C09972290 / invoice 10000

HISTORY
Presented for acute vomiting and suspected foreign body ingestion (sock) with history of sock ingestion.
Diet: Currently eating very little, threw up food that was consumed. Owner not feeding a specific diet - purchases food from supermarket, groomers, pet stores, etc.
V/D/C/S: Four episodes of vomiting this morning on rug and outside door mat, initially food then progressed to bile. Attempted defecation but unable to produce stool, appearing constipated.
Owner's son located lone sock, unchewed, on ground yesterday, unsure if dog may have ingested the other sock.
Very food motivated; owners' grandchildren (toddlers) also throwing food onto ground which Lula helps herself to.

EXAM
Mentation: BAR
Wt: 10.2 kg (noted as heavy for patient)
BCS: 7/9
T: 38.6
HR: 160, no murmur
R: panting in consult, clear lung sounds
MM: pink, CRT <2s
Eyes: clear
Ears: clean
Oral: Dental disease Grade 2
Abdominal: Flinching when palpated cranially. No spinal pain.
Rectal: nothing palpated in colon with rectal exam
Diagnostics: Blood test including pancreatic lipase recommended. Ultrasound with sedation recommended to evaluate for foreign body.

ASSESSMENT
Suspected pancreatitis
Suspected gastrointestinal foreign body - DDx: sock ingestion based on history of pica and witnessed sock consumption, severe constipation

PLAN
Diagnostics:
- Blood test including pancreatic lipase - estimated cost $375
- Abdominal ultrasound with sedation by specialist ultrasonographer - estimated cost $960 (approximately $700 for ultrasound, remainder for sedation and hospitalization)
Client Comms:
- Discussed financial estimate of $1,441 for diagnostic workup
- Explained risks of sedation and anaesthesia, client signed consent form
- Will contact client with results and further recommendations based on findings

EHW verbal report - no foreign body located in stomach or intestines, severe ileus and enteritis.
Blood results - mild elevations in RBCs, albumin, TP, Ca, ALP - dehydration? cPL 206 so very equivocal.

called owner - OK'd IVF, pain relief and metoclopramide. Discussed sending to afterhours - to check after 5PM if ARH open, otherwise SASH is open all weekend.

Started on 2x maintenance.
5mg Metoclopramide + 150mg paracetamol given IV @ 3pm.

4PM: still very uncomfortable in the abdomen, panting in cage.
Has not urinated/defaecated in hospital.

PLAN
Plan
- continue twice maintenance fluids
- continue metoclopramide - due 5mg IV/IM at 3am
- offer bland food
- continue paracetamol 150mg IV

TR called o for update 
Deny advised they took her to ARH BH however they were closed 
They went to Kellyville pets but they could not do an u/s that day, they said could make her V+ however had been 3 hrs post suspected ingestion so they advised may be ineffective. O's elected to take home and monitor. Since then o's have closely monitored her and she has been fine. back to normal self, no V+ , EDDU normal, BAR. If any issues noted o will call us asap

O will also call back later for appt to update vaccs 

O walk in - already closed

Poss sock ingestion, has eaten in past and passed
Has had multiple grass vomits today, not eaten breakfast, lethargic

Lula is QAR, MM pink, CRT <2sec

Advised cannot see tonight, referred to ARH BH as likely needs bloods and xrays and cannot do tonight. Will send hx to ARH BH -- cm