C09989302 / invoice 10000

Reason: Atypical Addisons - Seen ECC 22.2.26Problem List:Eunatraemic, eukalaemic hypoadrenocorticism (DDx iatrogenic)> diagnosed 20/02/26> ? if ACTHST affected by chronic use of topical mometasone for otitisHypoglycemic seizure 20/02/26 post-GAChronic allergies - pododermatitis, otitis, conjunctivitisRecent History:Prior to this surgery Murphy had been well. Murphy presented to VRH ECC following a seizure that occurred after GA for lump removals on 20/02/26. Hypoglycemia was noted when initially presented to rDVM for seizure and was treated with dextrose IV bolus though he remained obtunded/altered and recumbent. On presentation he also had signs consistent with SIRS (tachycardia, injected MM, leukopenia, acute haemorrhagic diarrhoea). He was treated supportively in hospital with IVFT (2.5% glucose) amoxiclav IV 20mg/kg, maropitant 1mg/kg. His demeanour and cardiovascular parameters improved and blood glucose remained normal. ACTHST performed diagnosed hypoadrenocorticism with lack of increased cortisol after synacthen. There was an absence of electrolyte disturbances (ie hyperkalaemia/hyponatraemia). Commenced on dexamethasone 0.2mg/kg. Discharged home with gastroprotectants (as had received meloxicam and had GI upset). Took him about a week to return to more normal energy levels, was sleeping more and just wanting to rest in front yard. Prior to illness had very good recall and recently has been less responsive, yesterday was good. Appetite - loves the loaf food but grazes dry food. Improved since discharge.Diet - prime100 salmon/tumeric for years the loaf and salmon based dried (Billy and Margot)Faeces - intermittent diarrhoea reported at least once a month prior to this illness for a few years. Score 2-4 faeces, had one episode of haematochezia after illness. Vomiting - intermittent, once per month for a few yearsResp - panting more since discharge, no coughing or nasal discharge. Recent reduction in exercise tolerance only on long hike otherwise seemed normal.Thirst - increased since discharge, not sure how much as 2 dogs. Urination - increased since discharge, polyuria without pollakiuria, no LUT signs. Mobility - normal, no issues with jumping. Gets stressed jumping into 4WD, hasnt been jumping on bed since illness. Behaviour - humping more than he used to since discharge, tried to rest him since discharge but has good energy levels. No episodes of ataxia or weakness prior to recent illness, maybe slight weakness in back legs was only sign noted. No altered mentation or pacing, has bumped into things a couple of times since being unwell which is unusual for him. His recall is also worse than it has been. Not been going for big runs since been unwell. Recent Diagnostics:POCUS 20/02 - no FFLaboratory:21/02/26 Ext CBC - Hct 0.35, retic 86, neut 8.2, band 0, lymph 2.1, eos 0.2 plt 107, small clumps, moderate lymphocyte activation, mild toxic changeBaseline cortisol <28nmol/L (Aurora); post-stim <13.8nmol/L IDEXX inhouse qcortac1VBG pH 7.409, pCO2 28.8, K 4.6, Na 144 L, Cl 122 H, iCa 1.26, Glu 4.7, lact 0.820/02/26 CBC - Hct 37.6, neut 2.85 L, lymph 1.58, mono 0.12 L, nrbc*,. Plt 133Chem17 TP 57, al;b 21 L, glob 36, Crea 135, Glu 5.52, urea 6.5, Tbili 4, chol 2.22, ALT 65, ALP 23VBG pH 7.332, pCO2 32, K 3.4L, Na 146, Cl 123H H, iCa 1.24, Glu 7.3, lact 2.1 HPost-seizure (rDVM): BG 1.35L, alb 20 L, neut 1.26 L, plt 95 LPre-GA: Hct 0.396, retic 110 H, lymph 7.151 H, neut 5.3, eos 0.24, plt 170TP 66, alb 25, urea 7.8, SDMA 16 H, Crea 133, ALT 75, ALP 17 LCurrent Medications:Prednisolone 10mg PO q24h (0.28mg/kg/d)Apoquel - given intermittently if pruritus noticed.Amoxyclav 750mg PO q12h x5dOmeprazole 40mg PO q12h x3dElocon (mometasone) topical administered to both ears weekly - not given in last 3 weeks. Has been less frequent than weekly. Previous Pertinent Medical History:20/02/26 Lumps removed: 1. Right lateral chest -5x5cm2. Right lateral chest just cranial to lump 1 -1.5x1.5cm3. Right ventrolateral chest -2×1.5cm4. Right axilla 6x5cm5. Left fore caudal triceps 6x5cm6. Left lateral chest 1.5x1.5cm7. Left groin inguinal area 2x2cm- All lumps grossly appeared to be lipomas on excision.April 2020 GI upset vomiting and diarrhoea after steroid/cephalexin course for skin diseaseHistorically recurrent otitis and pododermatitis> started weekly elocon 2021, apoquel intermittently since 2023Entropion resulting in recurrent bilateral conjunctivitis. Corrected surgically 13/01/23Dental scale and polish Jan 2023 recovered without issueSept 2024 - benign lump removed from elbow (fibrolipoma)Vacc: April 2025 C5, Worming: proheart yearlyTravel:noneBIOP  since puppyExamination:HR:	RR:	MM: pink/moist	CRT <2s 	Temp:Oral: no dental disease, no pain on opening mouth, no visible lesionsEars: no discharge, no erythemaEyes: no discharge no conjunctival/scleral hyperaemia, fundic exam not performedNasal: no discharge, no pain on palpation of sinuses, no evidence of deformityCVS: no murmur, normal rhythm, strong synchronous pulsesResp: normal effort, normal bronchovesicular sounds all quadrantsAbdomen: no pain on deep palpation, no palpable fluid wave, no masses palpableGenitourinary: Rectal: normal formed faeces, anal sacs palpate normally, no palpable irregularities to mucosaMSK: normal ROM, no pain on palpation, no palpable joint effusionsNeuro: appropriate mentation, normal gait and posture, no spinal pain. Brief CN exam WNLPeripheral LNs: submandibular, prescapular and popliteal nodes are symmetrical and smallBCS:   /9Weight:    kg Procedure:Sedation - Anaesthesia - Imaging:Laboratory:Problem List:Assessment:Treatment:Plan:Communication:Client - see discharge instructionsVet - Medicine referral summaryReason:History:Physical examination:Demeanour - Bright and alertVital signs - MM pink, CRT<2s, HR  bpm, RR  bpm, T  CCardiovascular - Cardiac auscultation normal, pulses strong and synchronousRespiratory - Effort normal, bronchovesicular sounds audible all quadrantsAbdomen - No abnormalities on palpationHead / neck - No abnormalities identifiedMusculoskeletal - Normal gait, no pain identifiedIntegumentary - No abnormalities identifiedGenitourinary - No abnormalities identifiedLymph nodes - Peripheral lymphadenopathy not detectedBCS  /9. Body weight  kg.Procedures:Premed - Anaesthesia - Laboratory:Haematology -Biochemistry - Urinalysis - Imaging:Assessment:Treatment:Plan:Client communication:Vet communication:    Vital Signs    Weight: 40.4;