C10008781 / invoice 10000

Reason: Unwell follow up on Cushin'g Tx progress and repeat blood.Examination Findings: Decreased appetite and weight loss (currently 3 Kg) Increased pot belly appearance and alopecia has progressed.Currently on Venotryl Physical Exam: Demanour: BARCardiovascular: HR 172, Grade 5/5 heart murmur/ could not assess MM and CRT (blind and head shy)Respiratory: RR:36, normal effort, no crackles or wheezingTemp: 38.3Laboratory: CBC biochem and lytes performedALT, LAP, GGT slightly increased than beforeModerate leucocytosis, neutrophilia, eosinohpila, monocytosisMild hyperkalaemiaTreatment: IVFT supportive care during the dayMethadone 0.3mg/kg IVCephazol 20mg/kg IV Assessment: HyperA increasing risk of infection - trial Abx and consider consider further investigation (repeat Stim, abd u/s and thoracic rads vs CT) if no improvementMurmur is present but at this stage monitor as no other c/s - consider rads in the future if warrantedPlan: Continue Vetoryl Amoxyclav 20mg/kg PO BID for 5-7 daysBuprenorphine 0.02mg/kg sublingual TID PRN for 3 daysAs above if further investigation required.    Vital Signs    Weight: 3;