C10012865 / invoice 10000

10/03/2026 DATE/TIME of CONSULTATION: 12:31hrs, Tue 10/03/26

CLINICIAN: AG

PRESENTING COMPLAINT: Vomiting, lethargy

HISTORY: 5 days ago started vomiting, vomiting bile. Has had history of GIT issues. Went to RV and given antinausea injection and put on bland diet (boiled chicken). 

About 48 hours ago vomited again overnight multiple times (food). Yesterday morning had dark stool, and then had a few drops of diarrhoea later in the day and since last night hasn't defecated since. PU/PD. Very lethargic. Went to RV today, was given probiotics and put on prescription GIT food (Hills'), eating a bit. No known access to any toxins, no recent drugs. 

Diet - Dry food, wet food. No recent changes before initial vomiting. 

Has another 5yo aussie terrier that is completely healthy. UTD with vaccinations and parasite prevention. 

Had bloods done at RV and was markedly azotemic. 

CLINICAL FINDINGS: QAR, HR - 132, RR - pant, mm pale pink, CRT >2, temp - 37.8. BCS 2/9
Cardiovascular: no notable murmurs or arrythmias auscultated, femoral pulses good and synchronous
Respiratory: normal respiratory rate and effort, normal bronchovesicular sounds on auscultation, no visible nasal discharge
Gastrointestinal: soft comfortable abdomen on palpation, no strong repeatable focus of pain,
Musculoskeletal: no strong repeatable focus of pain on gentle manipulation of limbs and joints, no notable lameness on walk
Neurological: cranial nerves intact, no notable ataxia
Integument: no obvious lesions
Otic/Ocular: normal ocular and otic structures
Lymph Nodes: no peripheral lymphadenopathy noted

PROBLEM LIST:
*Vomiting
*Diarrhoea
*PU/PD
*Azotaemia

DIFFERENTIALS: AKI secondary to hypovolemia/toxicity/congenital malformation. 

PLAN:
*Take blood pressure and run bloods (electrolytes, hydration status, renal parameters)

DIAGNOSTICS:
*Doppler BP - 110 mmHg #1 RFL
*EPOC - pCO2 32.7 (low), K+ 3.2 (low), Hct 56% (high), glucose 8.4 (high), Lactate 4.96 (high), BUN >120, Urea >42.8, Creatinine 336 (high). 
*Phos - 2.5

CLIENT COMMUNICATION:
*Advised that plan for now is to rehydrate with IVFT and manage vomiting with anti-nausea. Will repeat bloods again tomorrow morning to assess improvement in renal parameters. If improving and starting to eat and drink on her own, can consider discharge tomorrow. 

TREATMENT:
*Maropitant 1 mg/kg IV SID
*Ondansetron PO BID 
*IVFT 11 ml/hr supplemented with KCl

++++++++++++++++++++++++++++++++++++++++++++
AFTERNOON UPDATE: 

Blood Results: 
EPOC - severe azotaemia, hypokalaemia, elevated lactate 
PCV/TP = 74 - haemoconcentrated 
Baseline cortisol - 89.9 (normal) 
TREATMENT: 
Given fluid bolus - 10ml/kg over 10 minutes then started on twice maintenance (Hartmans with 12mmol of KCl added)
Maropitant injection 1mg/kg slow IV SID - given this afternoon 
Ondansetron 4mg - Give 1/4 of a wafer PO BID-TID - given this afternoon 

PLAN:
Continue IV fluids overnight and recheck PCV/TP and EPOC tomorrow morning 




******************NIGHT SHIFT UPDATE****************
CLINICIAN: EB 
EXAMINATION: QAR, mm pink crt <2 abdomen soft and relaxed, normothermic, eating chicken well, no vomiting 
DIAGNOSTIC TESTS: 
urine usg 1.012, ph 6, no protein, blood , glucose

ASSESSMENT: azotaemia- AKI ? 
PLAN:
Fluid plan: 2 x M 
Analgesia: comfortable 
Antinausea - 1mg/kg maropitant, ondansetron 2mg as required
Nutrition Plan: eating chicken well 
Monitoring:
- Recheck PCV/TP, EPOC, q24
- Monitor blood pressure q12


Discharge Criteria
- azotemia improved 
- Eating without assistance
- Clinically bright

CLIENT COMMUNICATION: 
owner visited - concerned that possibly underlying congenital disease- advised IVF and monitor azotaemia- if no change improvement, then likely recommend medicine ultrasound Thursday (will need to discuss/confirm
urinalysis pending