C09992708 / invoice 10000

Reason: Shaking KmAppointment Notes: Overdue remindersHistory- Under tx with UoM vets is werribee for CLL. Currently only on prednisolone to manage. Has noticed him going downhill in the past week or so. V+ and D+ this morning- explosive. No changes to diet. No obvious causes. Very flat- no interest in food- very unlike him.Examination- very flat. Mm pink and moist. Abdomen- quite full and hepatomegally present but no obvious mass effect but palpation limited. Chest ausc ok- mild tachycardia. Haemorrhagic D+ on rectal exam- very watery and gassy.Assessment- Possibly AHDS but cannot rule out progression of CLL- acute leukaemia/splenic/ Gi involvement??Plan- admit to hospital and start supportive therapy (IVFT and maropitant and ondansetron) and run bloods in house but also send haematology to IDDEXX for further analysis.IV catheter place din L cephalic and started on 55ml/hr hartmanns, 1.55ml maropitant given slow IV and 8mg ondansetron given PO.Bloods taken and ran in house and haematology sent to Idexx.Laboratory:Biochem- low K and Na- will supplement fluids with 20mmol/l KCl. Otherwise all wnl.Haematology- low platelets but has macroplatelets on smear so most likely normal for him.Neutrophilia and monoctyosis. Lymphocyte count not as high as previously but different calibration so suspect similar count. No obvious increase though.Lymphocyte count 5.81 Haematology sent to Idexx for haematology advantage- results will not be back until tomorrow.CRP-Plan will also start on IV metronidazole- 116mg slow IV over 15minutes - works out at 23ml over 15mins.2pm- metronidazole given IVAppears much brighter and ++++haemorrhagic D+ coming out.Spoke to O and informed re progress- brighter but still no interest in chicken and D+ extreme.20mmol/l KCl added to fluids as still not eating.    Vital Signs    Weight: 15.5;