C09981444 / invoice 10000

Appointment Notes: lethargic and flat. breathing still <30SubjectivePresenting Concerns:  Rosie Rousell presented for lethargy and inappetence.    Diet/Appetite:-   Not eating.  Drinking/Urination:-   Decreased water intake today.  V/D/C/S:-   No vomiting.  Current Medications:-   Furosemide.ObjectiveMentation: Quiet  Wt: 6.6 kg  BCS: --/9  T: Not taken  P: 160 bpm  R: —  MM: Pink, slightly dry. CRT < 2sec.  Hydration: Mildly dehydrated    Emotional Assessment: Accepted a liver treat during the examination.    Eyes: Clear. No discharge or erythema OU.  Ears: Clean with no discharge or erythema AU.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: Grade 5 heart murmur and tachycardia. Strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Blood collected for an in-house panel to evaluate electrolytes and kidney parameters.AssessmentLethargy and inappetence - DDx: Progression of cardiac disease, acute kidney injury, electrolyte imbalance, metabolic disease. The clinical signs may be secondary to furosemide administration.    Congestive heart failure - Previously diagnosed. Findings today include a grade 5 heart murmur and tachycardia.PlanPending Diagnostics:-   Await results of the in-house blood panel.  Medications/Treatments:-   Discontinue furosemide pending blood results.  Additional Discussion:-   The owner will wait for the results. A follow-up discussion will occur in approximately 10 minutes to determine the next steps.K+ = 2.0Also low Na and ClRecommend admit, start IVFT with 0.9% NaCl with 60mmol/L KCl added.Started at 16mL/hr.Up to NEVS overnight.    Vital Signs    Weight: 6.6;