C09980107 / invoice 10000

Lethargic, hasn't eaten since Wenesday
Vetwest said needs fluids.

Current History: Referred on from Vetwest as needing IVFT. Has only eaten tiny bits when coaxed since Thursday. No vomiting or diarrhoa seen, has been quieter than normal. No chnaging in drinking or urination seen. Has been gradually reducing the amount eaten over the past few months and maybe has gradually lost weight. No diet change no known access to toxins and not generally a FB eater
Previous History: CARE with handling. 
Other animals: other chihuahua
Current Medications: none
Exposure to toxins:none known

Physical Exam:  
Deameanour:QAR 
Weight: BCS 5/9  
mm: pale pink moist
crt:1s
Temp:38.4
HR:128
Cardiac Auscultation:no murmer or arrythmia
Pulse:  normodynamic and  synchronous
RR:32
Lung Sounds: normal BV sounds
Respir Effort:: normal 
Abdomen palp::no masses or organomegally mildly uncomfortable on palpation
EENO:no discharge or lesions
Integument:good coat no lesions
Rectal:not performed
LN:diam 1-6mm
MSK:no gait abnormalities seen
Neuro: :not performed

Diagnostics:
BG 5.3
Ketones <1

Bloods and ultrasound recommended. Will start with bloods and go from there
Severe azotaemia mild anaemia

Discuss with Os; CRF severe case, 2 of the 4 parameters we look at for kidneys are above what the machine can read. Can admit start IVFT and try and get those values down and get him eating again but we are not curing or repairing the damage and it will worsen again over time. We can start him on special diet and we may be able to do regular SC fluid on going but to be this high without him being at deaths door, the renal failure has been coming on gradually and is permanent. There is the risk that we may not be able to get the values down and get him home. 

Estimate given for 72hrs hosp IVFT and repeat renal bloods - 3000-3500. O consented and took some time to spend with him before we get set up in a bed. 

Os discussed, decided to euthanase as dont want him suffering for the sake of buying a few weeks to months. 

Treatments:IV catheter 24G left cephalic after triage with Os consent

Euthanasia consent form signed, individual cremation Os chose to be present. 
Propofol sedation 4ml IV
Euthanasia solution 5mL IV
Peaceful and quick, death confirmed cardiac ausc and corneal reflex. 

Assessment: CRF
Problem List
1.inappetence lethargy
2. severe azotaemia and hyperphosphataemia
3.severe increase SDMA
4.mild anaemia

Plan: private cremation Lawnswood contacted

Client Communication: 

Estimate:3000-3500
Financial Concerns:none mentioned

History sent to regular vet: Yes or No