C10007103 / invoice 10000

Reason: Worries About DKA SymptomsAppointment Notes: Special payment terms existConsultation Time: 00;13History: Went to the RSPCA yesterday for annual vaccination. There has been 2 months of PU/PD and some recent weight loss. Miki used to be 5.5kg which has decreased to 4.3kg.Bloods 7/3/26:- CBC: HCT 0.48 (0.29-0.45), reticulocytes 58 (3-50)- Biochemistry: glucose 21.6 (3.2-7.5), TP 86 (60-84), cholesterol 10.2 (2.2-5.5), triglyceride 3.3 (0.1-1.3)- Ketones: 1.4 (0-0.5)Miki has been lethargic the past 3 days and is sleeping a lot. Miki is eating wet food well, drinking lots. Normal faeces, no vomiting or diarrhoea. No coughing or sneezing.No other known health concerns. No current medicationsDiet: Felix cat wet, RC indoor kibbleIndoors only. One other cat at home who is wellVaccination up to date, no anti-parasite treatmentSubjective: QARObjective: Temp 38.0 MM pink and slightly tacky  CRT <2 seconds HR 180 FP SS RR 36BCS: 6/9  Wt: 4.24  kgCV: no murmur or arrhythmias noted, strong and synchronous femoral pulses RESP: normal BV sounds all quadrants, normal resp effortGIT: comfortable, no focal abnormalities notedU/G: moderate soft urinary bladder palpatedNeuro: appropriate mentation, no ataxia, full neuro exam not performedM/S: no lameness, no limb pain or swellingInteg: small amounts of dander, coat dry, mild skin tentOphth: pupils mid range and responsive, no dischargeLNs: small and symmetricalINTERNAL  LABORATORYPCV/TS: 42/92 clear(Cat: PCV 30-45%, TS 62-81 g/L)LACTATE: 1.9  mmol/L		Blood Gas(sample type: venous)Abnormal parameters: pH 7.316, pCO2 47.2, NA 159, glucose 18.8Interpretation: metabolic and respiratory acidosis, mild hypernatremia likely secondary to polyuria, hyperglycemiaBlood ketones: 4.0Problem List:- weight loss- lethargy- hyperglycemia- metabolic acidosis- ketosis- hypernatremiaAssessment: Miki presented to VRH after acquiring recent blood results showing elevated blood glucose. Miki has also been experiencing weight loss and has been quieter than normal. Miki on examination was mildly dehydrated, her vitals were otherwise normal and her abdomen was comfortable. Blood tests showed changes consistent with diabetic ketosis/acidosis.Options Offered to Client:1 - start insulin and manage at home2 - check bloods before deciding on next steps3 - admit for supportive care and investigationOwners elected to check some bloods which showed a diabetic ketoacidosis. They then elected to trial her at home with insulin and ondansetron with the plan to see their veterinarian in 2 days time. I discussed that Miki could deteriorate and require hospitalisation. Discussed signs of hypoglycemia and showed how to administer insulin. Owners will administer in 5 hours time at 6am. Disccused that this is likely to be a lifelong issue, can occasionally achieve remission, and that will need many rechecks. Owners have also reached out to Linda Fleeman for advice.Treatment:- toujeo solostar 300IU/ml - 2IU SID- ondansetron 4mg PO q12hPlan:- administer first dose of insulin at 6am, after eating, and then support as above- monitor closely, especially for signs of hypoglycaemia- revisit with regular vet on Wednesday - who will apply freestyle libre that owners have at home- wait to here for Linda Fleeman- revisit immediately if there are any concerns    Vital Signs    Weight: 4.24;       

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