C10020638 / invoice 10000

DISCHARGE NOTESPRESENTING CONCERNS:- Grape/ raisin ingestionPROBLEM LIST FROM PHYSICAL EXAMINATION:- Grape/ raisin ingestion and toxicity  ASSESSMENT:Grape & Raisin Toxicity  The exact mechanism of toxicity is unknown. Affected dogs have been shown to develop kidney failure within 72 hours of ingestion of grapes or raisins. The toxic dose required for this to occur is unknown. Affected dogs will develop vomiting and diarrhoea within 6-12 hours after ingestion. Other signs include lethargy, anorexia, abdominal pain, dehydration, increased thirst and tremors. Aggressive supportive therapy is required once your pet shows clinical signs as kidney function can deteriorate rapidly even with treatment. Aggressive fluid therapy is the most important component of treatment, with regular reassessment of kidney enzymes to assess function. Additional treatment also includes pain relief, anti-nausea medication and symptomatic treatment of other clinical signs. Prognosis once clinical signs have developed is very guarded. DIAGNOSTICS AND MANAGEMENT:Induce emesis – empty stomach contents if recently ingested  Biochemical analysis to assess organ function Anti-nausea medications SPECIFIC HOME CARE INSTRUCTIONS  Exercise:In order to facilitate your pets recovery, strict rest is recommended until they are back to full health and then gradually reintroducing walks.  Diet:Depending on the degree of kidney involvement and if there is permanent damage, your vet may recommend a kidney specific diet. If kidney function has returned to normal, a bland diet of chicken and rice is recommended until all gastrointestinal signs have resolved. After this your pet can return to their normal diet.Medications:NoneRECHECKPlease see your regular vet in 48hrs for repeat blood test to check kidney function or earlier if clinical signs as outlined below occur. What to look for at home:If your pet shows signs of increased thirst or urination, inappetance, vomiting, lethargy or is otherwise unwell re-check with Animal Emergency Services or your regular veterinarian as soon as possible.     If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. Thank you for trusting Animal Emergency Services with the care of Vinnie.    Vital Signs    Weight: 8.7;       

Reason: L4 Ate Multiple Sultanas 30 Mins AgoTIME:HISTORY:Current meds: Prophylaxis: Pre-existing conditions: Access to toxins eg. Rodenticide: TRIAGE: HR: RR: Temp: Mm: Crt: Mentation: Pain Scale (0-4): Hydration status (%): EXAMINATION:Body Condition Score: Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  - Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalities, faeces:  Urinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: peripheral lymph nodes normalEyes: NSFPROBLEM LIST: DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS: DIAGNOSTIC/MANAGEMENT PLAN: 1.2.3.4.Emesis was induced:Findings:Diagnostic Biochemistry RotorALB                         25 - 44 g/LALP                         20 - 150 u/LALT                         10 - 118 u/LAMY                         200 - 1200 u/LtBIL                          2 - 10 umol/LBUN                        2 - 9 mmol/LCa2+                       2.15 - 2.95 mmol/LPHOS                      0.93 - 2.13 mmol/LCRE                         27 - 124 umol/LGLU                         3.3 - 6.1 mmol/LNa+                          138 - 160 mmolK+                             3.7 - 5.8 mmol/LTP                             54 - 82 g/LGLOB                       23 - 52 g/LInterpretation:Diagnostic Biochemistry RotorALB                         25 - 44 g/LALP                         20 - 150 u/LALT                         10 - 118 u/LAMY                         200 - 1200 u/LtBIL                          2 - 10 umol/LBUN                        2 - 9 mmol/LCa2+                       2.15 - 2.95 mmol/LPHOS                      0.93 - 2.13 mmol/LCRE                         27 - 124 umol/LGLU                         3.3 - 6.1 mmol/LNa+                          138 - 160 mmolK+                             3.7 - 5.8 mmol/LTP                             54 - 82 g/LGLOB                       23 - 52 g/LInterpretation:    Vital Signs    Weight: 8.7;       

Reason: L5 DiarrhoeaTIME: 09:19HISTORY:Vinnie presented this morning for diarrhoea. About 4 days ago he had a diarrhoea inside with liquid and a small amount of hard stool and a single vomit. He then began straining to defecate the next day. Owners went to Harvey Bay and then gave him boiled chicken and rice last night. He has been fussy with his food the past 3 months. This morning he ate chicken and rice. There is no blood in the stools. He chews his soft toys sometimes and owner was concerned about him ingesting the fluff.Had normal stool in carpark.  No pre-existing medical history. UTD with Nexgard Spectra. Current meds: Nil Prophylaxis: UTD with Nexgard SpectraPre-existing conditions: Nil Access to toxins eg. Rodenticide: Nil TRIAGE: HR: 110RR: 28Temp: 38.8Mm: Pink, moistCrt: <2sMentation: BARPain Scale (0-4): 0Hydration status (%): EuhydratedEXAMINATION:Body Condition Score: 5/9Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait. Full neurological exam not performed. Musculoskeletal: Ambulating normally, no palpable neck, spine, limb or joint pain. Full MSK exam not performed. Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  1- Abdominal: no detectable pain on abdominal palpation- Rectal: no detectable abnormalities, faeces: empty rectum, light brown faeces on rectal exam Urinary: Small bladder on palpation Reproductive (incl ext genitalia): Entire male, normal conformation. Both testes descended. Integument/Ears: No alopecia or erythema. Ears free from discharge bilaterally. Lymph Nodes: Peripheral lymph nodes normalEyes: Clear and bright bilaterally PROBLEM LIST: Diarrhoea Single acute vomit (resolved)DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS: Differentials for acute diarrhoea:Gastrointestinal causes such as  dietary indiscretion, IBD, toxin ingestion. infectious causes (parvovirus, coronavirus Campylobacter, Salmonella spp, Clostridium spp. E. coli etc). and  parasitic causes eg. worms, Isospora spp, Cryptosporidium spp, Giardia spp . Other GI causes would include a partially obstructed or linear foreign body, or an intussusception. Non gastrointestinal causes of diarrhoea  (other signs usually present, diarrhea often mild), would include acute pancreatitis, hepatic/ renal disease, hypoadrenocorticism, Canine distemper, Infectious canine hepatitis .DIAGNOSTICS:None performed-recommended full bloods and fecal testing if diarrhoea persists or becomes profuse and liquidy or develops blood TREATMENT:Prokolin Paste: 3mls PO BID. Administered first dose in consult room with owner. PLAN:Monitor at home-if any deterioration or if diarrhoea becomes profuse and liquidy then recheck with AES or regular vetCLIENT COMMUNICATION:In consult-Discussed causes for diarrhoea (intra gastrointestinal vs extra gastrointestinal). Vinnie had a normal stool in the carpark and was bright and otherwise well. Still eating and drinking. Offered full bloods and fecal testing to rule out underlying causes for diarrhoea. Owner declined at this stage due to diarrhoea improving. Dispensed prokolin and administered first dose and recommended continuing with bland diet until diarrhoea resolves. Owner was happy with this plan. If any deterioration occurs within the next 24-48 hours then will recheck with AES for further workup.    Vital Signs