C09991153 / invoice 10000

Reason: Fit In - Excessive Thrist, Yellow Eyes, No ApetiteAppointment Notes: Camillo (Dog) - Consult [Veterinarian : Consultation(No Preference)] - No appetiteWeb BookingClient name: Rie KatoContact number: 0415872724Email address: rie.613@hotmail.co.jpPatient name: Camillo  ------- Sms reply: YesHistory:- Camillo has been slightly off food since 10 days ago and became completely off food approximately 3 days ago.- O noticed his eye turning yellow- O tried to feed chicken breast and rice after losing appetite to no avail. O then tried feeding digestive care food, ate a bit of wet food but stopped eating 3d ago.- Drinking a lot more water than usual, urination levels unknown- No vomiting, no diarrhoea, no coughing, no sneezing- Flea/tick prevention: Nexgard Spectra- UTD with C7 vaccinations (including Leptospirosis)- Possible access to toxins (off-leash at dog park)Examine: Mentation: QARBCS: 6/9 HR: 100, RR: 24, MM: Yellow, CRT 2-3s, T: 38.3 degrees celcius Dehydration level: ~5%CVS: Normal heart sounds, no murmurs, no arrhythmias Resp: Normal bronchovesicular sounds, normal respiratory effort and pattern Oral: Yellow mucous membranes Ocular: Yellow sclera, visual OU, no discharge nor epiphora bilaterally, no blepharospasm Otic: NAD Nasal: No crusting or ulceration of the nasal planum, no overt discharge, nose moist Integument: No ectoparasite, no alopeica, normal skin turgor, yellow-tinged skin Abdo: No palpable abnormalities, slightly tense on palpationPeripheral LNs: Palpably normal shape, size and texture. MSK: NAD, ambulatory, normal muscle mass, full examination not performed. Neuro: Normal mentation, no head tilt, full examination not performed Diagnostic Tests:Biochemistry:Hypoglycaemia 3.79 (4.11-7.95)SDMA 16 (0-14)Urea 1.5 (2.5-9.6)ALT 902 (10-125) ***ALP 1999 (23-212) ***GGT 13 (0-11)TBIL 320  (0-15) ***Na 142 (144-160)Cl 108 (108-122)CBC: NSFAssessment: 1. Marked hepatopathy2. Icterus2. Anorexia/Inappetence3. Lethargy4. Polydipsic Differentials for elevations in hepatic enzymes include hepatopathy due to toxin ingestion (plants, algae, medications), bacterial infections (leptospirosis), cholangiohepatitis, viral infection (CAV), parasites, functional liver diseases, neoplasia. Given the low urea, we are suspicious of chronic hepatic disease, although we cannot rule out acute liver failure. Discussed with O about hospitalisation with supportive care before abdominal ultrasound is done at 12PM with KQ. Also discussed that we don't have a vet overnight vs transferring to MediPaws. Offered referral (specialist ultrasound + bipsies). O elected for medical transfer to MediPaws.Treatment:IVFT + Glucose supplementation @ 36 ml/hr until glucose normalises then switch back to Hartmann's @ 56 ml/hrRecheck glucose in 2 hoursMaropitant 1 mg/kg SC given at 10.30 AMDenamarin 225 mg: 1 tablet PO SID given at 2.45 PM*Isolation + Barrier nursing due to leptospirosis risk*POCUS with KQ:- Liver: Rounded margins. Hepatic margins smooth/uniform. Diffusely heterogenous / increased hyperechogenicity. No masses detected.  - Gallbladder: moderate fill w anechoic bile. Walls subjectively uniform/normal thickness. - Spleen: unremarkable. - No free fluid detectedPlan:Transfer to MediPaws at 3PM    Vital Signs    Weight: 12.3;