C10011918 / invoice 10000

12yr MN Pug presents for V+ and D+. Started after having dinner at 4pm yesterday, started vomiting up food and bile and then started having diarrhoea. Overnight diarrhoea has progressed, continuing to vomit and diarrhoea has started to turn red. Last meal was at 4pm yesterday but didn't want anything to eat this morning. Drooling profusely. Presented yesterday for a lump check - MCT aspirated. Scheduled for procedure tomorrow. No access to toxins, doesn't eat any trash.

Clinical Exam
BCS : (5/9)
(BAR)
MM: (Pink and moist, CRT <2 sec.) 
Temperature:(39.2oC)
Cardiovascular: HR (160)/min, Pulse (strong and regular), (no murmur) auscultated
Respiratory: Rate  (40)/min, Normal bronchovesicular sounds
Mouth: NAD  dental score (2)/(1). Bite conformation (normal)
Eyes: (NAD, clean and clear, no discharge)
Nose: (NAD, clean, no discharge)
Ears : (NAD, clean, no discharge)
Gastrointestinal: Uncomfortable on palpation of the abdomen, no organomegalies, FBs or fluid waves palpated.
Genito/Urinary: (NAD). 
Integument: (Coat is clean, no ectoparasites noted)
MSK: (able to ambulate well in consult)
Neurological: (NAD, full exam not performed, BAR)
Lymph Nodes: (NAD)

Assessment:
Vomiting and diarrhoea (ddx histamine release from MCT/anaphylaxis v primary GI condition (infectious v indiscretion v inflammatory) v secondary GI condition (toxicity v renal v liver etc)

Treatment Plan:
ADMIT for IVFT, antinausea, antihistamines and bloodwork
Patient had haemorrhagic diarrhoea and vomited twice whilst in consult

24G catheter placed right cephalic vein. Bloods drawn for bloodwork
-> CBC + comprehensive profile WNLs

IN HOSPITAL MEDICATIONS
0.78mL maropitant administered IV
Started on fluids at 4x BW - Hartmann's 31ml/hr
Started on metronidazole 23.4mL IV over half an hour
No niramine available as injectable form (back order), given 4mg iramine PO 

CS called O - bloods all looking good, Zeus has had no more vomiting or diarrhoea

Given 5mg losec to assist with any gastric ulceration. 
Temgesic administered slow IV as patient hunched in the abdomen, concern for abdominal pain. 
After this, patient began sleeping soundly.

Throughout the day, patient began to show a small amount of expiratory effort - concern for aspiration pneumonia given vomiting and brachycephalic conformation. 
Xrays taken of the chest -> L lateral shows a mild alveolar pattern over the cranial apex of the heart. Concern for aspiration pneumonia. Some very small nodules present throughout the lung field that were not seen radiographically at last study done last year. Concern for metastasis of MCT. 

At this point, cannot rule out MCT metastasis to the intestines/GI tract +/- lungs. 

NEXT STEPS:
-> Losec BID 5mg for nausea and vomiting
-> Prokolin BID 3mL for diarrhoea
-> Metronidazole for haemorrhagic component of diarrhoea
-> Amoxyclav 125mg BID 14 days for potential aspiration pneumonia
Assess response. Procedure for tomorrow has been delayed. May need a revisit tomorrow.