C10000062 / invoice 10000

Reason: HGEInpatient:BAR this morning, looks good,No further v+/d+ o/n, eating wellHR 145RR PantTemp 38.7Abdo comfortableTGH this morning, ultrasound with KAB on Monday    Vital Signs    Weight: 8.4;       

Reason: unwell - Blood In Stool, V+History: Going off food last 4 days. Has eaten 1 meal last 3 days which was yesterday afternoon. Strawberry jam D+ at beach today followed by 2x vomits. No change to diet, no different environments. UTD vaccinations etc. No known liver toxins - Ivy is always supervised outside. Examination: QAR, Tense abdominal palpation. Slight lordosis. MM colour & Crt fine, pulse character fine.Chest auscultation NAD, LNs=NT=NLaboratory: Severe elevation ALT (1073)Moderate hyperbilirubinaamia TBIL 27Mild hyperkalaemia 3.6Differential Diagnosis: HGE - hepatopathy vs idiopathic vs dietary indiscretion vs IBD vs neoplasticHepatopathy - neoplastic vs hepatitis (less likely wbcs wnl) vs toxic (less likely dt hx)Treatment: 25mL/hr IVFT (hartmanns) 0.84mL maropitant IV SID at night1mL nexium IV BID0.015mg/kg (0.4mL) buprenorphine IV prn3mL pro-kolin PO BID225mg denamarin PO SID at nightPlan:Admit to hospital and reassess tomorrow. Q$1100-1600.5pm: rang O. W blood results. Explained need an abdominal u/s to confirm cause of high ALT. Weekend goals are supportive care. U/s would need to be done next week. O.'s seem keen to go ahead w u/s. Added Denamarin to tx plan in the interim.    Vital Signs    Weight: 8.4;       MMColour: pk;       Temperature: 37.9;       HeartRate: 80;       BodyScore: 5/9;       RespirationRate: 24;       CRT: <1;