C09979619 / invoice 10000

Reason: Ibuprofen ingestionCore nurse: ATShift time: 0500-1300Brief history:Potential massive ingestion of ibuprofen tablets approximately 48 hours prior. Emesis was induced, with partially dissolved tablets and powder noted in the vomitus. An attempt at activated charcoal administration has made but this is increasingly poorly tolerated and was discontinued yesterday to avoid aspiration. Carafate, activated charcoal and metronidazole were discontinued yesterday evening. IV catheter was chewed out and has since been replaced with a new long line in the left cephalic vein.Blood work (Day of admission - 01/03/2026):PCV: 45%Total protein: 60 g/LSerum: ClearBlood gas: pH 7.4, pCO2 36, BE -2.5, AG 15, Na 144, K 4.4, Cl 111, iCa 1.29, HCT 41%, BG 5.2, Lactate 2.3 (mild hyperlactataemia and mildly increased anion gap).In-house biochemistry: ALT 125 U/L (marginal increase), Creat 99 umol/L, BUN 6.6 mmol/L, Phos 0.81 mmol/L. Remainder unremarkable.Blood work (Yesterday - 02/03/2026):PCV: 47%Total protein: 63 g/LSerum: ClearBlood gas: pH 7.4, pCO2 45, BE 3.1, AG 10, Na 143, K 4.1, Cl 109, iCa 1.28, HCT 44%, BG 5.1, Lactate 1.6 (normal pH with borderline respiratory acidosis and mild metabolic alkalosis).Renal profile: Creatinine 93 umol/L, Phos 1.73 mmol/L, BUN 3.6 mmol/L. All within normal limits.Overnight update:Mentation: BAR, neurologically normal.Ins/outs: Eating well consistently. Urinating multiple times overnight. Had a formed black bowel movement at 4pm yesterday consistent with recent activated charcoal administration. No regurgitation or vomiting.Vital Signs: Eupnoeic. Normal heart rate and rhythm, haemodynamically stable.Weight: Unable to weigh overnight due to behaviour and size.Clinical assessment:Mentation: BAR.Hydration status: Normal skin turgor.Weight: Unable to weigh.Cardiovascular: Pink moist oral mucous membranes, CRT 1-2 seconds. Regular heart rate and rhythm, no murmur or gallop. Strong synchronous dorsal pedal pulses and warm extremities.Respiratory: Eupnoeic with normal bronchovesicular sounds bilaterally.Gastrointestinal: Abdomen soft and pliable.Urogenital: External genitalia unremarkable. Neuromuscular: Normal mentation and gait. Ocular: No ocular discharge.Nasal: No nasal discharge.Lymphatic: Peripheral lymph nodes unremarkable.Integument: Unremarkable.Indwelling lines: Patent IV catheter in left cephalic vein.Diagnostics:11:00:PCV: 38%Total protein: 60 g/LSerum: ClearIn-house biochemistry: Alb 39, ALP 67, ALT 99, Amylase 565, TBil 5, BUN 4.3, Ca 2.66, Phos 1.73, Creat 116, BG 6.5 (marginally increased), Na 145, K 4.5, TP 59, Glob 20. No haemolysis. No lipaemia.Urinalysis (voided sample):USG: 1016Dipstick: 3+ leukocytes, Nitrates negative, pH 6, 3+ protein, Glucose negative, Ketones negative, Urobilinogen negative, Bilirubin negative, 4+ haemoglobin.In-house sediment stain: RBC ++, WBC +, Rods +.Pending diagnostics:Urine culture and susceptibility submitted to QML via cystocentesis.Problem List:History of massive ibuprofen ingestionBacteriuriaHaematuriaProteinuriaAssessment:No evidence of renal or gastrointestinal injury following potential massive ibuprofen ingestion. Development of clinical signs is increasingly unlikely. In house urinalysis consistent with lower urinary tract disease, rather than proximal tubular injury from ibuprofen toxicity. Bacteriuria is likely nosocomial and associated with recent indwelling urinary catheter.Prognosis: FairTreatments:Continue:Hartmann's at 45 ml/h.Misoprostol 4.76 mcg/kg IV q8h.Trazodone 5.95 mg/kg PO q12h PRN (not required this morning).Add:Prescription for amoxicillin clavulanic acid 625 mg PO q12h for 7 days provided.Plan:Discontinue intravenous fluids.Discharge to owner's care this afternoon.Recheck with referring veterinarian in 3 days for repeat renal parameters.Will call owner with urine culture results by Friday.Communication:--- 03/03/2026 07:05:25 KN3:Updated CaseyZiggy is bright, eating well, doesn't want charcoal anymore which is fine at this stageUrinating frequently overnight, marking a lot, has been on fluids as well so not unusual - she says he marks usually as wellLooked at urine in house to look for signs of tubular injury - no signs of kidney damage but lots of inflammation and lots of rod shaped bacteriaOffered cysto and C&S (~$250-300) vs just trial a/bs that are likely to work, suspect hospital acquired so more likely to be resistant, she elects former Current bill $4.50 in creditNext blood test later this morning - if ok can go home this arvyWill be in touch this morning if any cysto complications/concerns--- 3/03/2026 12:32:06 PM KN3:Updated CaseyBloodwork looks greatCysto C&S pending TGH 2.30-3pmBriefly went over discharge instructions    Vital Signs