C09972596 / invoice 10000

Appetite was fine until yesterday morning - hiding behavior and only eating half of what he would normally eat. still drinking water (possibly more than normal). didn't get fed last night as didn't come home last night and this morning also onyl eating half normal amount.
No vomiting.
Still producing diarrhoea.
Diet: Maincoon kibble indoor cat introduced at the same time as getting diarrhoea & felix.

PE;
W 4kg
BCS 4/9
BAR
Pink MM, <2s CRT - minimal skin tent.
Hr 180, no murmur detected
RR effort normal, lung fields clear
Abdomen comfortable
LN NAD
T 38.2C

Assessment: diarrhoea - chronic
Await diarrhoea analysis/pcr test. 

Treatment:
Buprenorphone 0.06mg TM BID
Maropitant 1mg/kg given SQ
Ondansetron 4mg TM BID

O Requested abx given previous hx of clostridial dx - adv may change based on findings of diarrhoea sample.
TO keep cat in doors moving forward.
FLagyl 1.2ml PO BID for 5 days unless advised otherwise.

Discussed admit into hospital - recommended against as still bright/eating and will be stressed in hospital (already hissing at other cats). IF still NQR tonight/tomorrow - to consider admitting.
\Warned diarrhoea may take 3-7 days to resolve.

HISTORY:
Presented for: Diarrhoea, flat, slight weight loss
Has developed diarrhoea again (history of campylobacter and clostridium perfringens, responds to flagyl but difficult for owner to medicate) cowpat constancy on  
Started two days ago, then seemed normal yesterday but happened again overnight
When owner opened door to laundry (where he was overnight) he was sitting on ground, lo9oked hunched and sad
Eating normally, maybe with slightly less gusto today. Eats indoor cat RC kibble, felix. 
Up to date with 3 monthly control parasite control. No other medications 
No vomiting. 
Indoor and outdoor cat, mutli-cat household
Might be eating grass - some present in stool

EXAM:
Fine to handle today 
Mentation: QAR
BCS: 3.5 - 4/9, lost ~250g since last seen in December 
Hydration status: mm moist but skin tent present 
Eyes: nad
Ears: nad
Nose: nad
Mouth: Grade 2/4 dental disease, did not perform full oral exam due to temperament issues previously 
MM: pink and moist, CRT less than 2 
Throat: nad
LNs: nad
CV: HR: Purring in consult, HR 168bpm out in treatment room, no murmur or arrhythmia heard
Resp: 36bpm, auscultation clear
Abdo: soft and comfortable
MSK: nad, comfortable also on neck manipulation and spinal palpation 
Integ: nad
Neuro: nad
Genitourinary: nad
Rectal: not performed 
T: 37.3

Owner provided faecal sample (semi-soft) - sent for Diarrhoea Panel, PCR

Bloodwork in house:
Eosinophils *0.02 0.17 - 1.57 x10^9/L
Basophils *0.00 0.01 - 0.26 x10^9/L

- Urea 14.9 5.7 - 12.9 mmol/L. 
- IDEXX SDMA a 17 0 - 14 µg/dL
- Globulin 53 28 - 51 g/L
CRP accidentally run - normal results 

Urinalysis (collected via cystocentesis) 

ASSESSMENT:
 - Diarrhoea: infectious (ongoing campylobacter, other) versus inflammatory/dietary intolerance/IBD, neoplasia, secondary to renal disease, other 
 - Elevated urea and SDMA, creatinine within normal range (but has had mild weight loss): pre-renal (dehydration) 

PLAN:
1mg/kg maropitant given SQ
0.02mg/kg buprenorphine given SQ
Vet to call with faecal results once back 
Owner to feed bland diet in meantime (has pro-kolin at home but usually Milo will not take it) 
if declining at all at home revisit - consider admission for IVFT +/- abdominal ultrasound 

HISTORY:
Had positive for chlostridium perfringens + campylobacter
Had diarrhoea the last 2 days, flowed over the edge of the litter tray
Lying in a ditch outside
Feels lighter weight and feels skinnier
O unsure if having d+ outside
d+, pure liquid, brown, no melana or blood
no V+/C/S
sleeps in laundry at night
Eating but reduced 50% of normal, 
Likes to drink out of puddles outside, dirtier the better usually
O has not seen him drink over the last 2 days
lethargic last 2 days
After jumping backlegs a little bit wobbly/weak
Urinating normally

diet: urinary diet dry food hills c/d + stress, felix wet food
no diet changes
Goes outside + is quite a predator, eats mice/rats
worming: not UTD

Presented for: NSAEC: A couple of days of watery diarrhoea. Hx of hospitalization for this in the past - C.O 

EXAM:
Mentation: BAR
BCS: 4/9
Hydration status: mild skin tent suspect due to age, hydrated
Eyes: NAD
Ears: NAD
Nose: NAD
Mouth: NAD
MM: pale pink CRT<2s
LNs: WNLs
CV: HR: 204 BPM, no M Or A
Resp: normal rate, effort
Abdo: soft, comfortable
MSK: NAD
Integ: NAD
T: 38.0

ASSESSMENT:
Acute diarrhoea again - ddx repeat episode of clostridiual Perfringens/campylobacter infection

PLAN:
Flagyl 2ml BID for 7 days
Bland diet
Pro-kolin 2ml BID after finishing AB
Keep indoors in the future, concern for getting bacterial infection from environment
R/v INI within 7-10 days or sooner if not eating/drinking/vomiting/etc

COMMUNICATION:
Discussed repeating faecal testing again vs assume similar thing, if not resolving then AB may mask further testing.