C09996104 / invoice 10000

Reason: severe hepatopathyHistory: Kashi has remained in hospital during the day today with hepatopathy, suspected pneumonia requiring oxygen supplementation.During the day today, her vital signs have remained fairly stable, and her injected mucous membranes are starting to improve. Her SPO2 has been normal on her nasal oxygen line, running at 2 litres a minute. Her blood pressure has remained okay.She has been urinating. She has been drinking quite well with no regurgitation or vomiting noted. She has not wanted to eat anything. There was some discussion with the owner during the day, as regards to NAC. Decided a single dose of IV NAC was given at 11:00 a.m.Owner unable to source remaining NAC prescription, and has declined any further injectable NAC to be given due to cost.Kashi no longer feels uncomfortable and her buprenorphine has been discontinued.Examination Findings: , see smart flow for full record. Ongoing increased respiratory effort, ongoing dull mentation. Ongoing anorexia.Lab Findings: She has had repeat blood work run this afternoon. Blood glucose remains normal  6.8. Her PCV TP is 46, 56, two plus icteric.Her repeat liver panel has been run. ALT 752, good improvment from 2156.ALP 1481, improved from 1759.T bill 101, improved from 143. CBC was also accidentally run, not billed for as our error. However, at this stage, she still has adequate neutrophils and leucocytes.Ultrasound Report: Pocus, B lines still present, multiple lung fields all over.Abdomen, no free abdominal fluid, gallbladder, mild halo at this time no sign of sludge. Maybe starting to fluid overload??Abdominal fat reasonably white.Radiographic Findings: Plan from day staff for night staff to perform chest radiographs conscious.Chest radiographs have been performed.Reasonable quality laterals. DV somewhat twisted, unable to do better, conscious.Diaphragm appears intact, no obvious rib lesions noted.Heart appears normal size.Lung fields diffuse patchy alveolar pattern.Assessment: possible widespread pneumonia versus ARDS vs ALI vs pul TED versus other infiltration due to neoplastic inflammatory fungal disease considered to be less likely.Liver has shown good improvement in ALT, bilirubin still has a way to go.Plan: Add in ondansetron for additional anti-nausea medication. Consider trying mirtazapine tomorrow to see if feeding can be started versus potentially looking at feeding tubes.Owner has reported some cost awareness and permission would need to be sought for those two things to be placed.Client Communication: Owner call for update approximately 11:30 overnight.Vet still in with a critical patient, unable to return call.Sent text message as detailed below.--- 06/03/2026 02:40:31 exb:HI Rochelle, sorry for the delay in communications tonight. Kashi's liver blood tests are improved on yesterday. Her lungs have not improved at this stage and she is still very quiet. Please call after 8am for an update. Kind Regards Dr Emma    Vital Signs    

Reason: Severe HepatopathyAppointment Notes: Special payment terms existHistory Has been in hospital for the last 2 days with liver disease and difficulty breathing . Xrays show a marked alveolar pattern . She is oxygen dependent . Reduced mentation ,not eating . Her liver enzymes and bilrubin had showed some improvement since last night . Current treatment enrofloxacin sc ampicillin iv antinausea meds and had one dose of NAC.Examination . Still oxygen dependent when trialled of oxygen spo2 decreases to 93 % Walked to toilet as wont urinate in cage . Dyspnoea much worse on return . Vitals as per smart flow Abdomen distended Depressed demenour Assessment Not much improvement in clinical condition over the last 2 days . Asked owners to come down for in person discussion to go through radiographs and further workup /treatment.The best course of action would be referral to a specialist for ultrasound possibly a ct scan of abdomen and chest to try and further define cause of lung changes and liver .  Versus continued supportive care with antibiotics antinausea meds , iv fluids and monitoring of liver and lungs . Will likely need at least another 3 to 4 days in hospital given current condition .She may have lymphoma , generalised fungal infection . Liver disease with Acute lung injury . To further define workup biopsies etc needed. Treatment iv ampicillin 30 mg/kg Continued iv fluid support Continued nasal oxygenAsked owners to come in for discussion .Arrived in clinic at 10 am . Showed owner radiographs . Discussed that live parameters had improved but her respiratory effort and demeanour were still poor and she is not improving clinically . I discussed the options of referral for further workup , continue to treat supportively and see how she responds or euthansia . Her owner knows that her quality of life is not great normally with her ongoing skin issues ,eye issues ,nose issue . I advised that i  do not know if she will improve or whether there is an underlying disease . I do not know if she will improve or not unless we try . Owner has been cost constarined Her owner stayed in her with her till 130 pm and then gave permission to euthanise .Premed with 0.5 ml butophanol 0.2 ml acepromazine iv Then 10 ml propofol then 15 ml lethabarb with owners present . Paw prints taken and home for burial .    Vital Signs    

Reason: Severe HepatopathyAppointment Notes: Special payment terms exist--- 05/03/2026 17:33:58 KS STO - advised nasal flow by oxygen - recommended thoracic radiographs.  Owner advised unable to collect NAC from pharmacy.  O would like to hold off on NAC for now.  Advised will run repeat liver panel and assess if can acquire thoracic radiographs conscious.    Vital Signs