C09979732 / invoice 30000

Pancreatitis, suspect HyperA, likely dry eye, heart dz
CON 3 Non stop drinking water + pus in eye - Gd 4/5 heart murmur
Will need to go straight into a room


Green discahrge form eye - L eye - has a large lump on lower eyelid

Drinking alot of water

Mate is getting older and older- demetia setting in. and owners wondering about making a decision. 

History (as above

Massive diarrhea, very smelly in the consult. 
no history of diarrhoea at home but did have a diaet change TWICE in the last 2 weeks
Was eating 
- uncooked egg, 
- cooked mince. 
- dry food consistent
- wet food- was chaged off her regular for 2 weeks and restarted on her regular food 2-3 days ago. 
)
EDDU (Y)
Diet (- )
V+/D+ (N but had diarrhoea in the consult. )
Worming ()
Heartworm ()
Ectoparasites ()

Examine
Temperament  (BAR)
Mucous Mem   (P+M)
TEETH>       (3/4) 
EYES>        NAD
EARS>        NAD
Nares        (- )
SKIN>        NAD
UROGENITAL>  NAD
LN>          NAD
H MURMUR?    (HEART MURMUR - pounding 3-4/6 MURMUR.  was only 1-2 in Oct 2025. )  
H RHYTHM>    Regular 
CHEST AUSC>  NAD
ABDO PALP>   Soft and pot bellied. 
ANAL SACS    L () R ()
MUS/SKEL>    NAD

Assessment: (Disucssed with owner- recommenidng bloods. 

BG 5.4
Severely Lipaemic sample. 
Ran through the comp machine- mild elevated Urea but PCV 62/97!!
elevated Calcium - ran I-stat. 
Showed normal calcium. 
Small hard lump in Rgith anal gland- has been mentioned previously with the owner. 

Concerned re
- Diarrhoea, 
- Dehydration
- Cushings. 

)
Laboratory: ()
Treatment: (Admitted for IVF and further work up. 

)

Plan: (Vet pay and pet insurance.)



Comp profile
Elevated ALP, ALT, HyperCa (normal on i-stat), azotaemia (BUN only), Haemoconcentration, Hyperproteinaemia

iStat Chem8+
Na    (152) mmol/l   [141 - 150]
K     (4) mmol/l   [3.3 - 4.9]
Cl    (116) mmol/l   [109 - 121]
TCO2  (20) mmol/l   [16- 26]
Urea  (41) mg/dl    [7 - 26]         (14.6) mmol/l  [2.5 - 9.3]   [multiply x 0.357]
Creat (49) umol/l   [45-120]
Glu   (5.8) umol/l   [4.5-6.6]
iCa   (1.36) mmol/l   [1.21 - 1.45]
An Gap(21) mmol/l   [8 - 21]
Hct   (61)  %       [35 - 57]
Hb    (207)   g/L    [120 - 193]

(checked and updated 25 1 25 MH) 

URINALYSIS 

Urine received by (). Collected by (cysto). Notes (dog squirmed and needle bent)

Processed by (SKM). Requested by () Vet and reported to them by ().

Appearance ()
USG (1.028)
Dip Stik
    Urobilinogen (Nil)
         Protein (4+)
              pH (6.5)
           Blood (trace)
          Ketone (Nil)
       Bilirubin (Nil)
         Glucose (Nil)

Sediment - NSF
Inappropriate urine concerntation in the face of severe dehydration. 

cPli - POS

STT left eye -10mm
Fluoro - no ulcers
Only did left eye, in hindsight should have done both.

Suspect has HyperA, pancreatitis, dry eye

Hartmanns @ 50ml/hr initially, reduced to 25ml/hr o/n
Maropitant 0.95ml iv sid
Prokolin

Tomorrow
Should redo STT and fluoroscene for BOTH eyes.
Need to be careful with rehydration due to cardiac dz.
Consider doing PCV/TPP in afternoon.

Possibly send home tomorrow afternoon with a view to get back in a week for echo, ACTH stim test.
May need Tacrolimus drops for dry eye 
 
Level A  care by CVES on  02/03/2026

Nurse Management and Hospitalization 
under veterinary supervision of: (ML/JRG) 
SOAP PATIENT
Current Diagnosis (poss cushings)

SUBJECTIVE:
Hydration status: (overhydrated, nasal drip at 1900, bounding hr at 0500, fluids down to 15ml/hr)
Food/Water trial: (water available, ate little at 2100)

OBJECTIVE:
Frequency of TPR: ()

2100 QAR, urination +++, hartmanns at 25ml/hr

0100 QAR, HR 192, RR 40 mild effort. Pink, tacky, >2secs. Temp 37.3, 4/24 pain score. Urinated +++

0500 QAR, urination +++, normal defecation (large, faecal score 3). offered chicken, interested but not eating. Bounding heart so hartmanns down to 15ml/hr. Repeated PCV TP: 55/78, clear



TREATMENT: 
- Fluid Type:      Hartmanns                (50ml/hr @ 1600, 25ml/hr @ 1800. 15ml/hr @0500)
- Additives:                nil       ()
- Rate to be administered (ml/hr): ()
- New bag added ?           no       ()

- Medications (drug, dose (mg) , route, frequency, times given): () nil



ASSESSMENT: (Stable and comfortable overnight)

PLAN: (Return to GVH at 8.00 am )


PCV this morning is 55% (TP 78).
IVFT reduced overnight due to nasal drip. No lung crackles heard.
Some interest in food, but hasn't eaten
Normal faeces recorded at 5pm yesterday, otherwise none.
No V+
Tachycardic
Eating chicken in Hosp

**is she still on fluoxetine?? YES - gets it in the morning

COMMAS
Spoke to Jess @ 9am. Plan home at 5.30pm, trial to see if she will eat there. They can't come to visit her.

STT (1 minute each):
OD - 9 mm 
OS - 13 mm (despite presence of large mass)
-> likely KCS, needs to start immunotherapy. Optimmune or tacrolimus, BID.

Currently, needs to recover from pancreatis episode.
Underlying untreated  Cushing's increase risk of pancreatitis

In future needs:
Tx for KCS (above)
Echo +/- thoracic rads (est. $700 - 1500 for this)
ACTH stim test (to commence diagnostic process for suspect hyperadrenocorticism) - est. $510 but may not be diagnostic alone, LDDST + abdo US may be recommended
Repeat urinalysis & blood when euhydrated (yesterday USG was 1.028 despite dehydration) - primary renal. v Cushings

Script written for tacrolimus 0.02% One drop OD & OS, BID


Medications: Prevomax, 1mg/kg, 0.94ml SID
Pro-kolin 3ml PO BID
Fluoxetine10mg. 0.5 x 20mg tab PO