C09978862 / invoice 10000

Reason: Garlic Bread IngestionAppointment Notes: Ingested loaf of garlic bread, mutlivitamins, vit C, fish oil in the last hourHISTORY Henry presented approximately 2.5–3 hours after ingesting a full garlic bread loaf with butter. 4 fishoil tablets, 6 mens multivitamins and probiotics. Breakfast was given at approximately 08:30 AM.No recent vomiting or diarrhoea prior to this event.No known health concerns.No known chronic gastrointestinal disease.No current medications.No previous history of pancreatitis reported.PHYSICAL EXAMINATION Mentation: Bright, alert, responsive. Friendly and interactiveRespiratory effort normalCVS: partial auscultation - no overt murmur or arrhythmia noted. Had to abort full exam due to patient demeanor (reactive)Full exam unable to be performed, O stated full PEx at RV yesterday was completely unremarkable. PROBLEM LIST- Recent ingestion of garlic-containing food- Ingestion of high-fat meal (butter and fish oil)Risk of acute gastrointestinal irritationRisk of delayed pancreatitisRisk of oxidative hemolytic anemia secondary to garlic ingestionASSESSMENTHenry presented within the acceptable emesis induction window Garlic ingestion poses a dose-dependent risk of oxidative hemolysis due to organosulfur compounds causing red blood cell damage. Clinical signs are typically delayed (3–5 days post ingestion). The actual risk depends on quantity ingested relative to body weight.Butter and fish oil ingestion increase the risk of: Acute gastritis, vomiting, Delayed pancreatitis (24–72 hours post ingestion). Garlic poses risk of toxin induced haemolytic anaemia.PLANImmediate Management:Induction of emesis- Apo-morphine 1 tablet TM.Outcome- moderate amount of bread material was successfully produced. Approximately 3/4 of the bread loaf- Patient was not reversed in hopes that patient will vomit more after consult. Discharge notes provided to owner explaining risks, CSx of pancreatitis and haemolytic anaemia, when to return if necessary.    Vital Signs