C10023914 / invoice 10000

Appointment Notes: Gastro ***RECORD INCOMPLETE***GapOnly  - vomitting ,D++ , diabetic and increased ketones Pet primary diagnosis/suspected diagnosis:gastro and Diarrhea with diabetic increased ketones complications Suspected cause: infectionAny other conditions being treated (if any):noKnown health concerns:diabetic Date of first clinical signs (if known):12.03.2026SubjectivePresenting Concerns:  Henry Brown, an elderly male dog, presented for acute vomiting. The owner reported that the other dog in the household, Buddy, is also experiencing similar signs of gastroenteritis.    Historical Conditions:-   Diabetes mellitus, managed with daily Toujeo insulin.-   History of diabetic ketoacidosis, but is reportedly well-controlled currently.-   History of pancreatitis.  Diet/Appetite:-   Fed an exclusive kangaroo-based diet.-   Not eating much due to the current illness.  V/D/C/S:-   The owner first noticed Henry making funny noises and shivering at approximately 3:00 am this morning.-   By 6:00 am, there was vomit found everywhere.-   He vomits every time he drinks water.-   The owner observed sand in the vomitus.-   No diarrhoea has been reported yet.  Current Medications:-   Receives Toujeo insulin daily. The morning dose was administered.-   A continuous glucose monitor is in place, which is reportedly reading high.  Lifestyle Risk Factors:-   The backyard is undergoing renovation, and the patient was observed ingesting sand while attempting to eat grass.-   The patient was at a grooming facility 5 days prior to the onset of signs.ObjectiveMM: dry. CRT < 2sec.  Hydration:dehydrated.    Emotional Assessment: Stressed in the clinic environment.    Rectal: A rectal examination was performed; no sand impaction or other abnormalities were palpated.AssessmentAcute gastroenteritis – DDx: Infectious agent (viral/bacterial), foreign material ingestion (sand), pancreatitis flare-up. The concurrent illness in the housemate and recent visit to a groomer raise suspicion for a contagious cause.   Diabetes mellitus with hyperglycaemia – The patient's diabetes is dysregulated due to the acute illness, placing him at a high risk of developing diabetic ketoacidosis.    Mild dehydration – Secondary to persistent vomiting.PlanPending Diagnostics:-   Blood ketone and BG and electrolytes  levels will be measured to assess for diabetic ketoacidosis.  Medications/Treatments:-   The owner consented to hospitalisation for the day for supportive care.-   An anti-nausea injection will be administered to control vomiting.-   Intravenous fluid therapy will be initiated to correct dehydration and provide support.  Additional Discussion:-   The significant risk of Henry developing diabetic ketoacidosis as a complication of his current illness was discussed in detail with the owner.-   The goal of hospitalisation is to provide aggressive supportive care to prevent this progression.-   An update on Henry's condition will be provided to the owner in a few hours.-   If he responds well to treatment, he will be discharged this evening around 5:30-5:45 pm. If his condition does not improve, transfer to an emergency facility for overnight care may be necessary.UPDATE Ketones borderline at 0.3mmol/L, BG high at 17.7actrapid insulin given at 0.5IU IM and IV hartmans D+++ started once hospitalisedNo further vomitting IV metronidazole given as small blood specks in D++ and immunocomprimised BG down to 6.2mmol after Actrapid IM , brighter and now eating Ketones still 0.3mmol but not increasing (takes longer to decrease)Elecrtolytes, Pottassium wnl and Chloride slightly low 2:30pm once glucose dropped ate small bowl of warmed kangaroo prime 4pm, ate more food , BG 6.3 and ketones now normal at 0.2mmol/L yay Home with close monitoring and small meals of food     Vital Signs    Weight: 3.84;