C09970763 / invoice 10000

Reason: Diabetic. Hypoglycemic. EMERGENCYHistory:Charlie Brown was presented through emergency in the early hours of Monday morning for a hypoglycaemic episode. Known diabetic - owner checks BG EOD in the evening prior to giving insulin, currently getting 6IU glargine BID.  Noted to be motionless + floppy around 1145 - checked BG and was 1.9 so put honey on gums and brought down. Last vet check in Mid jan - advised to cut out the dry food and just give wet due to weight, has been slowly cutting back the bikkies and only gave 4 today (rather than the 6-7 she had given previous days). Looking at previous BG hx possibly sitting low regularly prior to insulin (4.6, 5.5, 3.3, 7.2 a sample of the recent readings on glucometer). Examination:General demeanour: Flat Temperature: 36.5Cardiovascular: HR 172, MM pink, CRT 1.5sRespiratory: RR 40Abdomen: Obese. Abdomen soft and comfortable Laboratory:BG 1.4Blood ketones = 0 EPOC - hyperCa (1.45), hypoglycaemic (1.1) and mild creat elevation (203). Remainder including lytes NSF. Treatment:IVC placed. Active warming commenced 1ml/kg 50% glucose diluted 1:4 given slow IV - signficantly brighter following, up and walking around and eating food Repeat BG 15.2Client communication:Discussed additional underlying pathology v lowered dietary intake v weight loss v remission as all potential causes of the hypo. Offered inpatient v outpatient care - owners comfortable to take home and closely monitor (one of owners = diabetic herself) with follow up for further diagnostics + to discuss ongoing dosing with ref vet tomorrow. Plan for this mornings insulin dose (530am) as will be unable to speak to referring vet prior so owners happy to be on the conservative side- If 5-15 - give HALF dose- If >15 - give FULL dose- If <5 give NO insulinConsider repeating / follow up re elevated ionised Ca also. Referring Vet:History emailed to referring vet :   YES Time: 3am    Vital Signs