C09970972 / invoice 10000

Reason: Grape Ingestion HISTORY:Luffy presented for ingestion of three grapes about an hour to an hour and a half prior to presentation. The owner reported that Luffy had not eaten a proper meal before ingesting the grapes. No other concernsCurrent meds: noneProphylaxis: UTDPre-existing conditions: noneAccess to toxins eg. Rodenticide: GrapesTRIAGE:HR: 120RR: 30Temp: not takenMM: pinkCRT: <2Mentation: BAREXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: normal, no mouth pain- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Recent grape ingestionDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Potential grape toxicityDIAGNOSTICS:Emesis inducedASSESSMENT:Luffy presented for ingestion of a potentially toxic dose of grapes (three+) approximately 60-90 minutes prior. Given the recent ingestion, the risk of acute kidney injury secondary to grape toxicity was discussed alongside with the unknown toxic dose (papers show likely 1 grape per 10kg can be toxic). The recommended treatment plan was to induce emesis to retrieve the grapes to be safe - O consented.Emesis successfully induced - grapes retrievedTREATMENT:Vomiting was induced with one tablet of apomorphine administered on the mucous membraneAt least two grapes were successfully retrieved in the vomitus. Post-emesis, 1mg/kg of metoclopramide was administered SCPLAN:- Decontamination via induced emesis has been performed.- Monitor for any signs of gastrointestinal upset (vomiting, diarrhoea) or lethargy over the next 24-48 hours.- Re-present for veterinary care if any clinical signs develop.- The owner was advised on the unknown exact toxic dose of grapes and the importance of preventing future access.CLIENT COMMUNICATION:Discussed the potential for grape toxicity and acute kidney injury with the owner. Explained that the toxic dose is unknown and that inducing vomiting is the best course of action given the recent ingestion. The owner consented to the plan. Advised the owner to monitor Luffy at home and to seek further veterinary care immediately if any signs of illness occur.    Vital Signs