C09970155 / invoice 10000

Reason: IDEXX - full report - JSU    Vital Signs    

Reason: In HospitalExamine: QAR.Mm pink and moist, crt 1secHR=PR=100, grade 5/6 systolic murmur.Not eating.Diarrhoea still.Spoke to karen.And update faecal PCR result.While c perfringens are unlikely the culprit of diarrhoea, it is important to address it before starting on steroid.Metronidazole is a good choice for c perfringens.Will start prednisolone this pm and monitor.Start on prednisolone 1mg/kg (7.5mg) PO at 1pm.Mirtazapine 7.5mg PO at 1pm4pm - ate dehydrated chicken very happily. Sprinkled dehydrated chicken on chicken. Ate some.Updated owner.Will go home    Vital Signs    

REASON: Still D+Verified: NoHISTORYPresenting for: Lily Jean presented for ongoing illness with severe diarrhoea and pancreatitis investigationHistorical Conditions: Low vitamin B12 levels indicating chronic gut loss. Blood work performed 10 days ago on 17th suggestive of PLE and pancreatitisDiet: Initially placed on bland diet (purina HA and chicken) which she ate ok. Subsequently became disinterested in prescribed diet and wouldn't eat when fed separately from other dogs. Has been getting into other dog's food, so no dietary control. V/D/C/S: Severe ongoing diarrhoea causing significant perianal scalding and rawness. Had an okay night but condition not improving overall. This AM, small formed faecal pellet in bed for the first time with all the diarrhoeaEXAMRectal: perianal scalding and rawness from chronic diarrhoea, similar to nappy rash in children. Significant discomfort and pain associated with the lesions.- ABDO: soft, sl guarding on cranial palpation- LN;WNL- ORAL: moderate calclulsu build up all teeth. O aware of dental condition - trying to stabilise the heart before ga for dentalASSESSMENTPancreatitis with chronic diarrhoea - Ongoing investigation with poor response to current outpatient management. Low vitamin B12 levels indicate chronic intestinal malabsorption. Severe perianal dermatitis secondary to chronic diarrhoea causing significant discomfort.PLANDiagnostics:- Repeat blood work to compare with results from 10 days ago to assess progressionNew Meds/Tx:- Hospitalisation for IV fluid therapy and supportive care- IV medications including anti-nausea therapy and appetite stimulants- Pain relief for perianal discomfort- Topical barrier cream (Sudocrem) application to prevent faecal matter adherence to perianal skin- Intensive nursing care for perianal hygiene management- Vitamin B12 supplementationAdditional Discussion:- Current home management insufficient for patient's needs- Minimum 24 hours hospitalisation required, likely extending to tomorrow morningand beyond- Patient assessment every 12 hours to determine discharge readiness- Rich, high-fat foods contraindicated for pancreatitis management as per breeder suggestionVitamin B12 injection due 2/03/26Continue vetmedin, apoquel and sotalol. O dropped offLAB:* CBC: regenerative anaemia ( hct 32.9), inflammatory leukogram (band Neutrophils 14.9, monocytes 2.03* Biochemistry: low crea 40 , low Ca 1.89, hypoproteinaemia 45 due to hypoalbuminaemia 17. Hyponatraemia 143. High cpli 555ASSESSMENT:> inflammatory/infectious cause> protein losing enteropathy > pancreatitisTREATMENT:- Hartmanns maintenance 17ml/hr- Maropitant 1mg/kg q24h slow IV- Esomeprazole 1mg/kg a12hr slow IV- Buprepnorphine 0.015mg/kg q8-12hr PRN IV- Metronidazole 10mg/kg q12hr slow IV Normal medications to continue (O's supply)- Pimobendan 2.5mg BID PO- Sotalol 1ml BID PO- Oclacitinib 5.4mg BID PONursing care:- Regular toilet walks- Bum clean and sudocream barrier- Encourage appetite. Bland dietCOMMS:- Adv O of the above. Adv likely overnight stay and reassessment q12hrly, likely into the weekend due to chonicity of condition    Vital Signs