C10018596 / invoice 10000

Reason: Hyper Salivating & UncomfortableAppointment Notes: Special payment terms exist, Overdue remindersHistory:Phoebe presented after being discharged yesterday, following a 4-day hospital stay for acute hemorrhagic diarrhea syndrome, with a known history of multiple pre-existing issues, including a multi-resistant UTI (Providencia stuartii). She was started on antibiotics (enrofloxacin), with signs of improvement initially but had subsequent concerns related to nausea and vomiting.Clinical Notes:On clinical examination, there was copious salivation, and the dog was observed to be more comfortable post-treatment. HR and other vital signs were stable, with a soft abdomen and no signs of distress.The dog showed improvement in demeanour, as evidenced by a wagging tail and walking.Hospital Monitoring Sheets: Vitals were monitored regularly, with noted improvement in hydration and alertness.Medications included Ondansetron for nausea, as well as other treatments for salivation control.Assessment:Hyper-salivation and GI discomfort, likely due to multi-resistant UTI, and Enrofloxacin.Overall, the dog seems to be improving under the current treatment, especially with the use of Ondansetron, which appears to help control the salivation and nausea. The hospitalisation sheets show improvement in her condition, though continued monitoring is critical to ensuring full recovery.Ann Hill BVSc She does need to stay on the enrofloxacin for a few more days . So im thinking perhaps going into her regular vet once a day for a sc injection of 10 mg/kg might be an allternative will need to ring Erina heights and run this by them    Vital Signs    Weight: 30.4;       

Appointment Notes: Special payment terms exist, Overdue remindersHistory:Phoebe has re-presented this evening after being discharged yesterday following 4 days in  hospital as an inpatient with acute haemorrhagic diarrhoea syndrome. She has a multitude of pre-existing issues, congenital issues as previously noted. GI signs were resolved however ongoing intermittant nasal discharge and in hospital a multi-resistant UTI (Providencia stuartii) was diagnosed.  She was started on enrofloxacin in hospital and several hours later became quite drooly and looked nauseous. Today owner reports:Drooling started around lunch time today and worsened but has since gotten better.  Owner has given 8mg ondansetron at 1:30pm Maropitant - last night 60mg at approx 6-6:30pm 3 nice poos have been observed since dischargeAppetite - did not eat everything from last night, this AM ate gastro canned food and prime 100.  No lunch offered Seems bright but there may have been an episode of pacing and cannot get comfortable.  Panting as well.  Prior nausea with enrofloxacin - smacking of lipsOwner also took e collar off and placed some neocort on the back end and Phoebe was observed licking this off at around middayNo dietry indiscretion - treats / scavenging noted since homeMedications:  apoquel given last night, propalin, panadol BID (500mg)Medical history:  recent diarrhoea / vomiting, cleft palate, recto-vaginal fistula, normal specialist ultrasound, UTIExamCopious volume saliva in e collar / mouthMm-pi, crt <2HR 120, regular, no murmurAbdomen soft and comfortableSubjectively much brighter than when i observed her on Sunday.  Wagging tail / walking2mg/kg maropitantAssessment-  Hypersalivation ddx- nausea (enrofloxacin, UTI, relapsing GI signs?) or from bitterant in neocort-  on enrofloxacin for multi-resistant UTI (Providencia stuartii) 10mg/kg PO SID - prior history of GI signs with enrofloxacinCommunicationOffered discharge and monitor and increase ondansetron to 8mg TID - discussed risks of switching antibiotics in a patient with mutli-resistant bugs - however if continues could consider switching to TMS / marbofloxacin but would prefer to discuss with medicine specialist 1st - have emailed vetnostics for medicine consult. Owner prefers to admit for monitoring to give her a rest / break this evening - advised in hospital increases risks of acquiring infections - owner would prefer to monitor here for a few hours until around 7-8pm then decide if can discharge or stay in hospital overnight - if staying in hospital owner will drive back with the rest of her medications.  Plan-  monitor salivation-  continue enrofloxacin 10mg/kg PO SID, maropitant 2mg/kg PO, ondansetron 8mg PO TID -  KS will call at 7pm and decide if staying overnight - MM approved overnight care package for monitoring / hour however if deterioration will need to call owner to advise additional charges    Vital Signs