C10001407 / invoice 10000

Reason: Still Not EatingPrimary Presenting Complaint:Anorexia (4 days duration)Other Complaint:Lethargy, hiding behaviour, constipationHistory:Seen 3 days prior for inappetence, vomiting, and polydipsia. Previous visit revealed electrolyte abnormalities (low potassium). Recent ingestion of plant material. Patient has history of being difficult for oral examinations. Previous episode of oral discomfort where patient couldn't yawn properly.    - Last Normal -     - Frequency -     - Last Ate - Last ate Wednesday (4 days ago)    - Vomiting - No vomiting since previous visit 3 days ago (vomiting was present at initial presentation)    - Stool - Defecated this morning, faeces notably malodorous    - Urination -     - Drinking - Polydipsia noted at previous visit 3 days ago    - Medicine Hx - Previous visit (3 days ago): pain relief injection, vitamin B12 injection administered. A/D diet dispensed for syringe feeding.    - Diet -     - Vacc Current -     - Worming Hx -     - Heartworm -     - Microchip - NoExamination:Lethargic patient with prolonged anorexia, faecal impaction, and difficult oral examination    - Attitude - Lethargic, hiding under couch, reluctant to moveHydrationj ok and body condition ok.    - Body Score - Appropriate/good body condition    - Hydration status - Good hydration status    - Temperature - T 38.7    - Heart -Heart and lung sounds ok, HR 144 bpm, no murmur mentioned    - RR - panting dt stress?    - Dental - Score(0-4)= Moderate dental calculus    - CRT - immediate    - Eyes - NVL    - Ears - clean and discharge free    - Abd Palpation - Comfortable on palpation, significant faecal loading palpated    - Gastrointestinal - Significant faecal impaction noted on palpation    - Urogenital - No Sig Findings    - Skin -     - Musculoskeletal - No Sig Findings    - Neurological - No Sig Findings    - Lymphatic - No Sig Findings    - Other Key Findings - Strong pulses. Patient non-compliant for oral examination - unclear if oral pathology present or simply behavioural. Recent plant material ingestion noted.Assessment:4-day history of complete anorexia with lethargy in patient with recent history of vomiting, polydipsia, and hypokalaemia. Current examination reveals faecal impaction and patient remains difficult to examine orally. Unclear if oral pathology is contributing to anorexia or if patient is simply non-compliant for examination. Possible contributing factors include GI obstruction/impaction from plant material ingestion, metabolic disturbances (hypokalaemia), or unidentified oral pathology.Problem List:1. Anorexia (4 days)2. Lethargy3. Faecal impaction4. Hypokalaemia (from previous blood work 3 days ago)5. Moderate dental calculus6. Recent plant material ingestionDDx:Anorexia/Lethargy DDx:- GI obstruction/impaction (plant material, faecal)- Oral pathology (dental disease, foreign body, stomatitis)- Metabolic disorder (hypokalaemia, other electrolyte imbalances)- GI inflammation/discomfort- Plant toxicityDiscussed:Owner consented to today's treatment plan including anti-nausea injection, microlax enema, and paracetamol for pain management. Discussed that mouth examination remains difficult and it's unclear whether oral pathology is present or if patient is being uncooperative. Explained that if no improvement occurs, next steps would include diagnostic imaging (radiographs or ultrasound), IV fluid therapy, supportive care, and possibly sedation for proper oral examination. Owner provided with emergency clinic contact information. Owner aware that faecal impaction is present and plant material ingestion may be contributing to current condition.Treatment Plan:1. Maropitant (Prevomax) 0.65ml SC injection administered for nausea2. Microlax enema administered to address faecal impaction3. Paracetamol prescribed for pain management - either 500mg tablet (quarter tablet PO 2-3 times daily) OR 100mg/ml liquid formulation (1.3ml PO 2-3 times daily) for 2-3 days4. Owner instructed to walk patient after enema to encourage defecation5. If no improvement: proceed with radiographs or ultrasound, IV fluid therapy, and sedation for oral examinationOngoing Prescriptions:Next Visit:Recheck if no improvement. If condition worsens or no response to treatment, proceed with diagnostic imaging, IV fluids, and possible sedation for oral examination +/- enema. Emergency clinic contact information provided for after-hours care if needed.The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.1pm passed 4-5 small firm pellets of faecdes and milked down several other firm faeces in the descending colon.    Vital Signs    

