C09990446 / invoice 10000

Reason: Breathing Hard, Feels Hot, Unsettled, Vomited Appointment Notes: Overdue remindersConsultation time:Hospitalisation period:  History:- O said he was breathing heavily when they got home today and felt warm to touch. Proceed to twice two times after that , both times are productive with bile and some grass .  Drink a large amount of water after that - Previous severe ear infection a couple of months ago, treated with a slow-acting, 28-day lasting medication. The anisocria coincides with this episdoe of ear infection and have presist since then. No recent changes in severity and does no seem to bother him - Hospitalised a couple of months prior for an unknown illness (O not sure) , spending several nights on an IV drip for dehydration at Main Ridge Vet.- Diagnosed with have a kidney related issue at the time ( x-ray +- ultrasound and blood work done). Received a short-term, 2-week course of 5-6 different medications for the kidney issue, and was due for a check-up. O not sure whether it was a AKi episode / pyelonephritis or whether he was diangosed with CKD - Last week was a bit  off food, sluggish, and moving poorly, symptoms resolved in the last 48 hours and have been well until today afternoon - No diarrhoea, solid stools yesterday- Currently eats one meal per day eg  of dog biscuits, roll - Noticed coughing this afternoon, right after he vomiting , none since then - Was drinking more water than usual before coming to ERH - Mobility is generally low, O said he is usually a lazy dog - No access to human medication or rat bait Examine:  Demeanour - BAR , was walking ok , bright in consult room but panting heavily T:   38.5    HR: 160-> 120 when in triage area        RR:  Panting   mm: Pink    CRT:<2Weight:  62 kg       BCS:  7/9Cardiovascular – Could not clearly auscultate the heart due to him panting so heavily even with mouth closed . Pulses are normokineticRespiratory – Subjectively mildly decrease breath sound on the left (could be positional ) . No obvious wheezes or crackles. Abdomen – Comfortable with abdominal palpation. No overt organ enlargement or masses. Not tympanic when flicking abdomen Musculoskeletal – Ambulatory on all 4, no overt lameness or pain on appoint palpation. Full musculoskeletal examination not performedIntegument – NAD outwardly. No notable alopecia or lesions Neuro – Not ataxic. No obvious cranial nerve deficit . Normal menace, palpebral - PLR subjectively reduce on the right - R pupil > L - L eye dilate when lights were turned off and the R eye does not constrict when lights were turned back on Eyes – Clear with minimal discharge . No sclera hyperaemia Lymph nodes -   Peripheral LN (submandibular, popliteal and prescapular) normal sizes and consistenciesUrogenital: NAD outwardly  SpO2 at 99% Imaging:AFAST: NO FF0/4, subjective reduced cortical medullary definition of the left kidney TFAST: Normal glide sign , no appreciable pericardial effusion . On one site on the left very mild scant pleural effusion noted on the initial scan but not noted when try to scan again when he changes his sitting posture Problem list:Panting heavily Vomited twice Assessment:Vomiting Gastroenteritis vs FB vs GDV though productive vs allergic reaction to insect bite vs others vs renal disease - Presdisposed deep chested giant breed for GDV - Not a typical GDV presentation, O said he does not seem bloated + productive vomiting + not tympanic on physical exam but cannot rule out a early GD/ GDV without x-ray - Ideally recheck renal parameter and compared to previous values Panting and unsettlesPain vs anxiety vs lung disease vs others - Normal respiratory effort and rate when panting stops, does not seem to be in respiratory distress- Cannot rule out aspiration pneumonia due to having history of vomiting Pleural effusion - Extremely scant and only appreciable on one site and not repeatable when he changes his posture. Potentially still worth investigating with chest x-ray Cardiovascularly stable and not oxygen dependent, can not localized problem on initial examination. Uneven pupil size have persisted for months and has not worsen according to O. Ideally next stop will be to repeat blood to reassess kidney function and x-ray for the lung +- abdomen to rule out a GDV Client communication:Communicated assessment with O - Recommended to have him admitted due to him being unsettled and potentially have scant pleural effusion. Ideally will do blood and imaging in to narrow down ddx quoted 2.5 for 3.5k overnight - O expressed financial constraint and would like to opted for symptomatic treatment and then revist  with regular vet tomorrow- Told O despite his presentation is not typical for a GDV can not rule that out without x-ray. Electing outpatient treatment carry the risk of he could deteriorate or collapse overnight if he is an undiagnosed GDV. O understood the risk and still want to opt for symptomatic treatment at this stage- Told if we admit him will likely have to repeat blood overnight has does not have access to main ridge record - Revisit with ERH overnight if he vomits throguh maropitant or if he deteriorates  Treatment:  Maropitant 1mg/kg SC Methadone 0.2 mg /kg IM Plan:- Revisit in the morning with main ridge for possible x-ray and repeat blood work - If he deteriorates then revisit with ERh overnight    Vital Signs