C09997664 / invoice 10000

Appointment Reason: Unwell, dehydrated*****************GAP PAY**************H: Not eating past 3 days,ate small amt weds am. last night looking more lethargic, gums looked white, tongue cold. Possible seizure, leaned to one side and couldn't walk properly for a short time. emergency centre last night, BT was 37.8, bloods run last night. Na 129, K 5.3, Na:K 24.3. BUN mild elevation, crea normal. Lethargic, not wanting to move, shiveringNo diarrhoea, unsure when she last defecated.E: MM sl pale pink, CRT delayed 2.5s, tacky, 7% dehydration. Pulses feel ok. HR 150, no murmur or arrhythmia. Moderate mid-abdominal pain. BT 37.5. A: lethargy, inappetance, single vomit, abdominal pain, low Na:K - possible addisons, ddx GIT obstruction, other systemic diseaseP: Admit for ACTH stim, IVFT, abdo imagingECG P waves present,  small magnitudeBloods taken: - In house comprehensive : Na 129, K 5.1, Na:K 25.1. Phos 2.22, BUN elevated18.7 , Crea normal. HCT elevated, 58.2.- Started IVFT Hartmanns at 50ml/hr. - Urine collected after <1hr IVF. USG 1.042, pH 6.5, protein trace, blood trace (cysto sample), rest of dipstick negative.- ACTH Stim. 0.13ml Synacthen IV , blood taken again 1hr post. - methone 0.1ml IV at 10am- mild sedation, continuing past 3pm- Abdo rads no obstructive pattern, GIT normal, liver possibly small. - Abdo u/s with HV :Bladder - anechoic urine, normalL kidney - unremarkableR kidney - unremarkableAdrenals - unable to find either adrenal glandLiver - normal echogenicity, slightly smallGallbladder - slightly distended with a small amount of dependent sludgeSpleen - slightly enlarged with normal echogenicities and no lesionsStomach - normalDuodenum - normal wall layeringJejunum - normal layering & wall thicknessLNs - normal sizeA - US: GB slightly distended secondary to hyporexiaUnable to image adrenal glands supportive of hypoadrenocorticism- 1:30pm TPR: HR 96, BT 36.4, RR 40 - started active warming with bair hugger and wrapped warm fluid bag in bed. BT at 2:45pm risen to 37.2- Dexamethasone 0.8ml given IV (0.3mg/kg) at 2:15pm , still awaiting ACTH stim results.4PM ACTH Stim results confirms Addisonian Cortisol 0 hour < 28 nmol/L ( 0 - 150 ) [* ]Cortisol 1 hour *< 28 nmol/L ( 240 - 470 ) * [ ]Recc continued IVFT and electrolyte monitoring at VRH overnight then start florinef and oral pred when eating. Ate small bit of prime chicken and rice roll at 4:15pm.     Vital Signs    Weight: 5.4;       Temperature: 37.5;       

Appointment Reason: Annual VaccinationHas been well, owner has no concerns. Had Duramune last year. UTD NG Spectra. O: BAR, sweet dogLean but healthy BC. Eyes, ears, nose and mouth healthy. Chest sounds and abdominal palpation normal. Skin healthy. Neuromuscular exam unremarkable.P: Vacc booster to C5 level - Protech Pi2 sc plus Protech Bronchi-Shield Oral.    Vital Signs    Weight: 6.2;       BodyScore: 4;       

Appointment Reason: Annual VaccinationHas been well, owner has no concerns.O: Grade 1 dental tartar and gingivitis, especially on upper carnassials and molars. Eyes, ears, nose and mouth otherwise healthy. Chest sounds and abdominal palpation normal. Skin healthy. Neuromuscular exam unremarkable. BCS lean low-normal.P: Vacc C5 - Duramune C4 sc plus Protech Bronchi-Shield Oral.Recommend dental scale and polishDiscussed dental home care - does not usually like chewing so Os open to trying tooth brushing. Email dental home care handout and scale and polish estimateDispensed Droncit tapewormer as on Nexgard Spectra, does get raw food in diet.    Vital Signs    Weight: 6.3;