C09991305 / invoice 10000

Reason: V+, D+ - IVFT, PCV, MedsCONTINUED HOSPITALISATION:AM: Nurse: HMHR - 96RR - PantTemp - 38.6mm/CRT- Pink tacky Eating? Yes all food eaten overnight, fresh RC low fat eaten this AM as wellDrinking? IVFTUrinated? Yes +++ in cage overnightDefecated? No, no more diahorrea overnightVomited? NoDemenour - BARPain score - Need to check with vet re pain relieft this AM?Am meds:3ml Prokolin PO4mg Ondansetron POIV fluids continued at 37ml/hr.CD - brighter this morning and abdomen seems comfortable, eating, no vomiting and no further diarrhoea Mm still quite dry/tacky PCV 23% TP 78 Has dropped, expected some decrease with rehydration Spoke to Kenny, he is keen to get her home today if possible, recommend IV fluids over day to try and better hydrate before comes home, provided not continuing to have signficant diarrhoea or vomiting ok to go home this evening. Plan from there:- continue pred 7.5mg BID - cerenia and ondansetron- recheck Monday and PCV- stop neoral, clopidrogrel and omeprazole for now. 10am- 30mg Cerenia POEating well a few more tbs of GI low fat eaten with tablet. HMDischarge info:‘Princess’ Allen        05 March 2026  MedicationsMedication	Drug Type	InstructionsPrednisolone 5mg tablets 	Immunosuppressant	Give 1 and a ½ tablets twice a day, next dose due this evening. Pro-kolin paste 	To help with diarrhoea 	3ml twice a day Cerenia 60mg tablets	Anti-nausea 	Give ½ a tablet once a day, next dose due Friday morning Ondansetron 4mg tablets 	Anti-nausea	Give 1 tablet to dissolve in the mouth twice a day initially, next dose due this evening. If she is eating well and no vomiting or signs of nausea we can try reducing to once a day Psyllium husks 	Fibre	Give ½ a teaspoon twice a day RevisitIf Princess is ok at home over the weekend, we would like to see her on Monday as previously planned to check her over and check her red blood cell levels. Once she has been feeling well with no diarrhoea or vomiting for at least a few days, we will consider re-introducing the Neoral (cyclosporine) but at a lower dose (1 capsule once a day, preferable frozen) to see if she is able to tolerate this. We can continue to give ondansetron +/- cerenia when this is restarted to help maintain her appetite initially. If she is tolerating this we will likely also restart the clopidogrel but also at a lower dose – 1/8 tablets (approximately) once a day. If she develops diarrhoea again with the reintroduction of Neoral then we will likely need to stop this and trial an alternative drug called azathioprine. Unfortunately this drug also has the potential to contribute to gastrointestinal problem or pancreatitis (as do all our options for additional immunosuppressant drugs).    Vital Signs    

Reason: Vomit + Diarrhoea + Bloody D OvernightAppointment Notes: Refusing food all day yesterday. Ate some chicken liver last night. CFPrep Profile Rotor and CBC (no manual PCV unless requested).History:  yesterday wouldn't eat at all over day, obtained another low fat food from list I gave them but not interested in this either, in evening they gave her some cooked chicken liver, ate this but vomited all back up again, severe diarrhoea has persisted since here on monday and now fresh blood in liquid diarrhoea, small vomits overnight, lethargic Examine: QAR Mm slightly pale pink HR 160Tense on abdominal palpation Admit for bloods, IV fluids, ant-nausea meds, will stop cyclosporine for now. Also stop clopidogrel given GI bleeding. Pre-approval for gapStarted IV Hartmann's 5% dehydration regime, Cerenia given IV, ondansetron PO Gave dexamethasone 0.3mg/kg as may not digest pred properly with GI upset To give pro-kolin later today if possible Buprenorphine given 2.45pm as small grunts/groans when palpate abdoAdvice from Bruce Mackay - stop cyclosporine until 'well' and then try restarting at 50mg once a day to see if able to tolerate lower dose (and if effective), he thinks cyclosporine is the best option if will tolerate. If not then will look at other options (azathioprine has possible link to pancreatitis and mycophenolate can cause severe GI signs so all come with risks). Suggests can give with ondansetron to reduce nausea and freeze (already freezing caps but owner finds more difficult to give. Updated Kenny, keep in overnight and will contact in morning (unless any change over afternoon) DiscuseedPM: Nurse: HMHR - 100RR - pantTemp - 38.2mm/CRT- P 2secEating? Ate 2x tbs through the day of RC GI, offerent more this evening but none eaten yetDrinking? IVFTUrinated? Think some urine on toilet walkDefecated? Yes, watery d+ leakingVomited? NoDemenour -  QARPM meds:4mg Ondansetron PO3ml Prokolin POIV Fluids dropped to 37ml/hr for overnight.    Vital Signs    Weight: 7.75;       Temperature: 38.9;       HeartRate: 160;       RespirationRate: pant;