C10013987 / invoice 10000

Laboratory: Blood Gas  ******* choose cat or dog and arterial vs venus, delete other templates *******
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Dog Venous **
A. Gases:
pH:  7.448    (7.350-7.450)
pCO2:31.0   (35.0-38.0 mmHg)
pO2:   63.6  (85.0-100.0 mmHg)
cHCO3-: 21.4  (15.0-23.0 mmol/L)
BE (ecf): -2.6  (-5.0-0.0 mmol/L)
cSO2: 93.2 (90.0-100%)

B: Chem:
Na+:   146  (139-150 mmol/L)
K+:     4.0  (3.4-4.9  mmol/L)
Ca++: 1.35   (1.12-1.40 mmol/L)
Cl-:   119  (106-127  mmol/L)
TCO2: 20.5  (17.0- 25.0 mmol/L)
Hct:   46   (35-50%)
cHgb: 15.7   (12.0-17.0 g/dL)
BE (b):  -1.5   (-5.0-0.0 mmol/L)

C: Meta:
Glu:    5.1  (3.3-6.4  mmol/L)
Lac:   3.3   (0.60-2.90 mmol/L)
BUN: 11   (10-26 mg/dL)
Urea: 4.1   (3.6-9.3 mmol/L)
Crea:   66  (44-115 umol/L)
BUN/Crea: 15.1  (0.2-400.00 mg/mg)
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Reason:   Vomiting and diarrhoea
History: Had vomiting since this morning. Had dark brown diarrhoea shortly before coming to Vet.   2 other family members have been vomiting too. 

Current medications:  No

Examine: 
Mentation: 
Body condition score:  3/5
MM: bright pink                CRT:  <2sec
HR:  100               RR: panting
LN: NAF
Temperature:  38.2

Ocular:  Bilateral nuclear sclerosis or cataracts
Oral/Dental stage: 2/4
Ears: NAF
Cardiovascular: NAF
Respiratory: NAF
Gastrointestinal:  Vomiting and diarrhoea
Integumentary & lumps (measurement, location): NAF
Musculoskeletal: NAF
Urogenital: NAF
Neurological: NAF

Problem List:
Vomiting and Diarrhoea. 

Assessment:  Clinically well. HR slightly elevated since last check. Last CBC  had mild non regenerative anaemia (corrected or possible dehydration)  Retic count is now normal. 
Blood gas showing slight elevation in Lactate. Electrolytes normal.  Offered client radiography to investigate elevation in lactate if not due to dehydration. Opted to observe and return if there's any worsening of symptoms. 
O. called later to report some blood in the diarrhoea. Mia still bright and active.  Recommend continue with Tx and if there's any vomiting then return ASAP.  

Treatment:  Maropitant, Pro-kolin and  RC low fat gastrointestinal food. 

Plan:  Monitor for any signs of worsening.  

On-going medications required: Y/N (use prescription tab for further supply):

Followup:  If not resolving. 

TTPNALM sms sent too 11:55am IP

Reason: Courtesy phone call 
Nurse:
History:
     Demeanour:
     Eating/ Drinking:
     Toileting:
     Any concerns?
     
Treatment:
     Medications being given:
     Patient taking meds as prescribed?

Assessment:

Next Appointment: