C10024872 / invoice 10000

PRESENTED FOR : Sudden onset of haemorrhagic vomiting and diarrhoea

DIAGNOSTICS DONE: Blood test

DIAGNOSIS: Gastroenteritis. Gastroenteritis can be due to changes in diet, eating garbage/compost or something that may be a bit off or too rich at the time. It can also be caused by viruses, rarely due to bacteria causes and can also be due to other underlying chronic and recurring causes such as inflammatory bowel disease, allergic enteritis or Addisons's disease.

TREATMENT: Intravenous fluids, initial pain relief and anti-nausea medication whilst in hospital with a good response to treatment. Now eating both chicken and the low fat Hills i/d diet with no further vomiting.
There is often still some ongoing loose stool over the next 1 to 2 days which should resolve over the next couple of days.

MEDICATIONS AT HOME:
1. Ondanestetron anti-nausea wafers - give one wafer morning and night if see signs of vomiting, regurgitation or inappetence - will dissolve in mouth and does not need to be swallowed.
2. Paracetamol /panadol (pain relief for mild to moderate pain and fever) can be used twice daily if pain suspected.
3. Gabapentin is a drug that acts on the central nervous system and can be used for pain relief and to control seizures and nerve pain. It can cause drowsiness, dizziness and loss of coordination in some animals. Please give as directed.

CHANGES DIET/EXERCISE/ONGOING CARE: 
We recommend feeding a bland diet for the next 5 days. When constructing a bland diet, the general rules are to avoid raw meat, unwashed vegetables, rich or high fat food. People will often used poached (boiled) chicken, with the fat trimmed off, and cooked white rice.

BANDAGES/PAIN PATCH/ELIZABETHAN COLLAR: 
There may a light bandage on the front leg from where the intravenous canula was removed prior to discharge - if this is still present please remove it once you are at home.

CLIENT HANDOUT PROVIDED: A handout on haemorrhagic gastroenteritis has been included.

******************DAY SHIFT UPDATE****************
PROBLEM LIST: AHDS 

CLINICIAN: JG 

EXAMINATION:
QAR, MM tacky, pink, CRT <2, HR 144-164, resp NSF. Abdomen mildly tense, improved with analgesia. 
Ongoing strawberry jam D+ in morning, tending to brown smears in afternoon. No interest in food. No V+. 

DIAGNOSTIC TESTS: nil 

ASSESSMENT:
AHDS

PLAN:
Continue supportive care, hold on further investigation for financial reasons 
LRS 10 mL/kg/h through day then reduced to 5 mL/kg/h
Maropitant IV q24, Paracetamol PO BID

CLIENT COMMUNICATION:
O cost constrained though has insurance. Initially planned to d/c this afternoon, so aggressive fluid therapy implemented. 
Reevaluated at discharge appointment, O comfortable to keep in hospital overnight with pre approval. 

OWNER UPDATED re ACCOUNT: Y 
CURRENT ACCOUNT BALANCE: $170


******************NIGHT SHIFT UPDATE****************
CLINICIAN: CX
EXAMINATION:
- Very BAR. 
- Eating chicken well if hand fed
- MM pink and moist, CRT<2s.
- Chest auscultation nad. Comfortable with abdominal palpation 
- Still developing smears of diarrhoea but not haemorrhagic anymore - yellow to brown. 

DIAGNOSTIC TESTS: 
PCV/TP 38/54

PLAN:
- IVFT 5ml/kg/hr as planned
- maropitant IV q24, ondanstron PO q12 if required
- paracetamol PO BID
- gaba 100mg PO BID

Discharge Criteria
- Vomiting and diarrhoea under control
- Eating without assistance
- Clinically bright

CLIENT COMMUNICATION: Nil overnight

DATE/TIME of CONSULTATION: 01:47hrs, Thu 12/03/26
CLINICIAN: CX
PRESENTING COMPLAINT: haematoemsis
HISTORY:
- Tonight O waked up and noticed she was vomiting blood on the bed, more lethargic than normal
- She also had haemorrhagic diarrhoea when she arrived
- She seemed a bit constipated yesterday.
- UTD with vaccination and deworming
- No potential access to rat bait or other toxins. Carer sometimes took her out for walk and not sure whether she ate something outside. 
- No other medical history. EDDU all normal before today
- Not on any medications

CLINICAL FINDINGS: 
Mentation: QAR HR: 150 RR: 24  MM: pink and moist  CRT: <2s  Temp 38.1. 
- Clear eyes, nose and ears.
- No obvious skin tent
- Heart auscultation nad, no audible murmur or arrhythmia
- Normal respiratory rate and effort, clear BV sound
- Abdominal palpation tense in all quadrants
- Peripheral LNs wnl
- Showing haemorrhagic diarrhoea in consult
- Skin nad
- MSK nad

PROBLEM LIST: Haemorrhagic diarrhoea and vomiting
DIFFERENTIALS: HGE vs toxin vs parasite vs liver vs pancreatitis vs addison's vs coagulopathy vs others

OPTIONS PROVIDED:
1) hospital admission + blood + supportive care + imaging if required
2) outpatient management with blood tests
3) outpatient management with medication trial only
Will go ahead with option 1

DIAGNOSTIC TESTS:
PCV/TP: 57/60
EPOC: Glu 7.1, Na/K ratio 37.4, unremarkable

TREATMENT:
- IVFT 2x maintenance then adjust based on ongoing losses
- maropitant injection 1mg/kg given
- buprenorphine 0.3mL given

CLIENT COMMUNICATION/PLAN:
- Will do supportive care tonight and discuss plan based on her response. O may consider transfer to reg vet if stable enough.