C10025901 / invoice 10000

Reason: Haemorrhagic D+/ VomitingHandover: Started having diarrhoea since monday Hemorrhagic diarrhoea short period of timeStarted on prokolin and metronidazole --> slight improvement Yesterday morning did not want to eat and vomiting continuously On presentation estimated 7% dehydration Abdomen comfortable ADHS vs pancreatitis Local vet workup vs trial at home? Bloods boring - ALT--- 13/03/2026 10:30:03 AWC:Attempted to call owner but no answer--- 13/03/2026 11:14:22 AWC:STO and advise lassie is doing well. Has not had any further vomits but has continued to have diarrhoea. Advise have no attempted to offer any food as kept NPO in case any investigation is elected to be conducted. Gave owners the following options:1. Conduct either US or  x-rays to assess abdominal cavity 2. Continued hospitalisation 3. Trial at home given otherwise bright demeanour.Reiterated to owner with diarrhoea they can require an extensive amount of time to resolve but if able to eat and otherwise stable can be managed at home. Owner elected to submit preapproval for insurance prior to making any further decisions    Vital Signs    

Reason: V++, Lethargic - HPP MemberHistory:- 8-year-old female poodle presented with diarrhoea for several days, now vomiting and lethargic today.- Ate a small amount yesterday, nothing this morning.- Initially had liquid diarrhoea on Monday, progressed to haemorrhagic D+ managed with Prokolin and Flagyl- Vomiting started after receiving Flagyl this PM, now not drinking > not keeping anything down since 17:00- Previous similar episode in 2020/21 with vomiting and bloody diarrhoea, full workup was negative, resolved with supportive care.- Diet at home is Hills Biome + boiled chicken; receives milk treats and dental treats.- Parasite control: utd- Pre-existing conditions: none discussed- Current medications or supplements: Flagyl, Lectade, Prokolin- Owner concerns: small bump on tail, blue dots in ear, increased licking of paws recentlyPhysical Exam:Body Condition Score: 5/9GENERAL: BAR, tacky mucous membranes with skin tent est 7-8% dehydrationHEART: HR: 144 bpm - regular heart sounds, no murmurs or arrhythmias detected, pulses strong and synchronousRESP: RR: 28, lung fields clear on auscultation, no crackles or wheezes, normal respiratory effort, no nasal dischargeEARS: responsive to auditory stimuli, unremarkable EYES: visual with no cloudiness, redness or ocular discharge OUABDO: comfortable on palpation, no organomegaly or masses palpated, unremarkable LYMPH NODES: no peripheral lymphadenopathy on palpationMSK: ambulatory on all four limbs, no lameness observed, good range of motionINTEGUMENT: mild interdigital erythaema, mostly unremarkableAssessment:- Lassie is presenting with non-specific signs of vomiting and nausea, recent diarrhoea/haemorrhagic diarrhoea. Given she is now not eating or drinking, hospitalisation for IVFT is recommended to prevent her 7-8% dehydration progressing to hypovolaemic shock. - Suspect acute haemorrhagic diarrhoea syndrome (AHDS) vs pancreatitis vs sequellae of dietary indiscretion; cannot r/o endocrinopathy vs mechanical ileusClient Communication:- Recommend IV fluids overnight and baseline bloodwork .- Consider adding CPLI to blood work to check for pancreatitis.- Holding metronidazole overnight to allow local vet to decide on continuation due to potential nausea.- Financial discussion: estimate for IV fluids overnight with basic blood work is approximately $1,500; full blood work with abdominal X-rays approximately $3,000. Owner has insurance and will proceed with overnight IV fluids and blood work.- Follow-up with local vet recommended.- Owner counselled on AHDS, pancreatitis, endocrine issues, and foreign body obstruction.- Counselled that if the problem has not resolved, signs may recur in 24 hours, necessitating follow-up.- Discussed possibility of increased licking due to seasonal atopic dermatitis.Laboratory:Packed cell volume 56 (37 - 55 %): Total protein 80 (55 - 75%): Serum colour: clearElectrolytes, metabolites, acid-base, blood gas & oximetry (Radiometer panel)Canine:		Sodium		146 (137 - 150 mmol/L): Potassium	3.4	 (3.3 - 4.6 mmol/L): Chloride		112 (105 - 120 mmol/L): Ionised calcium	1.21	 (1.25 - 1.50 mmol/L): Lactate		1.0 (0.0 - 2.5 mmol/L): Glucose		5.7 (3.3 - 6.4 mmol/L): pH		7.414 (7.350 - 7.460): pCO2		38.1 (38 - 47 mmHg): SBE		-0.2 (-4.0 - 4.0 mmol/L): HCO3		24.3 (18 - 24 mmol/L): Anion gap	13.7	 (12 - 24): Venous		PvO2		39.2 (54 - 65 mmHg): PvCO2		38.1 (38 - 47 mmHg): ctHb		17.6 (11 - 18 g/dL): sO2: 		73.9FO2Hb: 		69.5FHHb: 	                24.6FMetHb: 		1.5FCOHb: 		4.4CHEM 17 unremarkable		> CPLi not performed given test unavailable in hospitalAFAST: no FAF, no mass effect, no apparent intestinal motilityOscillometric BP 143/115 (120) > following 400ml fluid replacement IVTreatment:Maropitant 1mg/kg IVHartmanns 10ml/kg bolus followed by maintenance + 7% rehydration plan over 12hrPlan:Transfer to rDVM in morning for continued workup with option remaining to proceed with abdominal radiographs, CBC +/- referral with ARH    Vital Signs