C10001693 / invoice 10000

History:- Presented for inability to stand and dull mentation. This morning was unable to walk, condition has progressively worsened throughout the day.- Acute onset of back pain 3 days ago. Went to RV who dispensed meloxicam. No improvement so went to SASH 2 days ago. TL pain noted, ambulatory at the time. Dispensed 50mg gabapentin. Owner gave 3/4 of a tablet (37.5mg) last night and this morning.- Was initially more comfortable on medication and would walk gingerly to urinate. Ate well last night.- This morning, was reluctant to move, eat, or drink. Required syringing of water.- Episode reported by owner of yelping/vocalising, paddling of limbs while laying in lateral recumbency, body stiffness, and staring. Remained conscious during the episode with tongue out to the side. No urination or defecation occurred.- Crate-confined over the last couple of days. No access to marijuana or illicit drugs. Does not typically scavenge.- Allergies: Not known.Examination:- Mentation: Obtunded - HR: 160 bpm- RR: 20brpm- MM: pale, hypersalivating- Temp: 38.4- CRT: <2s- BCS: 4/9- BP: 160mmHg systolic Peripheral Perfusion Parameters: good - distal limbs warm to touch, core body temperature normal, CRT <2s, dorsal metatarsal pulses present and normal.Cardiovascular: cardiac auscultation with no murmurs or arrhythmias audible. Pulses synchronous.Respiratory: normal bronchovesicular sounds bilaterally, normal rate and effort. No nasal discharge or coughing.Abdominal: abdominal palpation soft with no pain or palpable abnormalities. Rectal exam: not performed.MSK: non-ambulatory, unable to maintain sternal recumbency or lift head. No overt swelling, pain or deformity of limbs. Groans when palpating thoracic spinal region.Neurological: neurologically very dull mentation. Unable to stand. Pupils even and responsive, PLR and menace present. Weak withdrawal. Superficial pain intact all four limbs.Urogenital: bladder soft and small, comfortable on palpation.Integument/Ears: no ectoparasites on initial examination, well-furred coat. Ears clean, no discharge or odour. No new wounds or inflammation on skin.Ocular: no blepharospasm or conjunctivitis evident.Oral: no abnormalities in oral cavity, including with lips and tongue.Lymph nodes: no enlargement or tenderness of peripheral lymph nodes.Diagnostics:- PCV/TP: 55/62, clear - Venous blood gas: hyperglycaemia (7.8), hyperlactataemia (5.76)- CRP: <10mg/L - Biochemistry: hyperglycaemia (7.7), elevated ALT (141) - CBC: - AFAST: nil FF or obvious masses, hepatic vessels appear hyperechoic. - TFAST: nil pericardial or pleural effusion, scant B lines Problem List:1. Non-ambulatory tetraparesis/plegia.2. Severely dull mentation.3. Hypersalivating4. Tachycardia.5. Pale mucous membranes (suspect due to young age)6. Inappetence7. Suspected seizure-like activity (however remained conscious)8. History of TL spinal pain9. Hypertension Differential diagnosis:- Intervertebral disc disease vs meningitis vs. shunt vs. toxicity vs. hepatic/renal dz vs. infectious/inflammatory vs. otherTreatment:1. IVC placed2. Maropitant 1mg/kg IV3. 10ml/kg IV fluid bolusClient communication:Discussed physical exam findings and possible differentials with the owner. Owner consented to bloodwork and initial stabilisation. Recommended transfer to SASH/QVS for ongoing management. Discussed  Investigations planned include blood work. Treatment planned includes an anti-nausea injection and transfer to SASH for hospitalisation and monitoring. Discussed that advanced imaging (CT/MRI) or CSF sampling may be difficult over the weekend. Advised owner that an estimate will be obtained from SASH. The owner was advised we would provide an update after the blood results are available, or sooner if Indy's condition changes.    Vital Signs