C09992450 / invoice 10000

Reason: SeizureHistory Summary:Presented for a first-time seizure episode. The seizure lasted approximately 40 seconds and involved shaking, paddling, urination, and defecation. There is no recent history of vomiting or diarrhoea. Pre-existing medical conditions include Cushing's disease and hypothyroidism, for which he receives Thyroxine (quarter tablet, morning) and Trilostane (1ml, morning). Vaccinations, flea, tick, and worming control are up to date. There is no known access to toxins. The owner reported some unusual behaviour in the week prior, including being somewhat "off" and falling down the stairs, although details are limited as the owner does not live with the dog as he is her parents dog. He is also partially deaf and blind due to old age. No vomiting or diarrhoea. TRIAGE:HR: 100 bpmRR: PantingTemp: Not taken on arrivalMM: Pink, tackyCRT: < 2 secondsMentation: QARPain Scale (MGCS): 0/4Hydration status (%): Mildly dehydrated, gums tackyEXAMINATION:Body Condition Score: 7/9Cardiovascular: Cardiac auscultation reveals a heart rate of 100 bpm. A possible low-grade murmur (3/6) is suspected, but auscultation is difficult due to increased lung sounds. Pulse pressures are normal and synchronous.Respiratory: Thoracic auscultation reveals mildly increased lung sounds bilaterally. Respiratory effort is characterised by panting. No nasal discharge.Neurological: Menace response is reduced bilaterally. Palpebral reflexes are present bilaterally. No other overt neurological signs were noted post-ictally.Musculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performed.Gastrointestinal:- Oral: Dental score 2/4 with some dental disease present. No oral pain noted. Hypersalivation present.- Abdominal: Pot-bellied appearance consistent with Cushing's disease. Abdominal palpation was non-painful.- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: Multiple small skin tags and lumps noted over the body.Lymph Nodes: WNL on palpationEyes: cataracts present bilaterally, Menace response reduced bilaterally, PLR present bilaterally. PROBLEM LIST:1. First time seizure episode2. Pre-existing Cushing's Disease and Hypothyroidism3. Mild regenerative anaemia4. Mildly elevated urea and ALKPDIFFERENTIAL DIAGNOSIS:Differential diagnoses for the seizure include intracranial and extracranial causes. Extracranial causes such as metabolic disturbances were considered less likely following normal blood gas analysis. Intracranial causes such as a brain tumour are considered a high differential given the age. Other intracranial causes include infection, inflammation, or head trauma. Idiopathic epilepsy is considered less likely due to the age of onset.Differentials for seizures in a dog include - Intracranial (infection vs inflammation vs neoplasia vs idiopathic) vs extracranial (metabolic vs intoxication) DIAGNOSTICS/MANAGEMENT PLANAn IV catheter was placed on presentation. The plan discussed with the owner involved performing in-house bloods (CBC and biochemistry) to rule out extracranial causes for the seizure. Options for hospitalisation for monitoring versus outpatient bloods and home monitoring were discussed. The owner elected for blood work to be performed prior to discharge for home monitoring.Blood Gas Analysis Results - source: venous- Decreased: ---- Increased: Lactate 4.2 mmol/L-Interpretation: Mild hyperlactataemia, likely secondary to seizure activity or poor perfusion. Otherwise unremarkable.Bloods were taken for in-house testing:Full bloods- Complete Blood Count  - Please find attached to the patient record.  - Findings: Mild regenerative anaemia with a haematocrit of 34.5%, haemoglobin of 11.9 g/dL, and an increased reticulocyte count of 172 K/uL. White blood cell counts were within normal limits.- Biochemistry  - Please find attached to the patient record.  - Findings: Mildly increased urea at 9.8 mmol/L and markedly increased ALKP at 1911 U/L, likely secondary to pre-existing Cushing's disease. All other parameters, including glucose and electrolytes, were within normal limits.REVISED ASSESSMENT:Extracranial causes for the seizure have been largely ruled out based on blood results. The primary suspicion is for an intracranial cause, with a brain tumour being a high differential. Idiopathic epilepsy is less likely.TREATMENT SUMMARY:IV catheter placed in right cephalic vein.NIL OWNER COMMUNICATION:Discussed physical exam findings, blood gas results, and differential diagnoses with the owner. Explained the difference between intracranial and extracranial causes of seizures. Outlined the diagnostic plan, including the option for full bloods and home monitoring versus hospitalisation. Costs for both options were provided. The owner consented to performing full blood work and then taking Toby home for monitoring. Advised to represent to a veterinarian if another seizure occurs. The results of the blood work were discussed, and a copy will be sent to their regular vet.FINANCIAL UPDATE: Outpatient option estimated at $900-1200. Hospitalisation option estimated at $1200-1800.PLAN:Discharge home with owner for close monitoring. Advised to present to their local vet or an emergency centre if any further seizures occur for consideration of starting anti-seizure medication. Blood results to be forwarded to their regular veterinarian (Algester Vets) For any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs    Weight: 6.3;