C10024095 / invoice 10000

Reason: Suspected ToadAppointment Notes: Special payment terms exist**History: **- Presented for frothing on one side of the mouth, and acute onset ataxia- Owner noted these signs after the dog was in the backyard.- There are toads in the backyard, and there is a history of chasing toads- toads have not been seen today- The dog is usually very active but became weird and wobbly on his feet. The signs were transient, and he had partially recovered before presentation.- Current on flea and tick prevention.- On paroxetine for anxiety, currently weaning off (quarter tablet every second day for almost two weeks).- Diet consists of boiled chicken breast, Hills brand pellets, and dehydrated chicken tenders.- Appetite has been normal.- History of killing birds and a possum.- Has had similar episodes after chasing toads previously.- Owner reports diarrhoea at home.**Subjective: **Mentation: BAR (Bright, Alert, Responsive) but noted to be very anxious and scared in the hospital environment.Temperment: Anxious, fearful.**Objective: **HR: 140RR: pantTemp: 40.0°CMM: Pink, not injected.PP: Strong and synchronous.Cardiovascular: Cardiovascular auscultation normal, no audible murmur or arrhythmia. Mucous membranes pink, peripheral pulse strong and synchronous.Respiratory: Bronchovesicular sounds normal and symmetrical. No overt upper respiratory noise.Neurological: BAR.  No overt neurological abnormalities observed in consultation. Facial nerve function appears normal. Full Neurological exam not performed.MSK: Ambulating normally, no overt lameness/ muscle atrophy.Gastrointestinal:  Rectal examination revealed diarrhoea. Abdominal palpation was soft with no overt pain or palpable abnormalities. Flatulence noted.Oral: No temporo-mandibular pain, Dental score: 1/4Eyes: Palpebral and menace normal. Bright and open. Full ophthalmic exam not performed.Ears: Normal external ear canal, no abnormal odour or debris. Membranes not visualised.Integuments: No evidence of pruritus or alopecia, coat full and appears healthy.Lymphnodes: normal size and consistence of on palpation.**Problem List: **- Hyperthermia (40.0°C)- Acute onset of neurological signs (ataxia, head pressing) and hypersalivation, now resolved.- Diarrhoea- Anxiety**Differentials: **- Toad toxicity- Snake envenomation- Other toxicity- anaphylaxis **Diagnostics: **Tfast: pericardial site: nsf Left hemi: a lines present Right hemi: a linesAfast: cc-0 ns-0 hr-0 dh-0 0/4ff PT aptt WNL **Assessment: **Stable.Suspected toad toxicity.produced copious amounts of brown diaherra in hospital **Client communication:**- Discussed the presenting signs of hypersalivation, ataxia- Informed the owner that clinical signs are suspicious of toad toxicity, although not classic as mucous membranes were not injected (brick red).- Advised that a focused ultrasound scan of the chest and abdomen would be performed to rule out other issues such as aspiration.- Discussed the plan for further diagnostics including blood gas analysis and coagulation times to rule out other causes like snake bite and to assess overall stability.- Discussed the finding of hyperthermia.- Agreed upon plan for diagnostics and supportive care.**Plan: **- home for obvservaiton - to come back with any changes in gait, lethargy, vomiting or worsening diaherraTreatment: Maropitant 1mg/kg IV    Vital Signs