C09994270 / invoice 10000

NOTES: Does like to attack insects, bees
Owner observed a bee in the vicinity, Alfie got to it and was seen trying to bite bee
Shortly after became subdue, quiet
When lifted up by owner, appears floppy and suspect could have stopped breathing
Also vomited afterwards

Had a few days of diarrhoea, was prescribed prokolin and ondansetron
Starting to improve and appears to be perfectly normal prior to this incident

Presented weak, drooly
QAR, EENO wnl
MM pale, CRT 2s, hypersalivating
Chest auscultate nad HR 78bpm, Lung sound wnl RR 66 bpm
Femoral pulse matching and adequate
Abdo pal slightly painful 2/4
T 38.3

Blood collection for EPOC
Adrenalin 0.1ml given IM
IV fluid bolus 10ml/kg given 

EPOC revealed, hyperlactadaemia at 5.39

Discussed admission for treatment and monitoring
Also recommended bee/wasp desensitization with dermatology (referral to be sent)

Assessment:
Responded well to adrenaline and IV fluid bolus, MM normal pink, HR 144 bpm
Recheck EPOC 2 hours later revealed Lactate of 5.05, mild decrease suspect secondary to adrenaline use

Treatment:
Overnight IVFT at maintenance rate
Maropitant given IV

Ongoing improvement seen, eating in the morning
Recheck EPOC in morning, lactate normalized

Plan:
Discharge
Watchful for biphasic reaction
Referral to Derm