C09970471 / invoice 10000

HISTORY: REASON – One grap eaten. Only eaten a couple of treats today.

HISTORY -  Patient ate a grape about an hour ago. O thinks only a single grape but cant guarantee wasnt more. Patient has been well otherwise. 

Appetite:  normal, no change
Water intake: normal, no change
Urination: normal, no change
Faeces: normal, no change
Energy levels: good
Coughing or sneezing: no  
Vomiting:  no 
Current Medications: none 

EXAMINATION- very good boy today, did muzzle for initial injection 
Demeanour: BAR 
BCS: 5.5/9 
Integument: clear
Eyes: bright and clear
Ears:  clean
Nose: clean
Mouth:-
CRT:          not assessed
MM:  pink 
Dental disease: Grade - 1/4 - limited exam 
HR: 132  BPM,    Rhythm: no murmur appreciated 
RR:  40 BPM,    Effort: none 
Temp:   38.7C
Peripheral LN's: WNL
Abdomen: comfortable on palp
Musculoskeletal:  NAD 
Neurological: NAD
Urogenital: not assessed
Rectal:  not assessed 

ASSESSMENT: grape ingestion 

CLIENT COMMUNICATION:
- discussed liklihood of kidney injury with single grape ingestion - O could monitor at home as single grape probably wont effect patient too much but cannot guarantee wont cause kidney injury. Recommended inducing emesis and running bloods to establish baseline and then rechecked kidney enzymes in 3 days time- O keen to do emesis and bloods. 

TREATMENT: Blood taken from R cephalic vein 
CBC: low platelets
Biochem: WNL 

Give 0.5ml diluted apomorphine SC inj (approx 0.1ml undiluted) - 1ml apomorphine mixed with 4ml sterile water to induce emesis. 
Patient brought up large amount of bile, fluid, material and grass- no grape found. 
0.72ml metoclopramide SC inj given as reversal.  

Dispensed 36ml activated charcoal to be given this afternoon by O. 
Repeats pre GA bloods (including SDMA) in 3 days time 

Found a large pile of chewed up fabric in patients vomit. Discussed with O- O thinks patient has chewed up a fabric blanket. O to monitor patient very closely- v+, toileting etc. as cannot rule out fb. 

PLAN: Repeats pre GA bloods (including SDMA) in 3 days time 
O to bring patient back earlier if condition deteriorates or any concerns. 

ESTIMATES: $400-$600 for emesis, consult, bloods today 

REVISIT: Wednesday for repeat bloods
WEIGHT: 7.20