C09994243 / invoice 10000

Appointment Notes: Overdue remindersSe previous entry under addendum for accompanying history.    Vital Signs    Weight: 4.44;       

Reason: Not EatingAppointment Notes: Overdue remindersHospital Time Period: admit 20:00History:Presented tonight for marked hyporexia.Last ate 10AM yesterday morning (1/2 normal meal), did eat small amount of sweet potato last night. Nil interest in food today. Has vomited once this morning (no visible blood). Hyporexic since Sat 28/2. Last week prior, still eating and reasonably bright. Hx of kidney dz, managed with MVSCCrea reportedly ~ 280 around 3 weeks ago, 2 weeks ago ~ 480, 2/3 Crea 519. P has had previous UTI, tx with Amoxyclav. Confirmed resolution. Most recent C&S 2/03. KH STO 2/03- advised that crea had increased marketedly, C&S still pending at this stage. As appetite was close to normal and she was drinking, O advised IVFT likely to be of minimal benefit if hydration adequate, dispensed maropitant as needed. Has previously been on Cyclosporine. Hx unclear as to why. Stopped 2 weeks ago Hx of ALP elevation & ALT elevation2/03ALT 356ALP 762O has also noted today that Dau Dau seems weaker to walk and has involuntary muscle movements. (new finding). Has previously had spinal sx1 sx in Hong Kong 20131 sx in Melb 2020. Diet- chicken breast, broccoli, carrot, pumpkin., Given maropitant 12mg PO 9AM this morning Subjective: QAR Objective:Temp:     39.0       MM:  pink            CRT:   <2          HR:   160          FP:   SSP           RR: 50BCS:    5/9                Wgt:   4.44 kg Pain Score (CSU):  0 /4CV:   gr2/6 HMBPS AV 135/96 (111)RESP:    no audible crackles or wheezes, normal resp rate and effort        GIT:  comfortable on abdo palpation, no splinting/tensing noted U/G: Urinary bladder soft and comfortable on palpation, both kidneys feel approximately equal sized. Neuro: Ataxia at walk, normal CPS all 4 legs M/S: Ambulatory, comfortable on ROM of jts Integ: no visible petechiae or ecchymoses. Ophth: Bilateral SNSLNs: Nil peripheral lymphadenopathy. INTERNAL LABORATORYPCV/TS:44/77	Blood Gases:@19:00                                        @ 01:00 pH 7.349                                      PH 7.421PCO2 41.4                                   PCO2 39.2 HCO3 22.3                                   HCO3- 25.2 BE -2.5                                         BE 1.1 cSO2Electrolytes:Na+ 158                                      Na+ 155 K     3.2                                       K+ 3.9 Cl   115                                       Cl- 114 Glucose  5.4                             glucose 4.6 Lactate 5.4                               lactate 2.5  Ionised Ca 1.23                       io ca 1.19  Crea 410                                  367 SDMA 49 Problem List:Gr2/6 HMElevated crea. Hyporexia- anorexia. Vomit onceShaking/trembling at home. Hypernatraemia. Assessment: Hx of Kidney dz and hx of elevation to creaDdx CKD on AKI vs progression of CKD vs AKI. -Have partial summarised hx from MVSC, however unsure when Crea was noted to be increased/abnormal from baseline originally. P is currently anorexicC&S performed recently- 2 days ago- negative. - UA C&S findings, however may not be reflective of pyelocentesis findingsIO ca+ normal @ AEC overnight. Dau Dau has been hospitalised overnight at AEC for supportive tx, with a view to referral back to MVSC today for ongoing mgt of renal issues. Consider further elevation into elevation of creatinine including comprehensive AUS.Consider echo to assess cardiac condition. O comfortable for review today at MVSCIf hyporexia and anorexia ongoing- O tube placement may need to be consider, however if hypotensive episode was to occur under GA- may exacerbate renal issues. Treatment:IVFT @ M Ondansetron 0.32mg/kg IV slow q 12 hours Plan: Diagnostic plan : STAT bloods, BPS Therapeutic plan : monitor mentation, appetite, analgesia, ins/outs Discharge plan : n/a Referral plan : n/a Client Communication:STORecommended admission, STAT bloods, supportive tx and then refer back to MVSC in AM for ongoing mgt and decisions. O has med appt at 11AM, however day vet can call to ascertain if able to do earlier transfer (pending availability) Discussed HM and kidney dzClinical update provided to O @ 05:30===================ADDENDUMDr S Varga7am checkSubjective: Quiet and responsiveObjective: HR 148, mm ink, CRT <2s, RR pant, temp - not taken so as to minimise stressMAP - likely inaccurate - reading low, growling with BPTreatment: On LRS + KCl 28mmol/L at 16.5ml/hrTotal vol received 205mlOndansetron 0.32mg/kg IV at 7amLaboratory: Rpt bloods not repeated this morning as going to MVSC.Vet communication: Called MVSC to notify them that Dau Dau is here.  No earlier appt available.  Keep 11.30am appt.Client communication: O phoned and made aware of the above.    Vital Signs