C09999204 / invoice 10000

Reason: EHVH TransferHistory:Transfer from EHVH for ongoing AHDS. Has a long backstory of congenital issues - ectopic ureters, cleft palate, rectal fistula. NO RECTAL to be performed.  She is on propalin for urinary incontinence and apoquel for allergies. Apoquel will be bought in by the owner tomorrow . Has continued to have bloody diarrhoea and remains inappetant. GP vet spoke to idexx medicine specialist today who advised against starting on antibiotics. IVFT continued at reg vet throughout the day @ 147ml/hrMaropitant 1mg/kg  IV  @ 1030Metaclopromide 0.08mg/kg/hrOmeprazole 1mg/kg IV @ 1230Ondansetron 0.23mg/kg PO @ 1230Buprenorphine 0.01mg/kg IV @ 1430Plan to continue supportive care overnight and for Phoebe to have a specialist ultrasound with Dave Collins tomorrow. O asking on admit whether it is possible for Phoebe to declined and die. We had a discussion about protein loss and the potential need for plasma transfusions as well as the possible development of sepsis. We discussed measures that we taek to identify this - regular monitoring of hydration, PCV/TP, BG lactate etc. O wanting to best care possible for Phoebe. Lovely O, very invested in her care. David Collins advised that he will be here between 9-10 am tomorrow. Metaclopromide 0.08mg/kg IV Propalin 0.94mg/kg PO @ 1900Prokolin 7ml PO @1900Ondansetron 0.25mg/kg TMO @2000IVFT @ 147ml/hr---TAB 2100-0600---Assessment: Bloods form yesterday (Thurs) show some poss band neutrophils, biochem unremarkableMDR bacteria suspected (related to previous cleft palate / rectovaginal fistula? Unclear from history)No vomiting but ongoing small quantities of frank blood dripping from back end. No significant change in mentation from yesterday to tonight - still very sad, wont lay down to sleep.Clear mucoid discharge from nose - may be starting to look purulent vs maybe small volume regurgitation dripped from noseSmell from mouth like infection somewhere - no source of purulent smell found.More comfortable after buprenorphineTreatment: IVFT Hartmanns @ 147ml/hrInadvertant small volume overdose of metoclopramide given (14mg given IV over 3 hours = 0.44mg/kg - not anywhere near enough to cause any clinical signs) so stopped for 6 hours on advice of poisons line as a precaution. Restarted 6am.Buprenorphine 0.01mg/kg IV q8hr if neededPantoprazole 1mg/kg IV q12hMaropitant (given at reg vet 10am)Ondansetron 8mg OTM q8hrPropalin and Prokolin given orallyPlan: Suggest repeat CBC and PCV in the morning, lytes +/- NSAID/TBILConsider addition ABs - concern for infection somewhere given purulent discharge and smell - discussion with Dave Collins and retrieving full history from ref vet to understand multi drug resistant comment.    Vital Signs    Weight: 31.8;