Reason: Poss Bloods? Still UnwellNot eaten since wed, o reports horrendous breath in last few days (i cant smell today but have no sense of smell)Drank alot wed evening after seenNo further vomiting since seen Not urinated since yesterday that o has seenV lethargic and flat Not a chewerDull but scared in consult Abdo palp not painful all other parameters within normal, bladder small Hr elevated Unwilling to have mouth opened in consult today but teeth i can see are good fDefinitely neuteredS: Anorexia since yesterday, lethargy, hiding under couch. PD noted Thursday. No urination observed since returning home this AM. Possible ingestion of plant growing plug with small amt dirt noted around mouth. Seen yesterday - no obvious abnormalities found.O: MM moist, no obvious dehydration. Quiet, depressed demeanor. Blood sample collected successfully.O: Bloodwork reviewed - glucose WNL, renal parameters WNL, hepatic enzymes WNL, CBC WNL (RBC/WBC unremarkable), thyroid WNL. Hypokalemia identified. No significant dehydration evident. PE: No abdominal pain, heart auscultation unremarkable, no focal abnormalities detected.A: Hypokalemia secondary to vomiting causing weakness/malaise. Addison's disease ruled out (electrolytes not consistent). Etiology of vomiting/inappetence unclear - no obvious GI obstruction or systemic disease identified on bloods.P: 1) Pain relief injection (single dose - hepatic/renal function adequate) 2) Vit B12 injection for GI upset 3) Oral electrolyte supplementation (leptade or hydrolyte from pharmacy, or low-sodium salt containing potassium) 4) Assisted feeding with a/d diet 5) Monitor overnight, emergency referral if deterioration 6) Recheck tomorrow if no improvementThe above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.    Vital Signs    Weight: 6.5;       MMColour: pink, moist;       Temperature: 38.0;       HeartRate: 130;       BodyScore: 5;       DentalGrade: 1;       CRT: <2;       

Reason: VomitingSubjective:Presenting for:Acute vomitingPossible dizziness, mild lethargy, increased water consumptionPossible ingestion of plant potting material (core portion) from balcony on MondayFrequency of issue: Multiple vomiting episodes over 24 hours - overnight, during morning walk, and at homeLast ate: Still eating well despite vomiting episodesDiet: Regular diet not specified. Normally receives chicken and duck treats (chicken lung, dried chicken and duck treats)Disease prophy:   Microchip: Y/N - scanned - ok?Objective:Clinically stable acute vomiting patient with suspected dietary indiscretionMentation: BAR but mildly lethargicHydration and body condition ok.EENT: NVL clean and discharge freeOral: Mild calculus on a few teethLN: No Sig FindingsChest: Normal heart rate, no murmur detected. Heart auscultation normal Normal respiratory rate. Lung auscultation normalAbdo: No obvious masses palpable, no pain on palpation Mild burping noted. No flatulence. No abnormal gut sounds on auscultation. No hunching or signs of abdominal discomfortMSK: No Sig FindingsSkin: okUrogenital (including mammary glands): No Sig FindingsRectal: T 38.2Neuro: No Sig FindingsOther: Patient is spayed. Weight 6.5kg. Possible slight dizziness noted when harness applied (went off at an angle rather than usual running off)Assessment: Acute gastroenteritis secondary to suspected dietary indiscretion (plant material ingestion) versus viral etiology1. Acute vomiting (multiple episodes over 24hrs)2. Mild dental calculus3. Mild lethargy4. Mild burpingDDxAcute vomiting DDx:- Dietary indiscretion (plant material ingestion - most likely given history)- Viral gastroenteritis- Foreign body obstruction (less likely given no palpable masses, normal gut sounds, still eating)- Metabolic disease (less likely given clinical stability and normal physical exam)Plan:Gave prevomax 0.65ml s/c (Antiemetic injection). Bland diet prescribed for 3-4 days consisting of boiled or steamed chicken breast (no red meat, no fatty cuts) mixed with boiled/steamed vegetables and rice or sweet potato. Discontinue all treats during this period. If patient returns to normal after 3-4 days, gradually transition back to regular diet. If vomiting persists, return for radiographs/ultrasound and bloodwork.Return if vomiting persists or condition worsens. Otherwise recheck in 3-4 days if not improving, or as needed if returns to normalCommunication:Owner consented to treatment plan. Discussed that if vomiting continues despite bland diet and antiemetic, next steps would include radiographs or ultrasound to rule out foreign body, as well as bloodwork to assess metabolic parameters. Owner aware ultrasounds currently difficult to schedule. Owner instructed to discontinue all treats for next few days. Owner understands to monitor closely and return if condition worsens or does not improve.The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.    Vital Signs    Weight: 6.5;       Temperature: 38.2;