C09993402 / invoice 10000

Reason: Ate 10 GrapesAppointment Notes: Overdue remindersConsult Time: 2105History: Daisy presented for ingesting potentially an entire branch of red grapes between 5-7PM.Not on any medications. EDDU normally. Examination: Demeanour: BARVitals: HR=PR= 132 , mm pink, CRT <2 sec, RR pantCVS: NAD on auscultation. No murmurs or arrhythmias noted. Pulses normal. Resp: NAD on auscultation. Normal bronchovesicular sounds. Normal respiratory effort and character at rest.Abdo: comfortable on palpation. MSK: normal gait. EENO: NADL/N: peripheral lymph nodes WNLIntegument: NADNeuro: No cranial or peripheral neurological deficits noted.Hydration: No clinical evidence of dehydrationNausea: None seenLaboratory: BASELINE RENAL PANEL: Alb 34 (26-46) normal BUN 6.7 (2.1-9.3) normal Crea 91 (35-141) normal Ca 2.43 (1.98-3) normal Phos 1.19 (0.81-2.19) normal Na 141 normal K 4.4 normal Cl 110 normal Assessment: 1. Grape ingestion -AKI risk A: emesis induced, Daisy brought up around 40 partially chewed and unchewed red grapes. Last vomitus was bile and foam. Reversed with metomide. Given charcoal. Advised no known published dose so ideally would treat all cases as potentially to cause toxicity given that the amount of tartaric acid in grapes can be variable per grape. O consented to baseline renal bloods which were within normal range. Plan: STRONGLY recommend repeat renal panel in 48h with RV.Grape toxicity handout printed. Monitor for vomiting, inappetence, polydipsia. Expect black stools for the next 48h with charcoal administration. Treatment: Consent has been given by the client to proceed with this treatment  -  Yes1. Apomorphine 0.5 tab OTM 2. Metoclopramide 0.3mg/kg SC 3. Charcoal 5ml/kg PO - ate this with gusto with some chicken    Vital Signs    Weight: 12.2;