C09993122 / invoice 10000

Hx:
- Presenting problem: Diabetic patient, not yet stabilised on insulin. Quiet, lethargic and not wanting to eat today. 
 - 7IU caninsulin BID, given this morning but not this evening
 - Insulin dose increased from 6IU to 7IU following BGC on 2/3
 - Has u/s findings and bloodwork consistent with potential hyperadrenocorticism- testing not been performed yet

- Eating: Hyporexia
- Drinking: PD
- Urinating: PUD
- Defecating: Normally

- Any V+/ D+/ coughing/sneezing None
- Vaccination status? UTD 
- Any current medication? 7IU Caninsulin BID; Synovan
- Any other concerns None

PE: 
Mentation: QAR
Eyes: NAD
Ears: NAD
Nose: NAD
Mouth: ds 2/4, MM pink, CRT <2
Heart: HR 120bpm, regular, no murmur, pulses wnl
Lungs: NAD
Abdominal examination: NAD
Skin and coat: NAD
LN: NAD
Temp: 38.0
BCS 4 /9
 MCS B /D
Weight: 6.86kg- lost weight

Assessment:
Spot glucose 32.7mmol/L
Collected urine:
USG 1.020
Glucose 4+
Ketones NEG

Concerned DKA or borderline DKA. 
Urine dipsticks only test acetoacetate not B-OH 

Options:
1) Refer to SASH for blood gas and poss tx for DKA
2) Monitor, recheck tomorrow in clinic OR at SASH if gets worse overnight

Going to SASH. 



Did discuss hyperA, will need to book for LDDST once settled from possible DKA episode.