C09978070 / invoice 10000

Reason: V+,d+Presenting Complaint:- Acute onset of lethargy, diarrhoea, and vomiting.History:- Presented for assessment following a 24-hour period of clinical decline.- A few days prior to presentation, had been started on a probiotic sachet (FortiFlora) and a dog fibre supplement for pre-existing anal gland issues.- Subsequently developed mucoid diarrhoea, described as slimy blobs, but remained otherwise bright and active.- Due to the change in faecal consistency, the probiotics and fibre were discontinued.- Yesterday, following a morning meal and a walk, became acutely lethargic and flat, which was uncharacteristic.- Had dinner last night and appeared to improve, going for a walk and seemed happy before sleeping.- At midnight and 2:00 AM, became restless, agitated, and was noted to be shaking. There was diarrhoea found outside.- Exhibited tenesmus, straining to defecate with no production, and had a persistent desire to go outside.- Vomited once just prior to presentation, which consisted of undigested food from dinner.- Past medical history is significant for a tonsillectomy.- No other medications, supplements, or known health problems.- No known allergies.Subjective:QARObjective:Temp: 38.8           MM:   Pink           CRT:   <2          HR:   140 BPM          FP: Normal and synchronous             RR: 24 BPMBCS:    5/9                Wgt: 4.65   kg Pain Score (Glasgow pain score):   0/20CV:  Normal Heart Rate. No murmurs, no pulse deficits. Average MAP=      Did not obtain RESP:   Lung sounds are normal.  No coughing, no dyspnea SPO2=Did not obtain GIT:   Has been vomiting and having diarrhea . No obvious pain on abdominal palpation. No feces or blood present on rectal U/G:  Unable to palpate a bladderNeuro:  Basic cranial nerve exam is normal. MGCS=18M/S:  NADInteg:  NADOphth:  NADLNs: Lymph nodes are normal sizeProblem List:Vomiting Diarrhea LethargicAssessment:  The clinical signs are suggestive of acute gastroenteritis with associated colitis. The tenesmus is likely secondary to colonic inflammation, creating an urge to defecate without faecal matter present in the rectum.- Differential diagnoses for diarrhoea include:- Primary: Infectious (Bacterial, viral, fungal, parasites, dysbiosis), inflammation, neoplasia, mechanical, toxin, motility disorder.- Secondary: Extra-gastrointestinal disease (Pancreatitis, liver disease, kidney disease, hypoadrenocorticism, hypothyroidism), central nervous system disease, motility disorder.- Differential diagnoses for vomiting include:- Gastrointestinal related: dietary indiscretion, inflammation, infection (Viral, Bacterial, Parasitic), toxin, neoplasia, obstruction.- Non-gastrointestinal: Pancreatitis, endocrine disease, liver disease, renal disease, neurologic disease, neoplasia, toxin.Treatment:Maropitant 1 mg/kg SQPro-Kolin 2 ml PO q 12 hours Plan:  Administered first dose of Ondansetron, an anti-emetic medication, in-clinic. The owner was dispensed 4 milligram quick-dissolving wafers to be given by mouth every 12 hours. Instructions were provided on administration, including the need for dry hands and placing the wafer in the mouth to dissolve.- Administered first dose of Pro-Kolin, a probiotic paste, in-clinic. The owner was dispensed a tube of the paste with instructions to administer two millilitres by mouth twice daily, starting from the next scheduled meal time. Instructions on how to use the dosing dial were provided.- Advised the owner to offer a bland diet of chicken and rice in a few hours.- Instructed the owner to keep the appointment with their regular veterinarian later today, particularly if there is no improvement, or if there is a refusal to eat or drink. Further diagnostics may be required if signs persist.- Discharged to the care of the owner with instructions to monitor closely.    Vital Signs