C10001413 / invoice 10000

Reason: Grape IngestionAppointment Notes: Overdue remindersReason: Eaten GrapesConsultation Time:  History: BIOP since pupNil hx health problemsNil current prescription medicationsEDUD all WNLHas eaten xxxxSubjective: BARObjective: Temp     MM pink   CRT <2s   HR    FP BCS:  /9                       Wt:  kgPain Score (CSU):   0/4CV:  Nil murmur/arrhythmia, FP readily palpable and synchronous,  skin turgor normal, mm moist       RESP:   NAD           RR and effort normal, lung sounds clearGIT:   Abdomen relaxed and non painful. NOAD palpable. U/G:  Neuro:  Mentation appropriateM/S:  NADOphth:  Pupils mid sized, PLR normal. LNs: NADBlood gasesLytesLactate glucose, caCreaProblem List:Grape ingestion Assessment: Recent grape ingestion, emesis yielded xxxxSmall risk AKI in coming 48h. Ideal to admit to ICU for IVF rx and monitoring during potential injury/extension phase AKIOptions Offered to Client:(i) Admit to ICU for decontamination, comprehensive dx, IVF and monitoring for AKI>most cautious approach(ii)Decontamination, bloods, home monitoring with RV at regular vet @ 24hrs for bloods/urinalysis>second option carries small risk of undetected development of AKIO elected (ii) Accepting risks as disclosedTreatment:Emesis induction apomorphine gingivalActivated charcoal/sorbitol 1g/kg PO Antiemetic not administered as unwilling to mask onset of GIT signs which may indicate very early AKIPlan:Rx as aboveRV overnight if any further concerns otherwise with RV tomorrow morningDISCHARGE INFORMATIONGRAPE TOXICITYDate:Patient name:It has been clearly documented that grapes, sultanas and raisins can cause kidney failure in dogs. What are the symptoms of grape or raisin toxicity?The most common early sign of grape or raisin toxicity is vomiting,, usually this occurs within 24 hours of ingestion. This may be followed by diarrhoea, excessive thirst, excessive urination or lethargy.  Acute kidney failure from a toxic dose of grapes or raisins will usually develop within 1-3 days. Signs of kidney failure include vomiting, diarrhoea, dehydration, abdominal pain, and tremors or seizures. Does it matter what type of grapes, sultanas or raisins my dog eats?The type of raisins or grapes does not appear to matter, with reported cases of toxicity occurring after dogs have eaten seedless or seeded varieties, commercial or homegrown fruits, and grape pressings from wineries.What is the toxic dose?There is no established toxic dose which will cause clinical signs in all patients.  Some dogs will eat many grapes and not show any signs.  Another similar size dog may develop signs after eating only a small number of grapes. What should I do if my dog eats grapes or raisins?If you suspect that your pet has eaten any grapes or raisins, please contact your veterinarian immediately. Do not waste any time. Since there are still many unknowns associated with this toxicity, it is better not to take any chances when it comes to your pet's health.How is the toxicity diagnosed?Unfortunately, the clinical signs associated with toxicity are non-specific, and are similar to kidney failure from many other causes. A presumptive diagnosis of this toxicity can be made based on a history of eating grapes, sultanas or raisins, or the presence of pieces of these products in the vomitus.  Blood and urine tests are required to establish whether kidney function has been affected. How is this poisoning treated?The goal of treatment is to block absorption of the toxins and prevent or minimise damage to the kidneys.  If your dog is presented to the veterinary clinic shortly after access to these fruits, vomiting is usually induced to empty the stomach.  Activated charcoal to block further absorption of the toxins is often administered. Intravenous fluids are recommended to flush any absorbed toxins out of the body as quickly as possible and to help maintain kidney function. The fluids are typically continued for a minimum of 24-48hours.  Drugs to control nausea or vomiting are administered as required.Kidney parameters are assessed over the course of treatment to assess progress and guide ongoing care. What is the prognosis for recovery from poisoning from grapes or raisins?Prognosis depends on many factors, including how many grapes or raisins were eaten, how ill the dog was when treatment was commenced and whether the clinical signs improve once treatment is started.If the dog only ate a few grapes or raisins, and received immediate treatment, the prognosis is excellent.  If severe kidney failure develops, the prognosis is poor. SPECIFIC INSTRUCTIONSYour dog has responded well to therapy and is now ready for monitoring at home.*MEDICATIONS*DIETPlease offer a band diet such as boiled chicken and rice (no skin, fat or bones) in two to three small meals daily.  Allow free access to water.  Ensure that your pet continues to eat and drink.  Please monitor all toilet habits.  Please DO NOT feed ANY other food types at present.  The bland diet should continue for a minimum of three to five days.  After this time, if your pet appears to be well and the diarrhoea has resolved, the normal diet can be slowly reintroduced. Your pet has been given activated charcoal and sorbitol in an attempt to reduce absorption of any toxin remaining within the stomach.  Some pets will develop soft faeces.  Most will produce dark or black faeces for 2-3 days. If this persists or you note any other abnormality, your pet will need to be reexamined.*EXERCISE RESTRICTIONSPlease keep your dog under careful observation. Walks and other exercise can be gradually reintroduced following over the coming days. 	*REVISITPlease make an appointment with your regular vet in 24 hours. Your vet may choose to repeat blood tests at this time.  Your dog should be rechecked earlier if you have ANY concerns especially if there is any food refusal or vomiting. IMPORTANT: Any plan we have discussed with you at discharge assumes that your pet will not experience any unforeseen setbacks or complications after you leave us. If you 	are at all concerned regarding your pet’s condition or recovery please seek further veterinary advice as soon as possible. This should occur regardless of any later, scheduled checkup or management plan discussed at discharge.Thank you for visiting the AEC with    Vital Signs    

Reason: Allergic ReactionConsultation Time: 0245History: Was asleep then all of a sudden noticed swelling and redness around his face.Was scratching a lot- o unsure where.No v+ or d+.Has access to backyard for toilet.O wasn't present when he went out for toilet.Never had any allergic reactions before.Been a healthy dog otherwise.Subjective:  BARObjective: MM pink, moist  CRT <2   HR 172   FP SSBCS:   7/9                       Wt: 11.1 kgPain Score (CSU):   0/4CV:  Nil murmur/arrhythmia, FP = HR, readily palpable       RESP:   Resp effort normal, mild pant. Lung sounds clearGIT:   Abdomen relaxed and non painful. No discrete organomegaly on abdominal palpation. U/G:  NOADNeuro:  Mentation appropriateM/S:  Ambulatory, nil lamenessInteg: moderate swelling around periocular region and muzzle. Gradually went down after injection Ophth:  Pupils mid sized, symmetrical, visualLNs: Nil peripheral lymphadenopathyAssessment: Type 1, IgE mediated hypersensitivity reaction, localised cutaneous signs. Nil evidence of haemodynamic compromise. Primary dx dt wasp/bee sting. Anticipate resolution of signs over 12-24h.Small risk biphasic reaction. Options Offered to Client:Recommend conservative rx and monitoring. Revisit if any further concerns. O indicated comfortable with this. Treatment:Chlorpheniramine 0.5mg/kg SCPlan:Confine and monitorRecheck ASAP if any concerns otherwise with RV if not 100% by tomorrow.===============================================================    Vital Signs