C10001873 / invoice 10000

Reason: Swollen faceHistory Summary:Has had a three-day history of loose stools and diarrhoea, followed by the onset of lethargy this morning.  Owner says stools have started to harden up today, however tonight the owner noted periorbital swelling and pruritis, which has progressively worsened. Hives were also noted on the ventral chest. There is a history of a cough developing after being in a kennel a week ago but has since resolved.  Vccinations and and preventatives upto date.  Has been inside all day, but owners are moving all the furniture as they are moving to China in 2 weeks.TRIAGE:HR: 124 bpmRR: PantingTemp: 38.2MM: Pink & moistCRT: < 2 secondsMentation: Bright, alert, and responsivePain Scale 0-4: 0Hydration status (%): Clinically adequateEXAMINATION:Body Condition Score: 5/9Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: No oral pain. Has an underbite. - Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: Urticaria noted, particularly on the ventral chest, with associated periorbital angioedema.Lymph Nodes: WNL on palpationEyes: Periorbital angioedema.PROBLEM LIST:1. Urticaria and periorbital angioedema2. Pruritus3. Diarrhoea (resolved)DIFFERENTIAL DIAGNOSIS:Hypersensitivity reaction is considered the most likely differential, likely secondary to an insect bite. Mast cell degranulation is a less likely differential given the absence of other clinical signs such as tachycardia.DIAGNOSTICS/MANAGEMENT PLANDiscussed that the clinical signs are most consistent with a hypersensitivity reaction. Treatment with an antihistamine and corticosteroid injection was recommended and administered. Dispensed oral antihistamines to continue at home if needed.Nil performedTREATMENT SUMMARY:- Chlorphenamine 0.5 mg/kg IM- Dexamethasone 0.1 mg/kg IM- Dispensed Chlorpheniramine (Iramine) 8 mg tablets to be given twice daily if required for pruritus or flare-up of signs.OWNER COMMUNICATION:Discussed the diagnosis of a hypersensitivity reaction with the owner. Explained that this is similar to an allergic reaction in humans and is most commonly caused by an insect bite (e.g., ant, bee, spider). Reassured the owner that vital signs are stable and the presentation is not consistent with true anaphylaxis. A rare possibility of mast cell tumour degranulation was mentioned but considered unlikely. The recent history of a cough was discussed and attributed to likely kennel cough, unrelated to the current presentation. The treatment plan was explained, and oral antihistamines were dispensed for home use. The owner's plans to travel internationally with the pet were also discussed.PLAN:Discharge home. Advised to monitor for recurrence of clinical signs and administer oral antihistamines as needed. Recommended follow-up with their primary veterinarian within 48 hours.For any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs