C10012055 / invoice 10000

Presented for A/H ataxia and agitation 

History:  
Tonight went outside for pee and then afterwards came back in and had a very altered hind end gait and ataxic with hunched stance. 
Has been completely well up until tonight. 

Exam: Alert and responsive but very wound up and agitated in consult 
 T=39.5, HR=140 + , RR=pant, BCS=3/5.
MM pink and a little red in areas, moist.  CRT<1s
Teeth: Some gingivitis and tartar build up. 
Eyes: Clean, corneas clear, anterior chambers clear, lens clear, no anisocoria. PLR intact. 
Ears: Ears clean.  No visible inflammation of pinnae or ear canals. 
Skin:  Full clean haircoat.
Chest: Tachy cardia and irregularly irregular arrythmia with pulse deficits,  chest ausc clear  
Abdomen: No masses noted, mild to moderate abdominal 
Rectal exam: Not performed
Lnn: Peripheral lnn smooth, symmetric and not enlarged
Gait: No limping.  No muscle wasting.
Neuro: No apparent neurological deficits.  
Spinal pain thoracolumbar region 
No neck pain 
dysmetria gait - recovered significantly from videos showed on owners phone 

Taken out back 1ml diaz IV, dysphoric and still tachy cardiac, another 0.5ml given still not settled, recumbent but very dysphoric. 
Urine detection kit positive for THC 
Given 0.1ml medetomidine settled after this heart rate 80 and rhythm return to normal with no pulse deficits. 

Full bloods 
Mild decrease retic haemoglobin 
rest WNL 

Dx
THC toxicity 

Assessment 
Emesis not induced as time of ingestion unknown and rocky sedate at time of finding risk of aspiration etc. Discussed urine test findings with owners. Owners aren't sure how Rocky could possibly have gotten access to this. Advised without knowing how much or what type of product ingestion (oil, edible, plant) that given the severity of presentation recommendation is for overnight monitoring and fluid therapy. Est $2800. Owners would like to take Rocky home for recover advised against this as would like him to be on fluids in hosp with supportive care. Owners agree to this but decline overnight monitoring. est $1800- 2000. Advised if Rocky wakes up dysphoric or progresses to seizure that no one will be here. 

Treatment 
0.92 ml maropitant 
IVFT 3ml/kg/hr 

Plan 
Vet assess in the morning 
If still painful in the abdomen then advised owner abdominal xrays recommended 
If looking bright and back to normal self can be discharge.  

Date: 10/3 
Vet: BMH
T:(38.9) P:(120) R:(32) MM:dark Pink CRT:<2s
Eating:(no), Drinking:(no) Urination:(++) Defaecation:(no) Vomiting:(no)
Demeanour:(Stressed)
Medication AM/PM: see chart 
Notes: Patient slightly ataxic this morning however also stressed and slippery floor not helping. Gums dark pink in places. Patient stressed in clinic. Trying to run out the door. No pain response on cranial abdominal palpation. No pulse deficits or arrythmias however still tachycardic at 120 (reduction  from intake) 
Owner contacted: YES - O to come and visit 5pm +/- discharge if appropriate. 

Catheter removed - bleeding. Will bleed from catheter site even after vetwrap application  for 2+ hours 
- Clotting profile APTT/PT run - WNL 
- E.canis neg 
- Possibly due to hypertenstion as patient extremely stressed in clinic. 
Eating chicken PM 

Patient in consult room with owners at discharge - pacing - not in one particular direction, ataxic and uncoordinated gait however O reports improvement from last night. O reported that he has been a bit more unstable for 1 week now? Patient also appears to have a mild hypermetric gait in all 4 limbs. 
- concern not THC toxicity but rather neurological disorder - made O aware of concerns. May require referral or further workup in this case. 

Discharge with O's 
- Removed bandages - no bleeding noted - given vetwrap in case starts bleeding overnight 
- Recheck tomorrow AM 
- O to call afterhours service overnight if any deterioration, seizure like activity or concerns 
- Keep Rocky as calm as possible - no running, jumping or playing tonight. 
- Consider referral if neurological signs continue. 
- Cryptorchid - advised castration once Rocky has recovered. 


 

After hours - Vomiting

H: Wulagi Vet client. In the last couple of hours, Rocky has had multiple watery vomits and been acting out of character. Refused dinner tonight but ate breakfast as usual this morning. Has ad lib dry food to graze on all day but O unsure if he did. Did not appear to be acting strangely prior to onset of vomiting. No diarrhoea seen. No access to any toxins or poisons. Gets tablet scraps at times, like icecream, salami, bread but this is not out of the ordinary.
Gets C4 vacc and Proheart Sr12 inj at reg vet and was only just vaccinated in the last couple of weeks. 
O mentioned both testicles are undescended and she plans to breed from him.
No current medications being given.

Exam: BAR. T=38.7, HR=160, BCS=3/5.
MM pink, moist.  CRT<2s. Skin tent over top of neck but possibly excess skin, no tent over thorax.
Teeth: Good condition.  No gingivitis
Eyes: Clean, corneas clear, anterior chambers clear, lens clear, no anisocoria.
Ears: Ears clean.  No visible inflammation of pinnae or ear canals. 
Skin:  Full clean haircoat.
Chest: No murmurs auscultated, pulse strong. No crackles/wheezes, trachea clear. 
Abdomen: No masses or organomegaly, nonpainful on abdominal palpation. 
Rectal exam: Soft, normal feeling faeces. At end of consult squeezed out two relatively normal looking nuggets, one had a slightly runny consistency at one end.
Lnn: Peripheral lnn smooth, symmetric and not enlarged
Gait: No limping.  No muscle wasting.
Neuro: No apparent neurological deficits.  
Refused cooked chicken in consult.

Initial plan: Can work up now (bloods, xrays, etc) or conservative (maropitant inj) and visit reg vet in morning. O prefer the latter.

Diagnosis: DDx: Gastric indiscretion, FB, pancreatitis, other secondary GIT cause

Treatment: Maropitant inj 0.77mL SC

Plan: Appt already booked at usual vet tomorrow morning so will attend that if no better for possible work up. Overnight, hold off feeding anything for a few hours then try bland food (chicken/rice). 
Also had quick chat about Rocky's behaviour in relation to his responsiveness. Would need get more information but could look at seeing vet with special interest in behaviour.