C10012897 / invoice 10000

Reason: V+, Shaking, Panting,  out of sortsHistory Summary:Presented for an acute onset of shaking, panting, feeling hot to touch, and lethargy this evening. The episode started approximately 1.5 hours after dinner. The behaviour was described as similar to his anxiety during a storm. A single episode of vomiting biscuits occurred this morning, after which he seemed well. A brief episode of shaking without panting or heat was noted a couple of days ago, which self-resolved. There is a history of a sensitive stomach to worming and preventatives, which is well-managed with a specific combination of Milbemax and Bravecto. He has a known sensitivity to chicken, which causes pruritus. His diet consists of turkey mince, vegetables, Greek yoghurt, omega-3 oil, and Science Diet sensitive skin and stomach biscuits. Urination and defecation have been normal.TRIAGE:HR: 140 bpmRR: PantingTemp: 39.1°CMM: Pink, slightly tackyCRT: < 2 secondsMentation: Anxious, shakingPain Scale 0-4: 0-1Hydration status (%): Mildly dehydratedEXAMINATION:Body Condition Score: 5/9Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort increased (panting), no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally. No apparent neck, spine, limb or joint pain on palpation.Gastrointestinal:- Oral: NSF- Abdominal: Initially tense and mildly tender on palpation, likely due to anxiety. Abdomen was soft and non-painful on repeat palpation.- Rectal: Some diarrhoea was noted per rectum.Urinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Acute onset shaking, panting, and pyrexia2. Vomiting and diarrhoea (gastroenteritis)3. Mild dehydrationDIFFERENTIAL DIAGNOSIS:Pain: Spinal or neck pain can present with similar signs, though no pain was elicited on examination.Anxiety/Stress: Can cause panting and shaking; may be a component of the clinical picture.Toxicity/Ingestion: Cannot be ruled out from history.Differentials for acute vomiting would include gastric and intestinal causes (eg. dietary indiscretion, foreign body, infectious, inflammatory, neoplastic, or toxic causes), abdominal disorders (eg pancreatic, hepatobillary, or renal disease or peritonitis) as well as metabolic and endocrine disease.DIAGNOSTICS/MANAGEMENT PLANProposed plan included a venous blood gas analysis and an AFAST scan to investigate the cause of the clinical signs. Admission for intravenous fluid therapy was discussed as the ideal treatment for hyperlactataemia and dehydration. A trial of an anti-emetic injection for symptomatic relief was also planned.Blood Gas Analysis Results - source: venous- Decreased: Chloride 107 mmol/L, Calcium 1.17 mmol/L- Increased: Haematocrit 52%, Glucose 7.1 mmol/L, Lactate 3.5 mmol/L-Interpretation: Respiratory alkalosis secondary to hyperventilation. Mild hypochloraemia likely due to gastrointestinal losses. Mild hypocalcaemia. Haemoconcentration, consistent with dehydration versus splenic contraction. Stress hyperglycaemia. Mild hyperlactataemia, potentially due to hypoperfusion or anxiety.AFAST/TFAST:- Peritoneum: The stomach contained some material but the pyloric outlet was empty. No free fluid was identified in any quadrant. No dilated intestinal loops were seen.- Pleural space: No free fluid was identified in either hemithorax.- Pericardial space: No free fluid was identified in the pericardial space.REVISED ASSESSMENT:Gastroenteritis is the most likely diagnosis. The mild hyperlactataemia is considered likely secondary to anxiety and mild dehydration rather than significant hypoperfusion, given the unremarkable AFAST scan.PATIENT UPDATE:Stable/Improved: Stable. Remained anxious but comfortable.  When settled in consult with owner HR dropped to 100 bpm.E/D/D/U/V: No further vomiting observed. Diarrhoea noted on rectal examination.TREATMENT SUMMARY:Maropitant 1 mg/kg SC was administered for anti-emetic and visceral analgesic effects.OWNER COMMUNICATION:Discussed the findings of the physical examination, blood gas analysis, and AFAST scan. The likely diagnosis of gastroenteritis was explained. The plan to administer an anti-emetic injection and observe for a short period was discussed and agreed upon. The estimated cost for consultation and initial diagnostics was approximately $650.PLAN:Discharge home and monitor closely for progression of symptomsFor any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs