C09988404 / invoice 10000

Reason: D&V With Blood, Not EatingAppointment Notes: Special payment terms existDiscussion with the owners - 00:08 to 00:35 and 01:31 to 01:52History:Presenting complaint of diarrhoea since Sunday, initially brown, now bloody as of today. Vomiting started today, containing pink-tinged fluid, no food. Last ate last night, anorexic today. Had similar black stools previously when on pain relief post-eye surgery, which resolved within a week after stopping the medication and starting sucralfate and omeprazole. Recently introduced a new dried fish treat. Reg vet: Bayside RhodesNormal diet and treats: Savour Life brand dry food (salmon or ocean fish flavour), with added white fish or chicken breast. Recently introduced dried fish treats. History of vomiting with kong cheese and large chew bones, suggesting a sensitive stomach.Vacc and preventatives: UTDCurrent medications: - Acular 1 drop OU BID - Trusopt: 1 drop OU TID  - Maxidex 0.1% 1 drop OU SID (dose reduced from two drops to one drop daily since 01/03/2026)Physical exam:*MENT: Bright, alert, and responsive.*HYDR: Seems euhydrated on physical exam despite history*TEMP: 38.9*OCU/AURAL: Eyes appear to have healed well, no redness. Ears clean. *ORAL: Grade one dental disease.*C/V: Heart rate 96 bpm. No murmur or arrhythmia. Strong, synchronous peripheral pulses. Mucous membranes pink and moist, CRT 1.5 seconds.*RESP: Panting, but no increased respiratory effort. Clear lung sounds auscultated bilaterally.*GI: Soft, non-painful abdomen. No obvious mass effect or significant gas palpated. Feels relatively empty.*INTEG: No abnormalities noted.*MUSC/SKELE: No abnormalities noted.*GAIT: Ambulatory.*NEURO: Appropriate mentation. Normal proprioception, normal cranial nerves. *RECT: Unable to perform, only just managed to get temperature.aFAST: 0/4, no gallbladder wall oedema.Laboratory:Na 155, K 3.5, Cl 126, iCa 1.36, Lac 0.7, glucose 5.1, pH 7.393, pCO2 29.2, SBE -7.1, HCO3 17.8, AG 14.9, pvO2 42.1, cHb 18.9PCV/TP 52/67 serum clearChem10 NADAssessment:- Haemorrhagic diarrhoea (bloody, strawberry jam consistency): Haemorrhagic gastroenteritis (HGE), dietary indiscretion, coagulopathy, other.- Vomiting (pink-tinged): Secondary to gastroenteritis, pancreatitis, foreign body, other.- Anorexia: Associated with gastrointestinal upset, nausea.- Mildly increased PCV (52%): Mild dehydration.- Mild electrolyte and acid-base disturbances (mixed acidosis/alkalosis): Consistent with vomiting and diarrhoea and respiratory alkalosis due to panting.On physical examination, appears bright. Normothermic, calm heart rate, good peripheral pulses. No abdominal pain on palpation. No signs of dehydration detected on physical exam. If blood work relatively unremarkable, could consider trialling at home care. Tentative Diagnosis: Haemorrhagic gastroenteritis. Suspected to be a reaction to a new fish treat, given the history of a sensitive stomach.Plan: suggestedSeveral options were discussed: 1) Hospitalisation for intravenous fluid therapy (IVFT) and monitoring. 2) Blood testing to assess hydration and organ function, followed by outpatient treatment. 3) Outpatient treatment with medications and home monitoring without initial diagnostics.Plan: actual, agreed by the owner1. Comprehensive blood test (haematology, biochemistry, electrolytes, blood gas).2. If nothing on bloods, outpatient careTreatment:Maropitant injection SCOndansetron 4mg TMS q6-8hPro kolin 5ml BID for 3 daysClient communication:Discussed presentation of bloody diarrhoea and vomiting. Tentative diagnosis of haemorrhagic gastroenteritis was explained, including the risk of rapid dehydration. The importance of monitoring and the potential need for hospitalisation with IVFT was highlighted.Blood results reviewed with owner. Showed normal organ function, mild dehydration (PCV 52%), and mild, mixed acid-base changes consistent with the clinical signs. Lactate was normal, indicating adequate tissue perfusion at present.Based on the stable clinical picture and blood results, the option of home management was discussed as a reasonable alternative to hospitalisation. Owner elected to proceed with home care as they can monitor closely working from home.Advised on diet: stop all current food including new fish treats. Start with a bland diet of boiled chicken and rice, offered in small, frequent soupy meals at room temperature. Slowly reintroduce normal food over several days once diarrhoea resolves. Advised on encouraging water intake, including flavouring water with chicken broth.Gave medications in consult to show owners.Strict instructions provided for re-evaluation: worsening lethargy, increased volume or frequency of bloody diarrhoea, persistent vomiting despite medication, or inappetence/refusal to drink. Advised that diarrhoea may persist for 3+ days but should become less bloody and less voluminous. Advised to return to us or their regular vet if any concerns.    Vital Signs    Weight: 17.9;