seems fair to me. Ellie's post bile acids were 106 and she gets 24%.

jadecomputergal, I wasn't saying that you claimed that. :) I am just letting the original poster know what I posted since her dog's BAT results are only 48 and are more indicative of MVD rather than liver shunt...

When it comes to liver compromised dogs...

If the dog does *not* have a history of HE symptoms, then protein should not be restricted to less than 18% but it should still be vegetarian/dairy protein because it is easiest on the liver...Meat protein causes a build-up of ammonia and causes the liver to work too hard *unnecessarily*.

If the dog does have a history of HE, then there are certain things that should be done to make sure the dog gets as much protein as possible without exhibiting symptoms.
For example, 4-6 small frequent meals helps lighten the load on the liver...They are able to take in more protein a day by doing this because they are getting smaller amounts of protein at any one given time, BUT they are getting more when you add up how much they eat in the entire day...Dr. Center recommends certain antibiotics to help the dog tolerate more protein as well...She also recommends fiber be given...Obviously lactulose is absolutely necessary as well b/c it helps pull the toxins from the bloodstream and sends them to the colon where they are pushed out...Enough lactulose should be given for the dog to have 2 soft stools per day. Then there are the supplements like milk thistle and denosyl that really help protect the liver...

Picky eating, lethargy(lack of energy), odd behavior, dark urine, small amounts of urine, smelly urine, and also the neurological symptoms are all symptoms of liver problems.
Dogs may not exhibit all these...

Getting sufficient protein is very important...That's why even if the dog exhibits symptoms of HE, the above things I mentioned should be done in order to ensure the dog is able to handle the proper amount of protein. If there is a history of HE symptoms, it is important to start the dog out on the lower end of protein and work up *slowly* to the goal amount of protein...It should only be increased a small amount every 7-10 days to see how the dog handles it. If he/she does well, then increase again in 7-10 days...This helps the dog big time..

Mayme started on her Denamarin on Saturday. It said to give it to her after an overnight fast and then wait an hour to feed. I gave her the pill and fed her 30 mins afterwards because she was searching for food. She then immediately threw up her food. Then this morning, I didn't put her food down until the full hour was up. However, she didn't eat it, and threw up bile an hour and a half after taking the pill.

Anyone using Denosyl, did your pup have problems like this?

Conner had liver issues a while back. We put him on Hills L/D canned (he hated it), then we tried the kibble (he liked that one). He was also on liver support pills. He had about 4 more blood tests until his tests finally came out normal. I still wanted to give him a lower protein food. I did some research and put him on Wellness Super5Mix Healthy weight. Crude protein is 17%. It also has glucosamine nd chondroitin (because he had a bad knee). He does really well on this food.