C09977610 / invoice 20000

Reason: Acth Stim + Urine For C+sClient Discussions: Laura ST TG on admission- Bentley seemed to be awake all night, sitting up, not able to rest- not sure if dt pain or gabapentin or other  (but low DR of gabapentin)Also has not defecated in 24hrsSeems much brighter this amHad morning trilostane 5mg and 100mg gabapentin  at 7am3 hours later Laura found a vomit- not sure when he did it, didnt see any medication in the vomitusLaboratory:  ACTH stim 0hr bloods collected0.3cc synacthen ivi1 hour bloods collectedVoided urine sample sent for urine c+sDefecated normal stool whilst here.    Vital Signs    

Reason: AG's And Check Of Hind Legs (Stiffness)Appointment Notes: KS - AG's done but also want to check on hind legs, very stiff/slow. He is due a cancer scan as well.History: presented by Eddie (son)Back legs have been trembling recently and has been stiff esp in the morningsThis morning he couldnt get out of bedImproved once he was up and about but still needed to be helped into the carCurrent meds- simarica trio- given last week                      Trilostane 5mg sid in pm                      Propallin                      Nothing for cancer/painObjective: appears BAR and waggyRises ok, looks slightly ataxic in back legs and can hear scuffing RHLRHL slipped out from under him on a turnAt rest is leaning, favouring RHLCP both  back legs wnlRestricted extension of R hip cf LHSStill able to jump up onto a small leged outside and lift his leg to urinateMm pink/moist, crt <2secEyes- snsEars nadPeripheral lnn wnlChest- HR 140 with HM 2-3/6 (not mentioned before)RR 20, normal resp effortAbdo palpation -bit sensitive over bladderGood coat and BCSExtremely thirsty - emptied bowl of water as soon as offered then emptied 2 2nd bowl when it was replacedTreatment: blood collected for htol,biochem lytes sdma                     Urine for in-house USG and dipstick                     Expressed AGs- mod large, liquidy secretionLaboratory: Htol wnlBiochem crea 169               Urea 16.3               SDMA 11                Lytes wnl               Stat cortisol- 41.2nmol/L - guidelines from idexx machine says doesnt r/o hypoA, needs acth stimUSG 1.018Dipstick no glucose, small blood, 2+ pr, ph 6.5Assessment: weak, trembling legs - hypopA ? (tho electrolytes and cbc wnl)                                  Needs acth stim but currentl;y giving trilostane in the pm                        Pu/pd  today USG 1.018                        Haematuria - dt tcc vs uti?                        Azotemia                        Restricted ROM R hip                        Heart murmur todayTelephone Call/ Text:: NT ST Laura- apparently Bentley HAS been getting his trilostane in the am- we should rpt an acth stim 10 days after starting 5mg sid dose-> scheduled for tomorrowBentley has been favouring his RHL , scuffing and slipping on turns. Cant give him nsaids dt azotaemia. He was previously on beransa but not for awhile-> start gabapentin 100mg bid  (might need a highter dose but we can start with this)Bentley has been drinking alot and [passing minimally concentrated urine. Laura reports he is v pu/pd at home, wets his bedding every night, propalin has helped a little. Could be related to hypo or hyper A , renal dz or UTI-> collect urine sample tomorrow for c+s    Vital Signs