C09972357 / invoice 10000

Reason: UnwellHISTORY:  Presents for inappetence and lethargy over the last 24 hours. Pekoe is a 16-year-old male desexed Domestic Short-haired cat with a history of kidney disease and hypertension diagnosed 12 months prior. Repeat testing 6 months ago confirmed ongoing kidney issues. The owner reports progressive weight loss over the last 6 months, which has recently worsened. Appetite was normal until yesterday. This morning, he ate a treat but refused his regular food. No vomiting or diarrhoea has been observed, however, he has outdoor access. He has been more lethargic and quiet than usual, remaining in his bed this morning. He is an indoor/outdoor cat with contact with other cats. He is on a renal diet (primarily dry food as he refuses the wet version), supplemented with other wet foods. Current meds: Amlodipine.Vaccination: UTD.Parasite Prevention: Recently wormed.Pre-existing conditions: Chronic kidney disease, hypertension, arthritis.Access to toxins eg. Rodenticide: none TRIAGE:HR: 160 bpmRR: 24 per minuteTemp: 39.7 degrees celciusMm:  PinkCrt: <2 secondsMentation: Lethargic and quiet.Demeanour/Behaviour: Lethargic and quiet. EXAMINATION:Body Condition Score: 3/9Pain Scale (0-4): 0/4Hydration status (%): 5% dehydrated. Increased skin tent.Cardiovascular: Grade 2/6 heart murmur.Respiratory:thoracic auscultation clear sounds bilaterally, respiratory effort normal. Small amount of blood noted on one nostril, significance uncertain.Neurological:neurologically no significant findingsMusculoskeletal: Palpable stiffness and reduced range of motion in hindlimb joints, consistent with arthritis. No other palpable pain.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):grade 1- Abdominal: abdomen relaxed, non-painful on palpation. Kidneys feel small. Bladder small.- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: quiet PROBLEM LIST:- Fever- Dehydration- Inappetence- Lethargy- Weight loss / low BCS- Pre-existing chronic kidney disease and hypertension- Arthritis- Heart murmur DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Fever of unknown origin (FUO)- Suspected bacterial or viral infection (e.g., UTI)- Acute decompensation of chronic kidney disease- Potential hyperthyroidism DIAGNOSTICS:None declined blood testing inhouse. ASSESSMENT:Peko presented for lethargy and inappetence. Examination revealed fever (39.7°C), dehydration (5%), and a low body condition score (3/9). A grade 2 heart murmur was auscultated. Abdominal palpation revealed small kidneys but was otherwise unremarkable. The fever suggests an underlying infection, which may be exacerbating his pre-existing chronic kidney disease. The primary problems are fever of unknown origin, dehydration, and anorexia in the face of chronic renal disease. The owner declined admission, in-hospital intravenous fluid therapy, and blood tests at this time due to financial constraints. TREATMENT:  - Subcutaneous fluid therapy administered in-clinic: 100mL Hartmann's solution.- Antibiotic therapy commenced: Amoxiclav 50mg tablets, 1.5 tablets to be given twice daily for 7 days.- Owner to continue Amlodipine as directed.- Owner to administer 1.5 tablets of amoxiclav tonight, 1.5 when they go to bed, and 1.5 in the morning. PLAN:The owner will monitor for improvement over the next 24 hours. If there is no improvement, re-evaluation with their regular veterinarian tomorrow is strongly recommended for further diagnostics, including blood tests and potential intravenous fluid therapy. The prognosis for a 16-year-old cat with these concurrent issues is guarded. Home into owner's care. CLIENT COMMUNICATION:Discussed the examination findings, including the fever, dehydration, and concern for an underlying infection possibly complicating his chronic kidney disease. Recommended hospitalisation for blood tests, intravenous fluid therapy, and supportive care. The owner declined this course of action due to financial concerns. The estimated cost for initial 12-hour hospitalisation, diagnostics and treatment was $1500-$2000, with subsequent 12-hour periods costing $1200-$1500. The alternative plan of subcutaneous fluids and oral antibiotics was discussed and agreed upon. The cost for today's consultation and treatment is $472. The importance of slow fluid administration for cats with kidney and potential heart issues was explained. Advised that if Peko does not show improvement, he should be taken to their regular vet for a recheck and further investigation. Discussed that even with treatment, we are managing a chronic, progressive disease in an elderly cat.    Vital Signs    Weight: 4.03;       Temperature: 39.7;