C09991899 / invoice 10000

Reason: RecheckAppointment Notes: running 5 mins late--- 05/03/2026 14:53:34 MN:Phone conversationAte last tuesday night after sash visit Lethargic todayWent for a dog walk and he was very clow and needed breaksReading are high about 29 mmol/L 1st thing this morning Now 3pm BG is 23 mmol/LHas been drinking water No vomiting O gave prozinc last night Recommended coming for recheck to check vitals and see if he needs to be hospitalisedHistory: - Diabetic patient on insulin therapy- Recent hospitalization at SASH with CT scan and blood work performed discharged on TuesdayWas discharged withProzinc insulin 90U SID at night --> o didn't give it on TUESDAY as per SASH's indications, but gave it last night Thyroxine 300mcg (1.5x eltroxin 100mcg) BID -> has been having it with yogurth but didn't  touch it todayMaropitant 160mg PO SID --> didn't give it today as he wasn't vomiting Prokolin 7mL BID  --> didn't want to touch any of this Ondansetron 24mg TM q8-12h PRN --> has had 2 doses of this Paracetamol 750mg PO q8-12h Cobalazorb 1000 ug q24h with food had this - Glucose readings: 13.9 on Tuesday, 24.2 this morning, current reading 25.3 during consult 4pm - Last Ondansetron given at 2:00 pm- No V+ and no D+ since discharged from SASH- Dark feces noted on surface, yellowish underneath (Wednesday)- Patient very thirsty - Hasn't eaten since Tuesday night. No food all Wednesday and no food at all today, owner offered chicken and salmon and yogurth which he normally loves- Required breaks during walks today with dog walker- has been drinking a lot +++- lethargic at home, although seems restlessExamination:- Mentation: Alert, friendly, picky with treats, only wanting small pieces of turkey treats- Lymph nodes: NAD- MM: Pink and moist- CRT: -2 Sec- Chest auscultation: Clear, no heart murmur- Abdominal palpation: unable to feel detail as obese- Musculoskeletal: not assessed- Dental: not assessedLaboratory: Yes -  free catch urine + BG reading during consult 25.3 Urinalysis (inhouse) --> Free catchColor: yellow USG: 1032PH 6 Leu 2+Pro -veGlu 4+Ket 2+UBG -veBIL 1BLD 1+Assessment: anorexia, hyperlucaemia, ketonuriaKetonuria due to poor glucose control. Underlying gastroenteritis likely contributing to metabolic instability. Current insulin may not be working effectively anymore +/- poor owner compliance. Patient requires stabilization with IV fluids +/-  rapid-acting insulin and ketonuria controlMay need insulin type change from current regimen to BID dosing.Plan:- Referral back to SASH for diabetic ketoacidosis management- IV fluid therapy, rapid-acting insulin to control glucose and ketones- Blood work monitoring- Possible insulin change to different type - Fecal sample collection when possible to rule out underlying parasites/infections for chronic GE- Continue current medications as prescribed- Recheck with internal medicine specialist Dr. Jody- Monitor eating and drinking at home    Vital Signs    Weight: 54.8;