C09973002 / invoice 10000

HISTORY:- Suspected ingestion of old Vyvanse 60mg tablets after breaking into a cupboard approximately two hours ago. Molly, another dog in the household, was also involved, but Digby is considered the more likely culprit.- The owner has not observed any definitive signs of toxicity. There was a single, isolated twitch noted a short time ago, but no constant trembling.- He is not on any current medications, though has previously been on ear drops.- Appetite and urination are normal. No vomiting or diarrhoea has been observed this morning.- He is known to be a hyperactive and anxious dog with separation anxiety.EXAMINATION:HR: 120 bpmRR: pant Temp: 38.5°CMM: pink CRT: 2sMentation: Bright, alert, responsiveHydration status (%): euhydrated Body Condition Score: 5Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures strong, regular and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal but panting, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait. No tremors observed.Musculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal: - Oral: normal, no mouth pain, dental score: - Abdominal: no detectable pain on abdominal palpation, normal gut sounds - Rectal: no detectable abnormalitiesReproductive (incl ext genitalia): male entre Integument/Ears: clean furcoat no evidence of otitisLymph Nodes: peripheral lymph nodes normal size/shape & not painfulEyes: clear corneas, nil discharge or blepharospasm. Pupils are responsive with no mydriasis.- Examination findings are consistent with his typical stimulated and anxious behaviour. He is able to stop panting appropriately and is not displaying inappropriate vocalisation or agitation.ASSESSMENT AND PLAN:1. Suspected Toxin Ingestion- At present, Digby appears clinically normal with no signs of toxicity. The physical examination findings are consistent with his usual excited and anxious demeanour rather than drug-induced symptoms.- The potential side effects of the ingested medication were discussed, including hyperexcitability, mydriasis, hyperactivity, hyperaesthesia, vocalisation, agitation, tachycardia, hypertension, panting, and tremors. It was noted that many of these signs would be difficult to distinguish from his normal behaviour. The worst-case scenario involves seizures with secondary hyperthermia.- The poisons board recommendation for hospitalisation with close observation was discussed. However, given the busy emergency clinic environment and Digby's temperament, this would likely require sedation, complicating monitoring.- The plan is to discharge home for close monitoring over the next 24-48 hours.- Return to the clinic immediately if any signs of toxicity develop, such as hyperexcitability, tremors, seizures, persistent panting, or other behavioural changes.DIAGNOSTICS:- No diagnostics performed.TREATMENT:- No treatments administered in-clinic.PLAN:- Discharge home with instructions for close monitoring by the owner over the next 24-48 hours.- The owner was advised to return immediately if Digby develops any signs of hyperexcitability, tremors, seizures, persistent panting, or any concerning behavioural changes.- Provided education on the potential signs of toxicity and the timeline for their appearance.    Vital Signs    Weight: 27.8;