C09987675 / invoice 10000

04/03/2026 DATE/TIME of CONSULTATION: 19:25hrs, Wed 04/03/26
CLINICIAN: Alycia Tsiang 
PRESENTING COMPLAINT: Referral for suspected bilateral ureteral obstruction 

HISTORY:
Currently being managed by reg vet for suspected IBD vs lymphoma (hx chronic d+, had an abdo u/s). Currently on pred, has been on this for 1 month. Was doing well, eating and gaining weight. V+ reduced 
Presented to Bundoora for 4 day hx weight loss, not eating, NQR. Started v+ yesterday. Was dehydrated, small bladder and palpable large kidneys. Bloods show severe azotaemia, K+ 8/5, neutrophilia
Rx insulin & glucose - potassium reduced to 5.1 overnight
Repeat bloods @ 1pm:
SDMA 82 
Urea >46.4 
Creatinine 1005 (71-212)
Phosphate 5.20 
Potassium 6.3 (3.5-5.8) 
Remained anuric in hospital, USG 1.028 protein 3+ RBC >50/HPF, casts NIL
Abdo u/s - renomegaly, dilation of both pelvises and concern bilateral ureteral obstruction 

CLIENT COMMUNICATION/PLAN:
Discussed guarded prognosis, workup would include internal med u/s to confirm bilateral obstruction, SUB placement, however abdo u/s findings @ Bundoora highly suggestive. Discussed complications with SUB placement i.e. infection, obstruction, kinking, repplacement and ongoing management with 3-monthly visits with medicine team. Discussed QOL ongoing + comorbidity of IBD/lymphoma 
Quoted $10k for SUB placement but may be $15-20k
Did not recommend pursuing further due to guarded prognosis + possible renal damage, offered euthanasia.
O elected euthanasia. Performed with O present, peaceful passing. Asystole confirmed