C10014602 / invoice 20000

Reason: Still Not Eating, Drinking Alot Appointment Notes: Overdue reminders ndHistory: Came in on Friday (2-3 days ago) for inappetance/hyporexia, polydipsia, weight lossIn house bloods showed increase renal and liver parameters Elected antibiotic trialHad something to eat after visit but went off food again for the weekendDid not eat but still gave antibiotics - vomited some of the tablets outStopped antibiotics Drinking a lot of water and urinating more Does have underlying renal disease (stage III/IV) and cardiac murmur Examine: QAR, timidEyes: bilaterally cloudy lensEars: NSFOral: Pink MM 1-2s, G3/4 dental disease, moderate tartarLNs: WNL CVS: 120bpm, G4/6 murmur, regular rhythmResp: clear chest sounds, normal effortAbdomen: soft and comfortable, no obvious organomegaly palpableMSK: NE Assessment: Hyporexia Weight lossCKDCardiac murmurDDx: open - renal failure vs cholangiohepatopathy vs neoplasia vs others Options:1. If keen for investigation, would recommend abdo u/s as next step + hospitalisation IVFT however must be aware will be costly and prognosis is unknown2. Hospitalisation for IVFT and supportive care3. Humane euthanasisa Declined all options, Elected to take home todayTreatment: Mirtazapine 15mg 1/4 tab SID PO Zofran 4mg BID PO OraladePlan: Review tomorrow INI, consider QOL    Vital Signs    

Reason: Not Eating For 2 WeeksAppointment Notes: nr/mv]History: handfeeding her, really decraesed appetite.Lost weight - lost 900g since last visit.Stools firm, not diarrhoea.GOing to the toilet three times overnight, drinking a huge amount.Subjective: QAR. DD grade III/IV.HR 100bpm, systolic murmur grade IV/VI.Cachexic appearnce, prominent pelvic bones.Laboratory: USG 1.016 Sediment occasional neutrophil.Dipstick clear.BUN 22.1 (was 27 at lsat bloods)Creat 228 (27-124).ALP 172 (20-150)ALT 152 (10-118).Plan: discussed haematol and biochem changes, concern with inflammation and potentially liver.Renal function stable.Home on noroclav 1ml BID PO, enrofloxacin 25mg SID PO, metronidaozle 50mg BID PO.Rv tomorrow if deteriorates with eating and discuss ultrasound.Discussed pts if deteriorates also, owners concerned re QOL.Would like to try antibiotics first, aware potentail malignancy with current weight loss also.    Vital Signs    Weight: 4.6;