C09997739 / invoice 10000

HISTORYHas had an itchy ear for a couple of daysNo swimming or bath latelyHas been through long grassSometimes vomits when he drinks water too fast.Boas sx has helped him vomit lessLEFT EARpurulent discharge in left ear- cocci +++, degen neutscan't see to TM, cannot rule out FBRight earstenotic canal, non inflamed, cannot see to TM eithernsf on cytologyTxApex PMP Left ear BID for 10 days3 days pred Plan:Recheck in 10 days or earlier if any concernsDiscussed allergies as possible contributing factor

Nurse: CHVenous Gases+Potential of Hydrogen    pH         -  7.435        (7.350 - 7.450)CO2 partial pressure    pCO2    -    38.0 LOW    (40.0 - 50.0) O2 Partial pressure       pO2       -   42.8 HIGH        (30.0 - 42.0)* Bicarbonate                 cHCO3 -    25.5 HIGH       (15.0-23.0)* Base excess                BE (ecf) -  1.3        (-4.0 - 4.0)*Oxygen saturation        cSO2    -    80.2% LOW        (90.0-100.0)Chem+Sodium                          Na+       -    148        (139 - 150)Potassium                     K+          -    4.6       (3.4 - 4.9)Ionized Calcium            Ca++      -    1.34       (1.12 - 1.40)Chloride                         Cl-         -     112       (106 - 127)                                      TCO2    -      24.7      (17.0-25.0)Hemotocrit                     Hct       -      39       (35 - 50)* Hemoglobin                  CHgb    -    13.4       (12.0 - 17.0)* Base excess                BE(b) -         1.4 (-4.0 - 4.0)Meta+Glucose                         Glu        -      6.4     (3.3 - 6.4)Lactate                          Lac        -      2.04     (0.60 - 2.90)                                      BUN      -      14     (10 - 26)                                       Urea     -      4.9     (3.6 - 9.3)Creatinine                      Crea     -       61    (44 - 115)                                  BUN/Crea -      19.9     (0.2 - 400.0)*calculated values 

hx - sinus infection? - owner thought this as he had a funny smell coming from his nose.  No discharge.Drinking lots of water + vomiting it back up (straight after drinking) - last 3 days.Eating fine - doesn't vomit food back up.Otherwise acting normal.Toileting ok.  No PU.No coughing or sneezing.DISCHARGE INSTRUCTIONS---Thank you for coming in today. Here is a summary of what we discussed. Your dog has been vomiting water and drinking excessively. We performed a blood gas test to check his electrolytes and hydration status. We also gave him anti-nausea medication. Please monitor his water intake and vomiting, and ensure he stays cool to prevent overheating. We will review the blood test results and decide on the next steps. If you have any concerns, please contact us.HISTORY---The patient has been drinking excessive amounts of water and vomiting the water without food. The owner reports no change in food intake, no vomiting of food, no diarrhea, and normal behavior. The patient has been experiencing these symptoms for the last 3 days. No excessive urination, coughing, or sneezing has been observed. The patient is described as energetic and appears to be in normal health otherwise.PHYSICAL EXAM---Weight: NAMentation: NAHR: NARR: NATemperature: NAMucous membranes: pink and moistCRT: <2 secsBCS: NAEyes: NADEars: NADNose: foul smell notedOral cavity, dentition: NADPeripheral LNs: NADCardiovascular: no murmurs or arrhythmia auscultatedRespiratory: NADAbdomen: NADIntegument: NADMusculoskeletal: NADNeurological: not assessedRectal: not assessedGenitourinary: not assessedDIFFERENTIAL DIAGNOSES---Nose: Possible sinus infection, foreign body, other nasal conditionsTREATMENT PLAN---Diagnostics: Blood gas analysis to assess electrolytes and hydration statusMedications: Anti-nausea medication administeredRecommendations: Monitor water intake and vomitingKeep the patient cool to prevent overheatingReview blood test results and determine next steps