C09997015 / invoice 10000

Reason: Ate A Little At 10am . Has Not Wanted To Eat SinceAppointment Notes: cant settle, was told to come in again if that was the case.  stayed over last night CCHistory:Has been quieter than usual today.Ate this morming and was more interested in owner.Over the evening has become quieter and not interested in any food. Usually is obsessed by food.Examination:Mentation - QAR, ambulatingBCS -   5/9Temp - 38.8Cardiovascular: HR=PR= 138;  Heart sounds- no murmur auscultated; rhythm normal - , mm pink, slightly tacky, CRT 1-2 seconds.  Pulses strong with no deficits, synchronousRespiratory: Breath sounds -  mildly increased over thorax; No upper respiratory sounds ; respiratory effort mildly increased with RR of 46. No nasal dischargeNeurological: Gait normal; Placing normal all limbs. Gag not assessed, facial symmetry, facial sensation, palpebral, aural sensation all normal. Menace normal.  PLR direct and indirect normal. Musculoskeletal: Well muscled with good symmetry. Cervical manipulation normal, thoracolumbar manipulation comfortable;  Full MS exam not performedGastrointestinal: - Oral: Oral mucosa - no lesions noted.  No petechiation or abrasions noted, minimal periodontal disease- Abdominal: Palpation - no masses noted, comfortable- Rectal: not performedUrinary: Bladder soft and comfortable. Reproductive (incl ext genitalia): Neutered dogIntegument: Good haircoat, no ectoparasites detectedLymph Nodes: NAD peripherallyEyes: No ocular discharge; ; Direct retinal exam not performedEars: No otitisLaboratory:PCV 27% / TS 72 g/LAssessment:Kiba is quieter and duller than normal, and not as aggressive with team members. He has increased breathing and an increaesd heart rate, but is ambulating.PCV has not changed since this morningReasons fo increaesd breathing, r inappetance and dullness could be nausea (due to hyperbilirubinaemia), or thrombotic episode . Unlikley be due to anaemia at PCV of 27%Plan:Disucssed ooptions with owner. Could monitor overnight in hospital, with possibiblity of IV fluids and IV anti nausea medications, or monbitor at home. Owner elects to monitor at home, understanding we do not have clear picture of why Kiba has deteriorated today and is inappetant4mg ondansetron wafer q12hr.    Vital Signs