C10003621 / invoice 10000

History Summary:Presented for acute onset of ataxia, tremors, and altered mentation (appearing scared and wandering), approximately one hour prior to presentation. The owner observed Zella near an ashtray containing tobacco earlier in the day and a wet cigarette butt was found on the ground. The patient was also seen biting a mop and near a bucket with soapy water, however, no gastrointestinal signs have been noted. There is a history of medicinal cannabis oil (20:20 THC/CBD) in the house, but no known access. The owner is uncertain about potential toxins in the backyard of the new house.TRIAGE:HR: 80 bpm (bradycardic)Mentation: Altered, appearing scared and wanderingEXAMINATION:Cardiovascular: Bradycardic (HR 80 bpm). Normal rhythm, pulse pressures normal and synchronous.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.Neurological: Ataxia, tremors, and hyperaesthesia (exaggerated startle response).Musculoskeletal: Ataxic gait, difficulty standing straight.Gastrointestinal:- Oral: Hypersalivation.- Abdominal: NSF.- Rectal: not performedUrinary: No urinary incontinence reported.Reproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Acute neurological signs (ataxia, tremors, altered mentation, hyperaesthesia)2. Bradycardia3. HypersalivationDIFFERENTIAL DIAGNOSIS:- Marijuana (THC) toxicity: Clinical signs of bradycardia, hypersalivation, and hyperaesthesia are highly suggestive.- Nicotine toxicity: Cannot be ruled out due to history of potential access to tobacco, although the presenting sign of bradycardia is inconsistent with the typical tachycardia seen with nicotine toxicity.DIAGNOSTICS/MANAGEMENT PLANA full diagnostic workup was discussed with the owner to differentiate between toxicities, including repeat physical examinations to monitor heart rate and blood pressure. The limitations of urine drug screening tests in dogs were explained (a negative result does not rule out THC toxicity, but a positive is confirmatory). Treatment is dependent on the causative toxin; supportive care for marijuana toxicity versus more aggressive treatment (hospitalisation, IV fluids) for nicotine toxicity. A stepwise approach will be taken, starting with conservative measures while monitoring closely.DiagnsotcsPCV 40TP 70Clear serumBlood gasGlucose 8Lactate 2.2ECG - nsr for the 6 hoursASSESSMENTSuspect toxin ingestion, nixotine + medicinal CBD vs otherOWNER COMMUNICATION:A detailed discussion was had with the owner regarding the differing clinical presentations and treatments for nicotine versus marijuana toxicity. It was explained that while the clinical signs point towards marijuana toxicity, it would be negligent to ignore the possibility of nicotine ingestion given the potential for severe consequences. A stepwise diagnostic plan was agreed upon, partly due to the financial implications of a full workup.FINANCIAL UPDATE:An estimate for a full diagnostic workup was provided at approximately $1600.PLAN:Plan to go home for continued monitoringContinue to monitor neurological signsRevise assessment with primary vet if clinical signs worsen    Vital Signs