C10011756 / invoice 10000

Reason: ConsultAppointment Notes: Special payment terms existHistory: Lethargy and reduced appetite started 1 week agoNo vomiting or diarrhoea or coughing./sneezingPossibly elevated RR upon further probing?Went to fox valley vet for IVFs for renal dz 3 days Wednesday to SaturdayHad bloods and UA, suspect UTI, culture pending, started on amoxyclav 50mg BIDUnsure what medications givenOn benazepril SID but does not get it when he doesn't eatHas maropitant to give at home but Os cannot give if he isnt eatingWill only eat dry food (not renal food), has gone of renal wet foodExamine: QAR, BCs 4/9, eyes and ears NAD, LNs WNL, coat NADMm pink and tacky, CRT = 2secs, moderate dental diseaseThoracic auscultation IV/VI systolic heart murmur, regular HR, fem pulses adequate and synchronous, lungs clearAbdo palp NAD, RTemp 37.8Problems:1. stage 4 IRIS CKD with proteinuria2. Lethargy and inappetance,  did not respond to 3 days IVFs3. UTDI with pseudomonas, further sensitivities pending3. New loud heart murmur4. Hepatopathy5. Weight lossAssessment: renal disease progressing, concern for concurrent cardiomyopathy and hepatopathyPlan: options1. Admit for IVFs, meds with full work up - bloods, UA, abdo ultrasound, echo, blood pressure2. Admit for IVFs, meds with no/minimal work up3. EuthOs opted for option 2, declined any further diagnostics, I discussed that supportive care will likely not provide a significant response with advanced renal disease and concern for concurrent issues. They are not ready for euth but I advised that if he does not improve that this will be best option for Percy as grave concerns for QOLOs consented to inital 24hrs of IVFsPreferred contact:  0411 250 844                          Secondary contact:Regular medication/Last given?: yes, given to EEAny food this AM?: -Known allergies?: -Bloods?: -Estimate given?: yesGAP?: yesWalked this morning?: n/aBelongings:Admitted by: MJ1030am - 22g cath placed R ceph; hartmans 11ml/hr (maint rate). ASPlan: Rx:maintenance fluids hartmannsMaropitant 0.43mL slow IV SID middayFortekor 1/2 (2.5mg) tab SIDMonitor appetite, start periactin if not eatingFollow up on urine C+S results--- 09/03/2026 13:09:32 WS:Offered renal wet food - ate it all--- 09/03/2026 18:23:39 ZL:Eating renal wet well. Seems bright.Grade IV/VI heart murmur, nad lung ausc, no wheezing or cracklesPeriactin not given as eating, otherwise plan as above--- 10/03/2026 08:00:30 ZL:C+S result back, sensitive to marbofloxacin.--- 10/03/2026 08:38:29 ZL:Generally bright, eating well renal wet food. Grade IV/VI heart murmur, HR 125, RR 24, clear lung sounds, soft on abdo palpation, no skin tentAssessment: Multiple issues as above. UTI sensitivity results backPlan: Start marbofloxacin 12.5 mg po sid, 1st dose given this AMFortekor given this AM--- 10/03/2026 17:49:41 ZL:Bright and eating still. PE as above.2nd dose marbo given PO this PM continue sidMaropitant 0.4 ml given sc this PM for support at homeClient comms: Discussed poor prognosis without further diagnosticsShowed how to tablet to see if able to at home even if not eating, can bring Percy in for nurse administration of tablets if struggling    Vital Signs    Weight: 4.3;