C10012899 / invoice 10000

Reason: CollapsedHospital Time Period: 22.00 - 06.00 hrs History:Elsa has been a previously healthy older dog. No major health concerns although O has noticed thinning of her hair coat over the last year or 2 and also increase in number of warts. No recent bloods. Has always been on the thinner side. O thinks weight was previously around 32-33 kg. Appetite has always been a bit variable. Often won't eat unless she has been out on a walk. HL occasionally collapses out from under her and owners have noticed that she has reduced the length of her walks - previously around 40 mins, now 20-25 mins only. Elsa tends to guide owners on how far she wants to walk. 4am yesterday, O noticed Elsa panting heavily. Turned on the AC and she settled and panting resolved, otherwise no change in behaviour until this evening when she lay down on her walk and went to sleep for 30 mins - v unusual for her. No vomiting or diarrhoeaNormal stools in yard. No known toxin access. No known access to sedative or sleeping medications. Does pick up possum poo in yard. Tends to drink lots Subjective:QAR, sweet dog -> BAR when out for AM checks. Objective:Temp: 37.9,   MM: pale pink,    CRT:   <2s,  HR: 45 at rest -> 100 within 4 hrs of admission.  FP: = HR,   RR: 40/panting. BCS:    2/9                Wgt:  30   kg Pain Score (CSU):   1/24CV:   Marked bradycardia with sinus arrhythmia seen on ECG on admission. Normal p-QRS-t complexes. BP MAP 104 mmHg on admission -> 145 mmHg by 5am. RESP:           GIT: Abdomen feels quite full/pot-bellied for overall body condition. No abdominal pain on palpation. Eating chicken with good appetite and drinking well overnight. No faeces. U/G: Bladder filling. No urination overnight. Neuro: Quiet mentation -> much brighter this morning. M/S: Ambulatory x 4. Integ: Thin coat. Rat tail. Normal skin turgor. Ophth: Pupils equal. Normally responsive to light. LNs: Nil peripheral lymphadenopathy.INTERNAL LABORATORYPCV/TS: 37/70	Blood Gases:pH       7.373PCO2   42.6HCO3   24.8 H BE        -0.6 Electrolytes:Na+   151K        5.3Cl       114 H Glucose   5.5Lactate    2.4Ionised Ca 1.32CBCAbnormal parameters: All red cell parameters marginally low. No reticulocytosis. BiochemistryAbnormal parameters:ALT 315 ( 10-125) ALKP 254 ( 23-212) GGT 26 ( 0-11) Lipase  4327 ( 200-1800) COAGSPT - 12.0 WNLAPTT 92.0 s WNLIMAGINGAFAST: No FAF. No gall bladder halo detected. TFAST: No pleural or pericardial effusion. Normal A-lines over all lung fields. Normal glide sign. TXR delayed to due to more emergent procedures. Problem List:Collapse and sleeping for 30 min on walk. - resolvedBradyarrhythmia - resolvedMild non vs pre-regenerative anaemia Mild hepatopathyHypertensionHx of PD, coat changesAssessment: Underlying cause of the bradyarrhythmia remains open. No major blood changes to account for bradycardia. Ddx - primary intra-thoracic or abdominal dx resulting in increased vagal tone, toxin or drug exposure, cardiac dx, other. Mild anaemia - pre vs non regenerative. Haemorrhage vs anaemia of chronic dxConcern for underlying HyperA given coat changes, PD, hypertension. Further investigation should be considered including follow up bloods +/- AUS. Treatment:IVC placed on admission. Plan: Diagnostic plan : Monitor BP. Consider AUS + follow up bloods +/- TXR depending on progress. Therapeutic plan : None currently. Discharge plan : Discharge to owners care this morning. Referral plan : Non currently. Client Communication:Spoke to owners this morning - Elsa's is much brighter this morning with no further bradycardia. Has become hypertensive this morning and ongoing monitoring of this i recommended. TXR delayed due to urgent patient procedures. Discussed options1) Remain at AEC for the day for TXR 2) Monitor at home with view to AEC or rDVM follow up if symptoms recur. O elected option 2. Will arrange recheck with rDVM in 2d, or earlier, for recheck BP and bloods.    Vital Signs    Weight: 30;