C09976801 / invoice 10000

Reason: Grape ingestion Consultation Time: 20:12Reason: Grape ingestion Consultation Time: 20:12History:Presenting complaint: Grape ingestion- first time eating grapes; but is a scavenger (eating dirt/ grass/ legos/ cat poops/ foam in the backyard/ dog park)- overall healthy, but last month had laceration on the side of the bodyLast normal: before eating grapes maybe an hour agoEDDU: EDDU all normalVomiting/diarrhea: noneLast eaten: Pre-existing conditions: noneMedications: noneAllergies: none that O knowsVaccination: UTDParasite control: UTDTravel history: noneDiet: boiled chicken, veggies, basa, kibblesPotential toxin exposure: Grapes x4Other pets: noneRegular vet:Subjective: Sweet Dog Objective:CV: Sinus arrhythmia, no murmur. Femoral pulse normal Hr 120    RESP:  Normal bronchopulmonary sounds             GIT:  No oral lesions. Soft on abdominal palpation  U/G: Nad, no obvious discharge. Limited exam  Neuro: Limited exam, appropriate mentation.  M/S: Limited exam- normal gait. Good muscle condition score 5/9Integ: Limited exam, no obvious pathology  Ophth:  Limited exam, no discharge LNs: All peripheral lymph nodes within normal limits Problem List: Grape Ingestion- AKI secondary to this Concerns for Foreign body obstruction Secondary Gastroenteritis due to pica Assessment: Scavenging and destroying Lego and rooting around in garden  of boredom. Grape ingestions - if clinical sings noted clients have been requested to represent Document with clinical sings printed out and handed to owner Continue with activated charcoal treatment- to be mixed with wet food and encourage water intake If any vomiting, diarrhoea then represent for bloods, if normal then radiographs recommended as foreign body is a concern due to hx of scavenging. Options Offered to Client:Emesis, Admit, IVFt, Bloods in 12 hours, activated charcoalDischarge post emesis with activate charcoal and anti-emtic reversal, follow up bloods in 24-48 hours or sooner if not doing well Discharge as out patinet post emess and montior for post grape ingestion clinical sings Owner decided to take Harry home with activated charcoal and follow up with regular vets Financial update (deposit, estimate communicated): Yes $1200- 1800 for first 12 hoursTreatment: 6.5mg apomorphine x 2tbas- emesis induced Metoclopramide e given subcutaneously 0.5mg/kg – 3.2ml – not charged as forgotten. 750 ml of activate charcoal- 250 ml each dose, one given in clinic that Harry ate - Harry post emesis was caught eating his vomit. Had not re-ingested ne the grape ingested. Owners think that he had eaten at least 4 grapes 2 brought up (1 whole, 1 halved, many other small broken pieces ) among other food material. No lego brought up, no other foreign body  	Plan: Diagnostic plan :Bloods- renal panel or full depending on Harry's clinical signs Radiographs/ultrasound of abdomen as FB is  a concern due to pica/ scavenging Therapeutic plan : Snt home with activate charcoal Discharge plan : Monitor for grape and Fb ingestion Referral plan : Under Ecc care Link- https://vcahospitals.com/know-your-pet/grape-raisin-and-currant-poisoning-in-dogs    Vital Signs