C09993501 / invoice 10000

Reason: Ingested Vyvanse Appointment Notes: spoke with Dr Alex and Dr Van - recommended emesis - amConsult Time: 1815History: Kaia presented for potentially ingesting up to 20mg of vyvanse up to 40 minutes prior to presentation.Not currently on any medications. EDDU normally. Examination: Demeanour: BARVitals: HR=PR=120  , mm pink, CRT  <2 sec, RR pant, Temp 39.5*C CVS: 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: PCV/TP: 53/70 (clear) Blood Gases: (venous) pH 7.388PCO2 37.4 LHCO3 22.5BE -2.5cSO2  87.2% LElectrolytes:Na+ 149K     3.6Cl   126Glucose  5.6Lactate 1.53Ionised Ca 1.32Urea 7Crea 11Assessment: 1. Vyvanse ingestion (dextroamphetamine) - up to 2.1mg/kg A: risk of tachycardia, agitation, hyperthermia, arrhythmias and seizures. Emesis induced - brought up food, last vomitus was bile. Reversed with metomide. Treatment:1. Apomorphine 0.5 tab OTM 2. Metoclopramide 0.3mg/kg SC 3. Charcoal 5ml/kg PO once off Plan:Admit to hospital for overnight monitoring for signs of amphetamine toxicity (e.g., agitation, tremors, tachycardia, hyperthermia, seizures).If stable, discharge tomorrow morning.If clinical signs develop, initiate further treatment (e.g., medication for tachycardia, seizures).Resuscitation status: CPR.Handed over to Dr Cathy Faye for ongoing care. Client Communication:Discussed the risks of amphetamine toxicity, including delayed onset of signs (up to 3 hours). Explained the need for hospitalisation and monitoring for at least 12 hours. Discussed the treatment plan, including IV catheter placement and potential interventions if symptoms develop. Provided an estimate of costs, approximately $1500 to a worst-case of $2000 by morning, noting it could be less if IV fluids are not required. Explained that extended hospitalisation would cost approximately $700-$900 per 12 hours, though this is considered less likely. Advised that no news is good news overnight, but they will be contacted immediately if any significant deterioration occurs. A deposit of $1000 was requested. Client agreed to proceed with the recommended plan.*******************************************************************************Hospital vet update Dr CF @ 0220Kaia has remained stable overnightShe has eaten very wellShe has been a little bit needy and vocal, given 0.02mg/kg ACP iv @ 2000HR has been 120- 130 bpmRR and RE wnlBP MAP 76-91 mmHGPlan discharge in the morningCF called 0530- no replyKaia can go home    Vital Signs    Weight: 9.5;