C10024102 / invoice 10000

Reason: Allergic ReactionHISTORY:Pepper presented for a suspected acute allergic reaction. The owner discovered urticaria ("lumps") on the skin this morning and visited the regular veterinarian. At the regular vet, Pepper received a chlorpheniramine injection, which temporarily resolved the clinical signs. The regular vet sent Pepper home with oral antihistamines, but none were administered by the owner. The urticaria recurred this afternoon, prompting presentation here. There have been no associated episodes of vomiting or collapse.Specific History Questions:- Vomiting: Nil v+/r+- Mentation/Behaviour: Energy levels normal- Defecation: Had diarrhoea this morning.- Urination: U+ wnl- Diet & Appetite: The only new dietary item was psyllium husk given last night for additional fibre.- Drinking: Drinking normallyCurrent meds:- Continuing treatment with toltrazuril for coccidia. Was previously on denamarin for liver support but this has been discontinued as the liver panel was normal today.Prophylaxis: unknownPre-existing conditions:- History of allergies to cephalexin.Toxins: nil access to known toxins including cycads, lillies baits, molds, medications or other known toxic plants.- Regular vet visit today (10/03/2026): Administered chlorpheniramine injection for urticaria. An ultrasound at the regular vet showed mild gallbladder oedema.Triage:HR: 120RR: 28Temp: 38.9 Mm: pinkCrt: 1-2secMentation: BAREXAMINATION:Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Mentation appropriate. Full exam not performed.Musculoskeletal: ambulating normally x4, nil back/neck painGastrointestinal:- Oral: NSF, dental score 2/4)- Abdominal: comfortable- Rectal: Not performedUrinary: nsfReproductive (incl ext genitalia): NSFIntegument/Ears: Urticarial lesions present on presentation, which improved significantly after treatment.Lymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Acute urticaria, likely secondary to an allergic reaction.2. Diarrhoea.3. Coccidiosis (under treatment).DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Acute allergic reaction (urticaria): Differentials include insect bite (ant, wasp, bee), contact allergy, food allergy (psyllium husk), or drug reaction.2. Diarrhoea: Differentials include allergic reaction (e.g., insect bite), dietary indiscretion, or infectious cause (coccidia).DIAGNOSTICS:- Blood pressure was measured and was within normal limits. Two readings were taken: 155/91 mmHg (MAP 106) and 151/72 mmHg (MAP 90).- Administered 1mL of an antihistamine injection IM. The urticaria showed significant improvement within 30 minutes post-injection.Systematic Abdominal UltrasoundHepato-Biliary System (Liver, Gallbladder):- Gall bladder: Mild gallbladder wall oedema noted. No free fluid observed around the gallbladder.Interpretation:The finding of mild gallbladder oedema is consistent with a systemic inflammatory or allergic process. No other significant abnormalities were detected.ASSESSMENT:Pepper presented with acute urticaria and diarrhoea, consistent with an allergic reaction. The urticaria responded well to antihistamine treatment. An abdominal ultrasound revealed mild gallbladder oedema, which can be associated with anaphylactoid reactions. The patient is currently clinically stable.TREATMENT (Fluid Therapy & Medications refer to Smartflow):- Administered 1mL of an antihistamine injection IM. The urticaria showed significant improvement within 30 minutes post-injection.PLAN:- Continue to monitor for recurrence of urticaria.- Continue toltrazuril for coccidiosis as prescribed.- Discontinue denamarin as liver values are normal.- The owner can administer cetirizine (Zyrtec) 10mg every 8-12 hours if the urticaria recurs, though it is not expected to be necessary as the signs have significantly improved. Re-assess in 8 hours and administer only if lumpy/bumpy skin returns.- Monitor for any worsening of clinical signs. The current allergic reaction is expected to resolve.CLIENT COMMUNICATION:The owner was updated on Pepper's condition. It was explained that the urticaria and diarrhoea are likely due to an acute allergic reaction. The possible triggers, including insect bites, contact allergens, or the recently introduced psyllium husk, were discussed. The positive response to antihistamine treatment was highlighted. The finding of mild gallbladder wall oedema on the ultrasound was explained as a sign consistent with a systemic allergic response.The plan to monitor at home and administer cetirizine only if the skin lesions recur was discussed. The owner was advised to continue the coccidia treatment and to stop the liver support medication. Instructions were provided to seek further veterinary care if Pepper's condition deteriorates.--------------------------------------------------------------------------------    Vital Signs