C10024182 / invoice 10000

Reason: Eaten Hot Cross BunsHistory Summary:Presented for ingestion of half a hot cross bun containing sultanas less than 30 minutes prior to arrival. The owner reports that the bun was left on a surface, and the patient consumed it when the owner turned away. There has been no vomiting or any clinical signs at home. The patient has a known history of Chiari malformation and is on long-term medication including gabapentin and Losec, as well as an allergy medication. There are no other concurrent clinical concerns reported by the owner.TRIAGE:HR: 120 bpmRR: 24 brpmTemp: 38.1°CMM: Pink & moistCRT: 1-2 secondsMentation: BAR and anxiousPain Scale: 0/4Hydration status (%): Clinically hydratedEXAMINATION:Body Condition Score: 6/9Cardiovascular: 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 performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: NSF- Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Raisin/Sultana toxicity (ingestion of hot cross bun)2. Known Chiari malformation (chronic)DIFFERENTIAL DIAGNOSIS:Potential for acute kidney injury secondary to raisin/sultana ingestion.DIAGNOSTICS/MANAGEMENT PLANInduce emesis to decontaminate.Administer activated charcoal to bind any remaining toxins.Advised owner on monitoring for clinical signs of renal failure such as lethargy, inappetence, and vomiting.Recommended a renal blood panel check with their regular veterinarian in 48 hours to assess kidney function.Nil diagnostics performedTREATMENT SUMMARY:Apomorphine 3.75 mg TM administered to induce emesis. This was successful, with hot cross bun material observed in the vomitus.Metoclopramide 0.5 mg/kg SQ was administered as an antiemetic following emesis.Meds TGH:- Activated charcoal with sorbitol 5 mL/kg to be administered on arrival at homeOWNER COMMUNICATION:Discussed the nature of raisin and grape toxicity, explaining that the toxic dose is unknown (estimated at 1 grape/raisin per 5 kg) and any ingestion is considered potentially serious, with the primary risk being acute kidney injury. Explained that decontamination via induced emesis was successful but is never 100% of stomach contents, usually 50-80%. Advised on the administration of a single dose of activated charcoal at home to help reduce absorption of any remaining toxins. It was explained that this will cause black stools for a few days. The owner was counselled on the clinical signs of kidney failure to monitor for at home, including lethargy, vomiting, and anorexia. The importance of a follow-up blood test in 48 hours to check renal function was stressed, and it was advised this can be performed at their regular veterinary clinic.PLAN:Discharge home with activated charcoal (5 ml/kg PO) to be given as a single dose as soon as possible.Monitor closely at home for any signs of illness.Follow-up blood test (renal panel) in 48 hours is strongly recommended.Return immediately if any signs of vomiting, lethargy, or inappetence develop.For any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs