C10006532 / invoice 10000

Unwell   WILL LUNGE WITHOUT WARNING
Paws App Details:

Booking Type: Sick pet 
Booking Notes: Has been unwell since yesterday. Spencer is a regular client under my parents name (Starling) but I am booking on their behalf


Hx:
1st visit to MV? (N)
Demeanour: Very lethargic, quiet compared to normal
Current diet: Raw kangaroo mince with cooked vegetables (sweet potato, pumpkin)
Parasite ctrl UTD? (Y Ñ monthly preventatives)
EDUF habits: Reduced appetite; urine passed this morning (yellow, concentrated)
Any V+/D+? (Y)
?sig health issues to chk: Y Ñ Acute illness started the night before. Initially multiple diarrhoea episodes the night before (~4Ñ5 times, watery dark brown), now vomiting predominates. Vomiting severe and progressive: ~15Ñ16 episodes total since onset, including ~7 episodes this morning alone.  Marked lethargy and anorexia; normally very food motivated. Possible ingestion risk from backyard (e.g. wood chips) or environmental exposure (e.g. rats).

PE:
Teeth/oral exam: Mucous membranes slightly dry, CRT: 1.5sec
Eyes: NAD
Ears: NAD
Nose: NAD
Heart sds:  ~120 bpm but rhythm regular
Lung sds: NAD
LN: NAD
Skin/Coat: NAD
Abdo: Soft; no bovious discomfort suspected though difficult to assess due to lethargy
Limbs/feet: Weak, reluctant to stand

Problem List:
1. Severe acute vomiting
   DDx: Acute gastroenteritis VS dietary contamination (raw meat) VS foreign body ingestion (e.g. wood chips) VS toxin ingestion VS pancreatitis

2. Dehydration and systemic illness
  
3. D+ 

Discussion/TMT Plan:
Ñ Patient significantly lethargic with severe vomiting; hospitalisation recommended.
Ñ Plan for IV catheter placement and aggressive fluid therapy to correct dehydration and electrolyte imbalance.
Ñ Blood tests to assess organ function, electrolytes, inflammatory markers, and pancreatitis screening.
Ñ Abdominal imaging (X-ray ± ultrasound) to rule out foreign body or obstruction.
Ñ Supportive care while hospitalised.
Ñ Further treatment dependent on diagnostics; surgery may be required if obstruction identified.

Cost concerns? (Discussed Ñ approx. $1800 initial diagnostics and hospitalisation)

RX/Treatment:
- Admit for Bloods and imaging 
Ñ IV fluids and supportive medications (hospitalised)



CBC: 
Mild monocytosis 
Mild eosinopaenia 
Suspected band neutrophils 
Blood smear not performed
Assessment: Early inflammatory changes

Biochemistry: 
Unremarkable

Canine pancratic lipase: 
Mild elevation - 221 U/L (upper reference limit 220 U/L)

C - Reactive Protein: 
Markedly elevated - 95.3 mg/L 

Assessment: Suspect inflammatory changes in intestine - proceed with abdominal imaging.

22G catheter placed in RCV
Started on CSL at 105ml/hr for first 6 hours to rehydrate

Sedation: 
0.38ml Butorphanol and 0.02ml Medetomidine IV to minimal effect 
1.2ml Propofol IV given as 2 x boluses to enable abdominal Xrays and US 

Abdominal Radiographs Series
Views Taken: RL, LL,VD,

Overall serosal detail: Poor to adequate 
Stomach:  WNL  - Gastric axis [vertical on left lateral view, parallel to costal margins]
Liver:  WNL 
Kidneys:  WNL inc location in retroperitoneal space & size [2.5-3 x length of L2 on VD] Left  localed lower
Spleen:  WNL - head visible on VD, Tail on Lateral view 
Duodenum:  WNL [normal location midline from the pylorus]
Small Intestine:  WNL,  Position - Normal, 
Large Intestine:   WNL [normal questionmark shaped] and location[RHS mid abdomen region]
Urinary Bladder:  WNL
Prostate:   WNL
Sublumbar lymph nodes:  WNL

