C09999255 / invoice 10000

Reason: Berwick Springs Referral    Vital Signs    Weight: 5.5;       

Reason: Berwick Springs Referral - hypoadrenocorticismConsultation Time: 19:22Hospital Time Period: Friday evening 06/03/26History:2 days ago Cookie did not eat. Yesterday morning Cookie still did not want to eat. Cookie seemed lethargic and was shivering. Taken to Casey Pet Emergency hospital last night. Given maropitant, methadone and subcutaneous fluids. There was no improvement overnight. Cookie was drinking less. Urination is normal, owner unsure of defecation. No diarrhoea noted. One small yellow vomit yesterday morning.Taken to Berwick Springs vet today where Cookie was admitted for the day. Cookie was diagnosed with hypoadrenocorticism. Bloods - biochemistry: ALKP 17 (20-150), BUN 17.3 (2.5-8.9), Na 129 (138-160), BE -11 (3.5-6.0). Glucose normal at 5.6 and K 5.3. ACTH stimulation test consistent with hypoadrenocorticism - not visualised.Medications today with regular vet:- methadone 0.1ml at 0900- dexason 0.8ml at 1400Cookie still seems lethargic and has only eaten a small amount today. Cookie has always had a variable appetite and has been picky. Her owner has noticed some weight loss over the past few weeks.Cookie develops some red and itchy paws intermittently that is most severe in the winter. This is managed with a cream from China that seems to manage things well. No other known health concerns.No ongoing medications.Diet: kibble (Advanced) - ran out one week ago, changed to Vitalife kibble. Coles canned food in the evening. Occasional raw meat from Costco (owner unsure what it contains), no bones.Vaccinations up to date.Nextgard Spectra monthlyNo known access to toxins or medications.Subjective:QARObjective:Temp:    37.7        MM:    pink and moist          CRT:       <2 seconds      HR:       120      FP:    SS          RR: 28BCS:    3.5/9                Wgt:  5.5  kg Pain Score (CSU):   0/4CV: no murmur or arrhythmia noted, strong and synchronous femoral pulsesRESP: normal BV sounds all quadrants, normal respiratory effort and pattern             GIT: comfortable, no focal abnormalities noted  U/G:  moderate soft urinary bladder palpable, passed large amount of clear yellow urine in consultationNeuro:  appropriate mentation, no ataxiaM/S:  no lameness noted, no limb swelling or painInteg: healthy skin and coat, no skin tentOphth: pupils mid range and responsive, no dischargeLNs: small and symmetricalInitial Tests:INTERNAL LABORATORYPCV/TS: 45/58 clear(Dog: PCV 37-55%, TS 55-75 g/L)LACTATE: 0.7  mmol/L	Blood Gas(sample type: venous)Abnormal parameters: pCO2 30.5, K 4.8, Na 130, Cl 105, BE -5.4, AG 5.5.Interpretation: NA:K 27Problem List:- hypoadrenocorticism- hyperkalemia- hyponatremia- hypochloremia- inappetence - resolvedAssessment: Cookie was referred to VRH after recent diagnosis of hypoadrenocorticism. Cookie's vitals were normal on examination and she was eating eagerly. Her blood gas showed some ongoing electrolye derrangements that should improve the addition of DOCP.Options Offered to Client:1 - management as an outpatient2 - admission for supportive care and bloodsDiscussed that we do not have the history from the regular vet and so would be starting treatment for hypoadrenocorticism based on a conversation. Owner understood risk and consented to commencing treatment.Financial update:Treatment: - LRS at maintenance- deoxycortone 2.2mg/kg SC	Plan: Diagnostic plan : recheck PVC/TP and blood gas in the morningTherapeutic plan : as above, prednisolone 0.2-0.5mg/kg SID from 24 hours post dexamethasoneDischarge plan : Home when eating well and potassium normalisedReferral plan : Consider if Cookie's hypoadrenocorticism is difficult to manage    Vital Signs