C09971376 / invoice 10000

Reason: Possible Advil IngestionConsultation Time:History: Eaten between 2-3 ibuprofen tablets (liquid gel capsules) at 6.07pm 3 found on floor, either 3 or 4 tablets in the package O found package with 1 empty capsule, and 2 half empty capsules +- 4th one they she may have eaten (owner unsure if 3 or 4 in package initially. Med hx - 1 episode self resolving gastro few weeks ago NO V+d+ past few days Allergies - nil Vax utd Worming utd Subjective:  BARObjective: Temp     38.8       MM  pk         CRT        1     HR    140         FPssBCS:   /9                       Wt: 2.75   kgPain Score (CSU):  0 /4CV:  NAD       RESP:   NAD           RR pantGIT:   NADU/G:  NADNeuro:  QAR ambulatory full exam not perfomred M/S:  NADInteg:  NADOphth:  NADLNs: NADVBG (basline renal parameters)Creat - 41 (62-105)Urea 3.8 2.5-9.6)Ca 1.45, Cl 111 K 4.33, Na 148, Glu 5.7 Lac 0.9 tbil <0 Hb 140, hct 42.8 pH 7.406, co2 42.7Problem List:Ibuprofen toxicity High end est 3 tabs = 220 mg/gk Low end est 2 tabs = 150mg/gkConcern for both renal and GIT signs, likley higher risk for renal injury as juvenile Assessment: ibuprofen overdoseGIT signs: Dogs: >25 mg/kg, Cats: >10 mg/kgRenal signs: Dogs: >150–175 mg/kg, Cats: Unknown, thought to be 2X more sensitive than dogsCNS: Dogs > 400mg/kg, cats unknownAll dosages above are based on acute ingestion by young, healthy animals, with no prior history of renal disease.6 Pediatric, geriatric, and patients with pre-existing GI, renal, hepatic, coagulation or CNS disease may be at risk at dosages lower than those listed. Whenever in doubt, it is safest to err on the side of caution.Although mild GI upset may occur within the first 2-6 hours following ingestion, significant GI hemorrhage and ulceration are commonly delayed for 12 hours to 4 days following ingestion. This delay reflects the amount of time required for GI cytoprotection to be lost and mucosal injury to occur. Vomiting (+ hematemesis), anorexia, abdominal pain, melena, hematochezia, and diarrhea may develop. GI perforation may occur subsequent to ulceration and may result in collapse and shock from hypovolemia and/or peritonitis.Onset of renal injury is usually detectable within the first 12-24 hours following ingestion, with polyuria, polydipsia, isosthenuria as initial signs. Glucosuria, hematuria, dehydration, oliguria, and lethargy may develop as renal injury progresses. Although in most cases, renal injury is apparent within 48 hours following an NSAID overdose, in rare instances the onset may be delayed for 3-5 days.Options Offered to Client:Discussed treatment to minimise perminant renal damage - early detection of bloods/urine and IV fluids starting now will minimse long term perniamt damage. Explained that by the time we see signs clinically we may not be able to reverse some of the renal damage) Discussed gastro concerns (ulceration and perforation, which they can die from, vomitng diarrhoea anorexia) Options offered included estimates 1. Full bloods and admission 2.5k2. Just renal parameters and oral meds 1800-2000 - if no complications 3. Outpatient care + radiometer, rDVM or cheaper vet clinic tomorrow AM for bloods and IVFT ongoing, 800 roughly tonight - this option NOT recommended unless unable to admit d2 cost constraints. O elected option 3 aware of risks Declined in hosp care Treatment:- SQ fluids 40ml - omeprazole 1mg/kg BID - script provided (10mg, @ 1/4 tab BID) - misoprostol 100mcg diluted into 5ml suspection -> 20mcg/ml -> give 0.1ml (2 mcg) PO BID. Showed o how to shake into suspection before giving so they dont overdose. Do not handle if pregnant. - charcoal 1mg/gk PO ONCE (recommend to conitiue, can continue rVDM) - ondansetron 0.7mg/gk PO q8-12Decontaminated - no pill on recovery -> reversed metoclop 0.5mg/gk IV Plan:RDVM or another clinic tomrorrow AM for repeat bloods + reassessment and ideally IVFT for renal protection, concern gastro signs will cause dehydration. check USG and renal parameters at admit, after 48 hours of fluids and 24 hours after discontinuing fluidsScript printed and at front desk at recepation    Vital Signs