C09993939 / invoice 10000

05/03/2026 **
NURSE: KR

REASON: NQR

HISTORY:
- Possible topical flea/tick product ingestion (Bravecto/Advtantix? unsure what brand) - upon questioning for hx, O realised they gave topical treatment orally 
- Gave yesterday afternoon  
- Seemed fine last night and slept through the night 
- This morning was showing very erratic behaviour, pacing, restless, panting/ hypersalivating
- Has not gotten worse throughout the day. Maybe slightly better, but still showing above behaviours
- Owner describes as "different dog"
- Maybe a bit wobbly? has trouble going downstairs earlier
- Did not eat breakfast - unusual for her. Is eating treats. 
- No V or D 

CLINICIAL EXAM:
- Mentation: Agitated
- MM: pink 
- CRT: <1
- Oral: no pain on opening of mouth, teeth 0-1
- Ears: Not assessed
- BCS: 4/5
- Lumps: None noted
- Abdominal: Comfortable
- Lymph nodes: Not assessed
- HR: 120bpm
- RR: Panting +++ 
- Temp: 39.2°C
- Neuro: PLRs and palpebrals normal, menaces variable
Gag normal
Ambulating normally
Hyperpanting with some tongue lolling

ASSESSMENT:
- Slightly neurologically abnormal and agitated behaviour 

DISCUSSION:
- If topical flea/tick type product ingested - carrier may be the issue rather than the drug itself 
- Hypersalivation noted in dogs/cats receiving topical fluralaner products orally at max topical dose under experimental conditions (Plumbs)
- Need to confirm exact product and dose before deciding on hospitalisation / plan 

PLAN:
- Send home for now, O to look at packaging and let us know. We will then request poisons hotline report. 
Excelpet flea and heartworm - 4mL moxidectin and imidacloprid

POISONS:
Moxidectin overdose - tremoring has passed (this morning) and can have some temporary blindness (hence inconsistent menaces)
Should improve overnight
Could use trazodone 
AES if starts tremoring again