Assessemnt: 
No obvious FB seen and no clear obstructive pattern
Proceed with Abdominal US 

Abdominal USE by BJ: 
Liver - appears size and detail/vascular triads seen. 
GB -  appears normal re location, size, and locn
Spleen -  normal size and location, normal echotexture throughout
Stomach - no able to examine in detail dt gas in lumen
SI/LI - mostly empty loops , one area I think duodenum was very  corrugated in appearance and had hyperechoic content in lumen, gives concern for poss early liner FB bunching vs inflammatory process./cause
Kidneys - L and R  normal size and architecture, no mineralisation een
Bladder - normal size, , no macroscopic uroliths seen
Pancreas - not clearly identified 
Adrenals -  not clearly identified 
FF?  - none seen
LNs - no enl noted.
Prostate - normal architecture and size 

Client communication: 
Spoke to Tash (Owner's daughter) and informed of findings on bloods and abdominal imaging. Explained that specialist abdominal US required to definitively rule out FB and confirm that corragation of SI in right cranial abdomen is inflkammatory. Therefore gave two options: 
Option 1: Referral to Animalius for urgent abdominal US 
Option 2: Home into owners care tonight with view to revisit tomorrow for repeat abdominal US. 
Given Spencer has been flat owner is concerned about him deteriorating overnight so gave option of referral to Balcatta Vet24 for monitoring and supportive care overnight. Owner is interested in this but concerned about having to wait in reception to be consulted through given Spencer is highly anxious in hospital. 

Plan: 
Tash to discuss findings with her parents 
Discharge booked for 5:30pm 

PawsApp Appointment deposit applied
Paws App Details:

Booking Type: New Puppy/Kitten
Booking Notes: consumed small amount of raisins (monday) ... had emergency vet attend ... forced reflux and retrieved the sultanas .. he suggest a follow up 48hours later for a blood test but wasnt concerned

HISTORY
Presenting for: Spencer, a 1-year-old male dog, presented for assessment following ingestion of Christmas cake containing sultanas/raisins approximately 2 days ago.
Historical Conditions: 
- Vomited 7 times after ingestion until stomach was empty
- Activated charcoal administered at time of incident
Diet: Normal appetite, eating well
Drinking/Urination: No changes noted, no increased thirst
V/D/C/S: Vomited 7 times after ingestion of Christmas cake until stomach was empty, including his previously eaten breakfast. No current vomiting.
Current Meds: 
- Activated charcoal administered at time of sultana ingestion
Lifestyle Risk Factors:
- High energy working dog breed
- Has both grass and paved areas at home
Other:
- Owner reports all cake and stomach contents were expelled during vomiting
- Black stool noted after charcoal administration
- very dog reactive - barking and at end of lead in waiting room, had to take into consult straight away

EXAM
Mentation: BAR
Behavioural: Reactive, gentle with treats, but def anxiety during examination and then lunged suddenly and barking at me without warning.
Cardiovascular: NE
Respiratory: panting resp 
Abdominal: NE dt dem
Integumentary: visually normal
Urogenital: NE dt dem

ASSESSMENT
Potential grape/raisin toxicity - No clinical signs of toxicity 2 days post-ingestion
Otherwise apparently healthy but anxious and very dog reactive

PLAN
Diagnostics:
- Discussed blood testing to check kidney parameters ($335 including consultation) - Client declined based on cost and  lack of clinical signs and complete evacuation of stomach contents shortly after ingestion
- we would probably need sedation or at least chill meds to reduce his visit anx for a blood draw.

Additional Discussion:
- Discussed that grapes/raisins can cause kidney toxicity in some dogs, but it's unpredictable
- Explained that kidney damage from toxins doesn't heal well, unlike liver damage
- Advised that treatment would involve hospitalisation for IV fluid therapy if toxicity occurred
- Noted that clinical signs would typically include increased thirst, increased urination, and inappetence

Client Comms:
- Advised to monitor for increased thirst, increased urination, inappetence, or any change in behaviour
- Instructed to return immediately if any concerning signs develop
- Reassured that risk is low given prompt vomiting after ingestion and lack of clinical signs 2 days post-ingestion

Attached to record