C09971235 / invoice 10000

DATE/TIME of CONSULTATION: 20:18hrs, Sun 01/03/26
Presenting problem : onion ingestion  125mg ( 10mg/kg) toxic dose > 15mg/kg 

TOXIN:
Time of ingestion: 8pm 
Present symptoms: none 
Prior medical history: been well - has had previous BOSC incident- see hx 

Clincal Exam: hr 120, mm pink crt <2 ,

Treatment : emesis : 1/2 tablet apomorphine onto gums 
Outcome: succcessful emesis lots of onion 

additional treatment: maropitant 1mg/kg sc 

Plan:
home on monitor 
recheck CBC at regular vet in 24hrs if concerns 
monitor energy levels, gum colour at home - revisit earlier ongoing vomiting/inappetance 

right hindleg slightly delayed  post apomorphine- owner  not noticed previously will montior overnight 

******************DAY SHIFT UPDATE****************
PROBLEM LIST: Vomiting, resp distress, suspected aspiration pneumonitis/pneumonia, anaphylaxis, CA
CLINICIAN:  JSM
EXAMINATION:  BAR, vitals stable WNL, eating happily, 
Soft cough am - intermittent, lung fields clear, Spo2 99% on room air, N RR/RE
DIAGNOSTIC TESTS: Nil further
ASSESSMENT: Doing remarkably well
PLAN:  transitioned to orals - closely monitored post initial dose Amoxycalv - no CS reaction
CLIENT COMMUNICATION: Phone update- happy to trial at home 
Amoxyclav 187.5mg BID
Ondansetron 4mg up to BID/prn inappetence/nausea/vomiting
Codeine linctus 0.5-2mg/kg up to TID if required for persistent coughing
Monitor SRR and rr/re
Small freq supervised bland meals
Review pending progress
Disc CS asp can take up to 72 hrs to develop - imaging/bloods indicated if showing signs suggestions development
** owners think that initial vomiting was cause by eating some plant in the garden that can cause gastric irritation and/or some bark
D/c notes provided  

DATE/TIME of CONSULTATION: 19.00 hrs, Sat 20/09/25
CLINICIAN:  EB 
PRESENTING COMPLAINT: resp distress
HISTORY:

know anxious dog- previously been on fluoxetine
does not like the vet 

vomiting and diarrhoea this am
went to RV this pm
- methdone sedation
- iv maropitant given

ultrasound - no evidence of FB or mechanical obstrction-   and bloods- mild haemoconcentration and hyponatremia 

regurg post sedation for ultrasound - concern about aspiration 
increased resp distress
0.2ml dexason given IV
iv  alfaxan induction-, intubation and iv propofol CRI

iv amoxyclav 20mg/mg - started in clinic and then completed by ready set go

continued with CRI propofol - spo2 100% (intubated), hr and bp stable -in van

CLINICAL FINDINGS:
Sub: -sedated/intubated
Obj: HR: 140, MM pink, moist CRT<2 T: 37.8
BP 121/70 
spo90-100% on 2 % o2 
Cardiovascular: no notable murmurs or arrythmias auscultated, femoral pulses good and synchronous
Respiratory:  normal bronchovesicular sounds on auscultation, no visible nasal discharge
Gastrointestinal: soft comfortable abdomen on palpation, no strong repeatable focus of pain, flatulence 
Rectal exam: n/a
Musculoskeletal: no strong repeatable focus of pain on gentle manipulation of limbs and joints, no notable lameness on walk
Neurological: cranial nerves intact, no notable ataxia
Integument: on admission muzzle oedematous and erythema, swollen eyelids, oedematous paws 
Lymph Nodes: no peripheral lymphadenopathy noted

PROBLEM LIST:
Regurg post sedation- possible aspiration 
Gastritis
Resp distress= intubated
allergic reaction/anaphylaxis- Juno 

OPTIONS PROVIDED:
discussed Resp distress and anaphylaxis- consented to all required treatment- up to $5000 in first 12 hours 
DIAGNOSTIC TESTS:

-EPOC -  severe resp acidosis
mild haemoconcentration 
serve hypercapnia- TCO2 60-70 

TREATMENT:
0.6ml chloraphmine on admission IM
0.1ml adrenalin given iv 
spo2 -2%
fluids- LRS- maintenance rates 
profofol CRI - started at 20ml /hr (- rapidly reduced down to 9ml/hr ue to severity of hypercapnia- with muscle twitching
0.5mg mizoplam- no improvement in muscle twitching and increased hypercapnia

while weaning down spo2 and proprofol with manual ventilation
sudden from in Tc02, resp and then heart stopped- commenced cpr/ 0.1ml adrenalin- hr returned but bradycardic- atopine 1ml given, stopped propofol
return to regular breathing, Tco2 normalised, HR 150-160 

1ml dex given iv ( only 0.03mg/kg given at RV so increased to 0.2mg/kg total)
another 0.25 mg of midazalam  gven IV

slow recovered but spo2 stable
breathing well though tube- extubated 
RR/effort/colour stable

post extubating
medetomidine CRI to affect to reduce anxiety
monitor RR/Effort /spo2

CLIENT COMMUNICATION/PLAN:
owner aware of Resus- came back to visit
aware was extubated but still a risk of deterioration

plan
keep on ivf 1x maintenance
medetomine CRI  to effect 
repeat EPOC - Q12hrly
consider chest xrays but only if minimal stress
maropitant 1mg /kg Q24hrly if required 
home if spo2, RR stable and eating