C09983232 / invoice 10000

Reason: Breathing? Pale Gums, Not Acting As NormalAppointment Notes: would like to see sue but Jb suggested we see him asap.History:Lethargic and sedate, not reacting to much around him Depressed breathing, a little fast than 35 a minute, breath holding Ate normally for breakfast No vomiting or diarrhea No coughing or sneezing Gums possibly a bit pale ''Toileting normally, possibly weed outside of litter box a few days ago, cleans litter box regularly, no vocalising/straining, no repeated usage, poos great/not softDid det trial, no response to removing chicken - for vomiting, 3x a day. Since stopped. Feliway Moved houses in Jan, drinking water more readily here On anti anxiety medication - gabepentin, o feels she could smell medication in urineExamine:Plan:Weight loss HR 120RR 60T 38.7 ABAR, pink mm, crt<2s.Ophth:  nadOtic:  nadDental:  nadLNs: nadCV:  nadResp/Chest:  nadU/G:  nadGIT:  nadNeuro:  nadM/S:  nadInteg:  nad    Vital Signs    Weight: 8.1;       

Reason: RecheckHistory:Rv for recheck of plan for managing potential phenol toxicity following Dettol ingestion post-bath.Was started on carafate and omeprazole, following dose of activated charcoal on Monday.Largely clinically normal until today. Has been hyporexic/anorexic this morning.Demeanour slightly reduced. Toileting behaviours as normal, with slightly hardened faeces (normal for Epictetus).No vomiting this week. Had been vomiting previously but managed with dry-food only diet.Examine:QAR, pink mm, CRT 1-2sCVS: HR 140, no murmur/arrythmiaResp: clear lung sounds. Increasing RR throughout exam.LN: mild enlargement submandibular LNs - have decreased since Monday according to OOptic: pupil dilation bilateral. Intact PLR.Oral: small erosive lesion over chin. No mouth ulceration or lesions identified.GIT: mild abdo distension. Overall comfortable during palpation.Integ: soft external coatAssessment:Clinically stable and hydrated on PE.Suspect hyporexia secondary to some alimentary erosion/ulceration, as visible externally on the chin.Plan:Discussed outpatient monitoring vs admit for hospitalisation and supportive care.- O happy to monitor closely at home and continue supportive GI medicationExtended dose of carafate available.O aware progression to endoscopy required to confirm alimentary lesions.    Vital Signs    Weight: 7.45;       

Reason: bathed in dettolHistory: Owner was told that bathing cats in dilute dettol reduces grooming behaviour due to the taste/smell (he is prone to Vs and vomited a hairball recently).  Owner did it this morning, and he immediately started licking himself all over.  The dettol was very dilute - it didn't even turn milkly in the water.  Owner googled it and realised that it can be toxic so she immediately bathed him in a flea shampoo that she had.  He has stopped grooming now, but doesn't seem himself - was hiding/not interacting with owner.  He did eat some food.  Owner noticed a lesion on his lip about 90 mins ago.He is usually fairly healthy - attends pets in the park recently.He is currently on a chicken free diet to try to reduce his vomiting - seems to be working.Examine:BAR, pink mm, crt<2s.Ophth:  nadOtic:  nadDental:  nadLNs: submandibular LNs enlarged - this has not been noted before.CV:  nadResp/Chest:  nadU/G:  nadGIT:  nad Neuro:  nadM/S:  nadInteg:  tiny inflamed area on most rostral part of mandible (skin).Tongue and mouth looks completely normal at this stage.Assessment: Cause of enlarged submandibular LNs uncertain - may be due to dettol ingestion.I could still smell the dettol slightly from his coat.Advised owner that dettol can cause mucosal burns (eg tongue or other parts of GIT), or systemic symptoms due to the inability of the liver to metabolise the active ingredient - a phenolic compound.Plan: We decided to administer charcoal - was able to get in 19mLs.Also supplied sucralfate and omeprazole to start tonight.Also gave owner a small amount of manuka honey wound gel that she can put on the inflamed area of his lip (although I wasn't terribly concerned about this just yet as it was mild).Recommended recheck if deteriorating.  Owner to monitor his tongue's appearance.Suggested getting his LNs recheck in the next few weeks if they remain enlarged (owner could feel them).    Vital Signs    Weight: 7.5;       Temperature: 38;       BodyScore: 7;