C10017660 / invoice 10000

11/03/2026 
Reason: vomiting

History: 
 - not lethargic at home
 - abdominal stretching started this morning
 - yest was retching a little and didn't want to eat
 - today vomiting bile and liquid
 - 10-15 minutes after giving meds last night she vomited so O very concerned about her not getting her medications in
 - for this reason gave her 4mg ondansetron. Settled without any further vomiting
 - this morning she started pacing and abdo stretching again. Passed normal faeces. Still vomiting today. Last vomit about an hour and a half ago
 
Pre-existing conditions: addisons
Current medications: 
 - florinef 1.5 in the morning and 1 in the evening
 - cortate only for stressful situations, hasn't had any for weeks 
 - ondansetron 9pm last night
Diet: no changes, croc and tapioca roll and beef mince


PE
Mentation:BAR, anxious, 
BCS: 3.5/5
MM: pink and moist
CRT: 1-2s
HR: 120 bpm, no murmurs or arrhythmias detected
PR: normodynamic and synchronous
RR: normal effort and no abnormal lung sounds
Temp: not taken
Ears: nsf on external examination
Oral/dental stage: 2/4 
LN: submandibular, prescapular and popliteal are small, symmetrical, non-painful and WNL on examination
Abdo: no organomegaly or masses palpated
 - some discomfort on cranial abdo palpation
 - decent GIT sounds
Integument: normal skin turgor, nsf
Urogenital: no significant abnormalities 
MSK: ambulatory, normal gait and strength noted. No evidence of lameness
Rectal exam: not performed
Neuro exam: nsf on cursory examination

Assessment:
vomiting

Laboratory: Blood Gas  **Dog Venous **
A. Gases:
pH:   7.417   (7.350-7.450)
pCO2:L 32.4   (35.0-38.0 mmHg)
pO2:   37.9  (85.0-100.0 mmHg)
cHCO3-: 20.9  (15.0-23.0 mmol/L)
BE (ecf):  -3.6 (-5.0-0.0 mmol/L)
cSO2: L 73.8  (90.0-100%)

B: Chem:
Na+:   150  (139-150 mmol/L)
K+:     3.9  (3.4-4.9  mmol/L)
Ca++:  1.4  (1.12-1.40 mmol/L)
Cl-:    109 (106-127  mmol/L)
TCO2:  20.1 (17.0- 25.0 mmol/L)
Hct:   H 57   (35-50%)
cHgb:  H 19.3  (12.0-17.0 g/dL)
BE (b):   -2.4  (-5.0-0.0 mmol/L)

C: Meta:
Glu:    4.2  (3.3-6.4  mmol/L)
Lac:     1.05 (0.60-2.90 mmol/L)
BUN:  19  (10-26 mg/dL)
Urea:   6.6 (3.6-9.3 mmol/L)
Crea:   80  (44-115 umol/L)
BUN/Crea: 20.5  (0.2-400.00 mg/mg)


Discussion: 
lytes are fine, pH and lactate normal
 - ok to go home while we wait for the rest of the results

Treatment:
1ml maropitant SC

Plan
 - call w results tonight

GHP BLOODS
nothing diagnostic on these bloods
 - RBC WBC all OK
 - panc lipase wnl

Asessment
 - gastric upset of unknown cause at this stage

plan
bland diet and monitor closely