C09987268 / invoice 10000

Reason: NQR, Vomiting, Altered, Straining To Defecate, AnoConsultation Time: 0424History: BIOP 3 months Jack Jack presented for evaluation of acute onset vomiting, lethargy, dizziness, and excessive drooling. These signs developed rapidly over the preceding day and night. A rash on stomach was also noted. The onset of signs occurred a few days after returning from a camping trip to the Murray River, having returned 3 days ago The owner reports that Jack Jack has been vomiting overnight prior to presentation. There is associated hypersalivation, which is more pronounced than his usual drooling. He last ate normally yesterday morning and has been inappetent since. He returned from a camping trip a few days ago and was initially well, though described as being a bit gassy. During the trip, other people fed him various foods. No weakness observed hindlimbs. He seems less energetic He has been seen to lift his right hind leg intermittently for a brief moment. He does not bark frequently, and no change in vocalisation has been noted. The owner also reports that Jack Jack has been constipated and was seen straining to defecate throughout the night. He appears unusually flat and subdued compared to his normal behaviour.Completely raw meat diet with various meats, transitioned to once adopted. Has tolerated it well Subjective: QARObjective: Temp   37.7         MM    pink          CRT    <2         HR     96        FP  Bilaterally synchronous BCS:  5 /9                       Wt:  35.0 kgPain Score (CSU):   0/4CV:  Nil murmur or arrythmia       RESP:   Normal bronchovesicular sounds, nil effort           RR  44GIT:   Pyalism. Soft and pliable comfortable abdomen. Nil distention or discomfort. Refused cooked chicken. Rectal exam shows liquid brown diarrhea on glove. 1x regurgitation attempt in hospital with foul odour U/G:  No urination or dribbling of urine Neuro:  Mild altered mentation, with dazed appearance. Intact PLR bilaterally. Mild ataxia. Gag reflex present. No hyperaesthesia M/S:  Able to rise, ambulatex4, nil lamenessInteg:  Normal skin turgor, full fur coat Ophth:  No ocular discharge LNs: Palpably normal Problem List: - Acute vomiting and ptyalism - Inappetence- Lethargy and dull mentation- Hindlimb ataxia- Constipation with some evidence of diarrhoea on rectal examination- Mild hypothermia- No current tick prevention- Raw meat diet - Rash on stomach Assessment:Ddx Primary vs Secondary GIT causesThe clinical signs are suggestive of toxin ingestion, gastroenteritis, or a foreign body obstruction. The neurological signs, such as ataxia and dullness, are concerning for a toxicity, with potential differentials including recreational drugs such as marijuana, although the owner reports no known access. The history of being in a tick-endemic area (Murray River region) without prophylaxis makes tick paralysis a differential diagnosis, although some clinical signs are atypical and patient has a gag reflex. The history of a raw diet and being fed other foods raises the possibility of infectious or dietary-indiscretion-related gastroenteritis. A gastrointestinal obstruction is also a possibility, though the neurological signs are less typical for this. Parasitic infection such as neospora cannot be ruled out Options Offered to Client for Ongoing Care:Two primary options were discussed with the owner for ongoing management:1. Admission to hospital for further diagnostic workup and supportive care. This would involve placing an intravenous catheter, administering intravenous fluids, performing blood tests, and potentially a urine drug screen. This would allow for close monitoring and administration of medications as required.2. Outpatient management with option of a  single anti-emetic injection. The owner would then monitor Jack Jack closely at home. The benefits of reducing fluid loss via vomiting were discussed, as was the risk that the injection could mask the progression of clinical signs. Option (2) was elected  with the plan to seek further veterinary care with their regular vet in a few hours O declines anti-emetic with concern of masking clinical signs Treatment:None Plan:Therapeutic plan: The owner has elected to wait and see their regular veterinary nurse who can offer a discount in a few hours, as long as Jack Jack remains stable. An anti-nausea injection was offered for comfort until then, but the owner declined in favour of monitoring.Discharge plan:Discharged for close monitoring at home with the plan to present to their regular veterinary clinic in a few hours for further diagnostics and potential hospitalisation. The owner was counselled that if his condition deteriorates, he should be presented for veterinary care immediately.    Vital Signs