C10015735 / invoice 10000

Reason: (V3) CON1/ HOSPComing Back Down  Not Eating, LethaHistory:Poppy was discharged from ARH last night, she ate some chicken when owner came in at 10pm an dthus was discharged for ongoing care at home for her diabetes. She has insulin resistance from being entire and in heat, she may also have cushings disease. (see prev entries for abdo u/s findings and plans discussed). Since going home Dina reports Poppy seemed originally ok when they left, she was walking around normally, but overnight to this morning she has been very restless, getting up and down trying to find new spots to get comfortable. She is not eating this morning at all. No vomiting, passed normal stoolsBut very lethargic and seems weak. Have been monitoring her BG overnight on the sensor has said HIGH overnight constantly, this morning since midnight it is reading above 27. Owner had called for advice AYS advised giving 10IU SC of insulin rather thna 12, advised that she is a complex case to know what dose of insulin is going to be safe, seems unlikely she will have a hypoglycemic event given her insulin resistance, and feel she needs insulin. Had lengthy chat with Dina today, she is understandably upset and wants the best for Poppy but also does not want her to go through too much. Discussed that ultimately she would need to have surgery and likely a feeding tube at that time to allow her to get appropriate nutrition and be able to go home, owner does not wish for her to have a feeding tube. Advised recovery from surgery otherwise would be 2 weeks rest, discussed if admitting her today, will need to stabilised next 24 hours and if stable tomorrow could discuss surgery, would probably expect Poppy to be here around 3-5 days again from now if has a surgery, then there is also the possibility she has cushings which could still cause nsulin resistance and needs investigation with further blood testing and medications. Options offered to owner;1) Admit for stabilisation, and discuss sx plans tomorrow or friday, advised placing NG tube because nutrition very important 2) EuthanasiaOwner elected 2. Treatment;IVC placed5ml/kg bolus LRS IV Humane euthanasia - zoletil IV, pentobarbitone IV    Vital Signs