C09982517 / invoice 20000

02/03/2026 History:
- Presented for lethargy, inappetence, and one episode of vomiting today (02/03/2026). The owner reports the patient has not eaten since yesterday morning. The inappetence is not entirely abnormal as the patient can be a picky eater. The patient drank a large amount of water this morning at approximately 7:30 am and then vomited the water. Has appeared very lethargic and miserable since. No further vomiting has been observed. No diarrhoea reported.
- Owner reports increased panting over the last two days. The patient appears uncomfortable and is posturing with weight shifted onto the front legs, which is unusual behaviour. The owner notes a significant trip on the preceding Friday, involving a drive from Geelong to Sale and an overnight stay at a house with multiple other dogs and animals, which may have caused significant stress and overstimulation. Weight today is 6.5 kg, which is a decrease from 7.0 kg at the last visit. The owner reports a normal weight of approximately 7.5 kg.
- Diet:Variable diet. Lives between two houses and has different walks daily. Fed at nighttime, but sometimes does not eat until the following morning.
- Vacc Status:Not discussed.

Physical Examination:
- Demeanour: Lethargic, quiet.
- Vitals:
 - Temp: not taken
 - Pulse: nad
 - Respiration: nad
 - Body Condition Score: 3/5
- Cardiovascular / Respiratory: heart auscultation normal, lung fields clear
- Mucous Membranes / CRT: pink/1s
- Abdominal / Rectal: Abdomen feels empty on palpation, not tense or painful.
- Musculoskeletal: nad
- Neurological: nad
- Urogenital: nad
- Integument: nad
- Lymph Nodes: nad
- Eyes: nad
- Ears: nad
- Oral/Dental: Significant dental disease noted, but not the primary issue for today's visit. gde 4

Assessment:
- Acute gastroenteritis with lethargy and dehydration is suspected. The clinical signs are non-specific, and the recent weight loss is a concern. The history of stress and overstimulation from the recent trip could be a contributing factor. The primary concerns are determining the degree of dehydration and ruling out other underlying causes for the acute illness.

Discussion:
- Discussed the clinical findings with the owner. The patient's miserable appearance and lethargy are the main concerns. Explained that while the abdominal palpation was not overtly painful, the patient's posture suggests discomfort. The weight loss is significant. Recommended in-house blood tests to assess for dehydration, organ function, and other underlying issues. Explained that the results would be available within approximately one hour. Discussed two potential pathways based on the blood results: if dehydration is mild, outpatient treatment with an anti-nausea injection and a bland diet may be sufficient. If dehydration is significant or other abnormalities are found, hospitalisation for intravenous fluids and further treatment may be necessary. The owner consented to the diagnostic plan.

Plan / Treatment:
- In-house blood tests (haematology and biochemistry) to be performed.
- Will contact the owner with the results in approximately one hour to discuss the next steps. Depending on the results, treatment will involve either an anti-emetic injection and outpatient care or hospitalisation for intravenous fluid therapy.

02/03/2026 Bloods show severe azotaemia with suspicion of primary renal dysfunction.  Advised owner best tx is to go on to GAE for IVFT and then back to us tomorrow.  Can't afford GAE tonight so will admit tomorrow for IVFT.  Estimate given For tonight given 0.7 mls maropitant SC | 03/03/2026 Admitted.  O reports miserable overnight, did not eat or drink. No further vomiting. Did not toilet

Exam:
Depressed.
Dehydrated.
Teeth awful....difficult to exam as mouth painful.  Lots of tartar and slime.
HR 120 with gr 3/6 murmur.
RR pant
Temp 38.0
Inc resp effort.
abdo palp comfortable
Free catch urine sample - SG 1.020, pH 6, rest of dipstick normal.
IV catheter placed RF.
Start IVF at 30ml/hr.

Spoke to Scott.  Unable to discern between acute vs chronic renal dz but given age and anaemia, chronic more likely.  Rex is likely to need several days hospitalisation with no guarantee we will be able to stabilise him, or that he won't get sick again once home.
Scott has cost constraints so euth is a consideration.

He would like to give him the day on fluids, take him home tonight and consider situation.  
Back tomorrow morning with decision re euth or further treatment.

5pm
Brighter.
Ate 3 bowls chicken throughout day.  No vomiting.
Went out to urinate twice.
TPR stable.
0.7ml maropitant SC.

Home overnight with IV catheter in place.
Lengthy chat with Scott at discharge.  Rex has improved over the day.  Explained difficult to differentiate between CRF and AKI but highly suspicious of CRF.  This means that we can try to stabilise in hospital, but he will deteriorate again with time.  Unable to give accurate timespan, but I guess over a couple of weeks.  At which time he will need to euth.
Finances are difficult for him but he will drop off for admission tomorrow at 8am (has to go to work), and he will have had a chance to see how Rex is at home overnight.  I have said Jess will assess Rex at 9am then call Scott to discuss.  Suspect we will give him another day on IVF, unless he is terrible overnight, in which case he may pts.

Scott lives between here and Endeavour Hills.  Has to work in Warrandyte on Friday and will be staying at Endeavour Hills, so that will complicate things.