C10008103 / invoice 10000

07/03/2026 Diet: hypoallergenic 
L ear ablation - prone to ear infections, just finished treating the R ear. 
Pro-kolin yesterday - really runny poos, craigieburn petstock runny on sample still awaiting results. 
No brekky yesterdat, tried testerday then vomited, at a bit of dinner, then drank a big amount, and today not at all interested in food. Looking for grass. 
No access to toxins/drugs/baits. 
Inside most of the time
Fluoxetine 20mg SID 
regurg more than v+?
reduced urination perhaps
drinking a whole L then regurgitation. 
Diarrhoea wednesday thursday, and a bit yesterday. 

Exam
BAR in consult but quiet for her. BCS 4/9
EENT: Mild tartar G1/4 dental. MM P 2s, slightly tacky. Did not examine ears. Eyes clean and clear. 
CVS 140bpm, ssfp, clear ausc
Resp increased sounds BV to wheeze especially ventrally, increased effort on inspiration. 
Rectal T 38.8
LNs: SMLN wnl
Abdo palp: generally uncomfortable, maybe more cranially. 
MSK: comfortable in consult
Urogenital: slightly decreased urination reported. 
Integument: small areas of erythema and alopecia on trunk and chest. Nil skin tenting. 

Initial Assessment:
Increased lung sounds ? aspiration pneumonia
V+ vs r+ ddx primary GI vs secondary disease. 
D+ resolving ddx dietary indiscretion
Flatulence

Medications:
0.2mg/kg methadone with 4mcg/kg medetomidine IV. 
Alfaxan top up 1ml to facilitate imaging. 

Laboratory:
PCV 47 TP 63 clear
CBC
Reticulocyte
Haemoglobin
31.6 22.3 - 29.6 pg

Biochem
IDEXX SDMA a 32 0 - 14 µg/dL
Creatinine 556 44 - 159 µmol/L
Urea 25.5 2.5 - 9.6 mmol/L

Cystocentesis 
USG 1.014
protein 1+
pH 6.5
blood trace
Otherwise neg

Imaging:
Thoracic radiographs not clearly indicative of any aspiration pneumonia
Abdominal imaging fluid filled SI, occasional gas coming through, nil obstructive pattern noted. 

Assessment:
Marked azotaemia and poorly concentrated urine ddx renal injury (AKI > CKD, or acute on chronic) vs >> dehydration
V+/r+ and hyporexia likely dt renal injury
D+ open
Anxiety - on fluoxetine
Increased lung sounds ddx normal variation vs referred UR noise? >> aspiration pneumonia. 
SI gas ddx ileus from hypo and anorexia vs >> obstruction. 

Comms:
Recommended referral for supportive care. 
AVC Initial 12h $2-2.5k (including supportive care and repeat bloods and some abdominal imaging) q12h $700-1000. 
Abdo u/s additional $1000.
Advised can investigate further with abdominal u/s after long weekend with us. 

info@advancedvetcare.com.au