C09994865 / invoice 10000

Clinical Notes from 4/3/26:

2x USGs recorded. 
- 1.004
- 1.008 (after 5 hours of no wees)

Frank was not examined today as can be quite reactive. Discussed recently blood and urine results with O and explained next steps outlined below. 

Assessment: 
1. PU/PD with Hyposthernuric-isothenuric urine. DDX: cushing's v neoplasia v central/nephrogenic diabetes insipidus v psychogenic v other 
2. Hypothyroidism v euthyroid sick (cholesterol normal). 

Plan:
Give Frank's age consider abdominal U/S (+Urine cortisol/creatine ratio +- blood gas for ionised calcium) next. 
Could also consider > LDDST > vasopressin trial v medicine referral.
But would suggest imaging first given his age. 

Owner dropped off urine sample

- collected at 5.30am

SG 1.008

JM STO
still PU/PD, urine results show low USG - was not first morning sample
advised o of this and to see if we could get first morning urine sample and bring in just to test USG at no charge 
depending on urine results and how Frank is doing, teleconsult / normal consult to be booked to go through further plan and potential treatments 
o happy with this plan, will try bringing urine sample in tomorrow, knows to keep in fridge if too early for our opening hours 
JZ / JM

Assessment:
PU/PD with hyposthenuria. 
DDX: cushing's v central/nephrogenic diabetes insipidus v psychogenic v other 

Plan:
Await morning sample. If truly hyposthenuria could consider abdominal U/S > LDDST > vasopressin trial v medicine referral.