C09992943 / invoice 10000

Reason: Vomiting / DiarrhoeaOR started V+ on Saturday No further V+ on Sunday Monday V+ again Tuesday V+ and passed some D+ Wednesday - no V+ or D+ reported OR V+ found again this morning OR V+ undigested food (soft wheetabix mix) - no fresh or digested bloods seen D+ 2 voids seen -> cow pat consistency and watery brown - no fresh blood, melena or mucous OR acting normally - bright and well in self, normal behaviour from O perspective - no lethargy OR mainly V+ through the night No changes in appetite - still hungry No further stools passed since Tuesday that O aware No changes to other ct at home that aware of UTD with vaccinations O not sure if UTD with FTW tx No access to toxins that O aware of Indoor only CEX Weight stable BAR in consult Eyes, ears and nose = clear Oral mm pink and moist, CRT <2s Dentition - very mild plaque formation, no gingivitis - grade 1/4 periodontal disease observed Chest ausc = HR 162 - grade 3/6 HM PMI ventral chest and RR sniff - normal lung sounds on ausc Abdo palp NAD soft and comf - no palp masses or opacities Pulses good and sync Palp LNs = all wnlDerm NADBCS = 5/9 T 38.7Disc based on hx and CEx - ddx for V+/D+- primary GI (dietary indiscretion, infectious inc viral/bacterial/parasitic, inflamm inc allergies/intolerance/sensitivity, FB, neoplasia) vs secondary GI (hepatic, renal, pancreatic, endocrine, metabolic, toxin) Disc with O based on hx - suspect dietary intolerance component, bit cannot rule out other ddx such as FB without FI/Dx Disc with O options for FI/Tx O1 - Symptomatic tx management - anti emetics and/or anti-nausea and  probitoics RV INI in 24-48hrs or worsening O2 - Screening bloods to assess for any changes and RV based on results O3 - transfer for inpatient care and work up inc bloods, IV meds inc analgesia and/or imaging Disc pros and cons of options - O opted for O1Disc maropitant - 1mg/kg given s/c -> very reactive to inj, adv if V+ through inj then RV asap Adv prokolin PO BID for up to 5d Adv INI in 24-48hrs or if any worsening RV sooner for recheck and further work up O happy with plan    Vital Signs    Weight: 5.0;