C10001039 / invoice 10000

Presenting problem : TOXIN INGESTION

TOXIN: Chocolate
Time of ingestion: 30 mins prior to presentation
Present symptoms: nil
Prior medical history: nil 

Clincal Exam: NAD

Treatment : emesis :
Outcome: successful emesis

additional treatment: nil

Plan: tgh

DATE/TIME of CONSULTATION: 21:50hrs, Wed 18/02/26

CLINICIAN: EH

PRESENTING COMPLAINT: V up a puffer fish

HISTORY:
- out by the river all day 
- was swimming and chasing rocks in the water
- not on any current medications 
- has been well up until today 
- when o got home was drooling and v+ for approx 1 hour then brought up sand, water a fish - took a pic was about 3/4 of a small fish with no spikes - o concerned its a puffer fish, she also brought up a green looking thing that o suspected was part of the fish 
- seems ok now  

CLINICAL FINDINGS: 
- BAR, gums pink crt 1-2 secs
- anxious, dilated fairly non-responsive pupils
- heart - HR 120 reg, chest norm BV sounds all 4 quads
- abdo is tense but comfortable
- LN wnl  

PROBLEM LIST:
- o concerned puffer fish ingested
- presented alive, pic looks not like a puffer

DIFFERENTIALS:
- suspect salt toxicity, sand ingestion may be underlying cause of v+ and fish was subsequent finding, due to clinical progression of puffer fish tox unlikely to be this as would be most likely dead by now

OPTIONS PROVIDED:
- recomm bloods 
(epoc)

DIAGNOSTIC TESTS:
- Na++ 155, K+ 31, Cl- 110, Hct 46, glu 5.4, lac 1.2, BUN 15, urea 5.2, crea 52, BUN/Crea 24.7

DIAGNOSIS:
- suspect mild salt tox/dietary indiscretion 

TREATMENT:
- maropitant 1mg/kg sc

CLIENT COMMUNICATION/PLAN:
- recomm bland boiled chicken rice and clean water access this evening and for the next 3-4 days while resting
- represent if concerned tonight or if v+ through the maropitant over the next 24hrs