C09978077 / invoice 10000

Reason: VomitingAppointment Notes: Overdue remindersPresenting Complaint:- Acute onset of vomiting.History:- Presented for multiple episodes of vomiting this evening, starting after dinner. At least four to five episodes have occurred.- There is a recent history of diarrhoea, which started on Friday night and lasted for two days. This resolved after instituting a bland diet and administering Pro-Kolin paste. The owner suspects the diarrhoea may have been due to ingesting an excessive quantity of blueberries.- A presumptive diagnosis of colitis was made by the regular veterinarian on Sunday.- The last dose of Pro-Kolin was administered this morning; it was withheld at dinner as stools had firmed. The owner now expresses concern for potential constipation, as only one bowel movement has been observed today.- The current diet is boiled chicken, pumpkin, and rice.- Presented approximately two weeks prior for ingestion of a single grape, which was successfully managed with induction of emesis.- Vaccinations are up-to-date, making parvovirus a less likely differential.Subjective:QARObjective:Temp:   38.0         MM:  Pink            CRT:  <2           HR:  128 BPM           FP: Normal and synchronous             RR: 44 BPMBCS:    5/9                Wgt: 17.5   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=GIT:   HAs been vomiting no diarrhea. No obvious pain on abdominal palpationU/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 Assessment:  The primary problem is acute vomiting. The aetiology is unclear and may or may not be related to the recent episode of enterocolitis.- Differential diagnoses for vomiting include:- Gastrointestinal related: dietary indiscretion, inflammation, infection (viral, bacterial, parasitic), toxin, neoplasia, obstruction.- Non-gastrointestinal related: pancreatitis, endocrine disease, liver disease, renal disease, neurologic disease, neoplasia, toxin.Treatment:Maropitant 1 mg/kg sq Plan: - Outpatient management was elected due to the bright and alert demeanour.- Administered Maropitant 16.8 mg via subcutaneous injection for antiemetic effect.- Advised to continue the bland diet of chicken, pumpkin, and rice, but to offer smaller, more frequent meals.- Instructed the owner to withhold food for approximately six hours, then re-introduce small amounts of food and water.- Advised to return for re-evaluation if vomiting persists, or if there is any decline in clinical status, such as lethargy or inappetence.- Discussed that if symptoms do not resolve, inpatient work-up including blood work and abdominal radiographs would be the next recommended step.    Vital Signs    

Reason: Eaten One GrapeConsultation time:21:00History:Ingested  1 grape in last 1 hr witnessedHad dinner 1800Subjective: BARObjective: Temp  -     MM  pink, moist   CRT <2   HR   108  FP=HRBCS:   5/9                       Wt:   14.8kgPain Score (CSU):   0/4Cardiovascular : No arrhythmia or murmur auscultated, FP readily palpable.Respiratory : Normal bronchovesicular sounds in all 4 quadrants, normal respiratory effortGastrointestinal : No pain or discomfort on abdominal palpationMusculoskeletal : Nil discernible lameness, ambulatory Otic: Pupils symmetric, visualLymph nodes : No peripheral lymphadenopathyProblem List:Recent ingestion of  single grapeAssessment: Ingestion of grape , small risk of causing AKI. Prompt retrieval grape (still intact) via emesis. Nil further complications anticipated. Treatment:-apomorphine 1/2 tbl otm-emesis productive - yielded food and 1x grape-metoclopramide 0.5mg/kg SCPlan:Confine and monitor Recheck asap if any further concerns =================================================    Vital Signs