C10009378 / invoice 20000

Reason: Abdominal Pain, HepatopathyAppointment Notes: Overdue remindersEMERGENCYHospital day: 2Subjective: QARAnorexic Urinating normal, not defecatedObjective: Temperature: 37.98CCVS: no murmur or arrhythmia, pulses moderate and sync HR = 80bpm Respiratory: normal on ausc, RR = 36bpm Abdomen: substantial cranial abdominal discomfort on palpation. Genito-Urinary: normal urination M/Skeletal:ambulating normal Neurological: normalEyes/Ears: normal Integument: tent okay, wnl BWT: 10.25kgNutrition: anorexic Fluid therapy: @30mls/hr hartmann's Laboratory: PCV/TP- 40/78  (45/88 ytd 12pm) Biochem- CHloesterol 8.7 mild H (10.11 ytd 12pm)- ALT 486 H (648 ytd 12pm)- AST 75 H (75 ytd 12pm)- k 3.7 mild L (3.1 ytd 12pm) CBCWnl Assessment: 1. Improved ALT 25%, though still high, alongside AST increase2. Electrolyte normalised3. Cranial abdo pain persist despite ketamine CRI +methadone4. Anorexia persistClient Communication: (daily update)--- 10/03/2026 09:58:29 vyu:Discussed that ALT improved but still moderate pain same region abdo. Recommend for abdo u/s with specialist, may consider feeding tube/hepatoprotective meds pending on findings.Owners are on board, will pick him up to vsosV2V done with vsos. Ketamine CRI to be packed Hole 11am methadone. Prevomax due 2pm. Account update provided:  YES    Vital Signs    

Reason: Abdominal Pain, InappetAppointment Notes: Overdue remindersEMERGENCYHospital day: 1Reason: Vomiting, Inappetence Subjective: No interest in food this evening, no vomiting or diarrhoea noted. Quiet, some urinary dribbling noted. Hypothermia developed. Objective: QAR Thorax - nad on auscs, moderate pulses. Moist pink OMM Moderate cranial abdominal pain Moderate urinary bladder - able to express small amounts Prepuce unremarkable Laboratory: Repeated AFAST - no FAF present EPOC PH 7.26 < PCO2 60.4 > HCO3 27.3 > Na 153 > K 3.4 < Cl 110 GLu 8.1 > Lac 3.43 > BUN 28 > Urea 9.9 > Crea 168 > Assessment: Cranial abdominal pain Ongoing inappettance Elevated AST/ALT Pre-renal Aztoaemia - suspect dehydration Hypothermia Urinary retention - pain vs neurological vs overflow Plan: IVFT Hartmanns 10mmol KCL/L @3-5% dehydration Methadone 0.3mg/kg IV q4 Maropitant 1mg/kg IV SID -> active warming started, held methadone to reduce sedation and started on Ketamine for pain relief. 0.5mg/kg IV bolus, started on Ketamine CRI 0.1-1.0mg/kg/hr -> recheck ALT 24 vs 48hr as in vs outpatient. Consider hepatoprotectants at this time Client Communication: CM SW Kerry - discussed some concern re ongoing pain in abdomen and decreased temp. Discussed plan to active warm, increase pain relief and EPOC/Afast. Advised will call overnight if concerned. Advised unlikely AM discharge and discussed repeating liver panel in AM to assess changes here. AM updated expected. --- 10/03/2026 05:28:00 SBT:Normothermic from 3amUrination no defecation. No interest in food. Subjectively more comfortable than previous on combination of methadone 0.2mg/kg q4hr IM + ketamine CRIReferring Vet: Gx--- 10/03/2026 06:10:32 SBT:Client Communication:ST Kerry 615am - advised temperature improved and slightly brighter since ST CM however still not interested in eating. Confirmed no access to cycads or paracetamol or other hepatotoxins. Advised plan initially repeat bloods at 11am however rec pushing forward to 9am - if continuing to see increases abdominal imaging (likely referral for specialist ultrasound) indicated as would be concerned re an ongoing process. Kerry is at work at Syd airport however husband can come down if needed. Next update post bloods - Kerry will call if hasnt heard by 11am    Vital Signs