C10029788 / invoice 10000

Laboratory: Blood Gas 
---------------
Dog Venous **
A. Gases:
pH:   7.387   (7.350-7.450)
pCO2:  39.0 (35.0-38.0 mmHg) *H
pO2:    48.6 (85.0-100.0 mmHg) *L
cHCO3-:  23.5 (15.0-23.0 mmol/L) *H
BE (ecf):   -1.6(-5.0-0.0 mmol/L)
cSO2:   83.6(90.0-100%) *L

B: Chem:
Na+:  149   (139-150 mmol/L)
K+:     4.4  (3.4-4.9  mmol/L)
Ca++:  1.38  (1.12-1.40 mmol/L)
Cl-:    115 (106-127  mmol/L)
TCO2: 22.6  (17.0- 25.0 mmol/L)
Hct:     44 (35-50%)
cHgb:    15.1 (12.0-17.0 g/dL)
BE (b):    -1.4 (-5.0-0.0 mmol/L)

C: Meta:
Glu:   5.3   (3.3-6.4  mmol/L)
Lac:    1.53  (0.60-2.90 mmol/L)
BUN:   14 (10-26 mg/dL)
Urea:   5.1 (3.6-9.3 mmol/L)
Crea:    117 (44-115 umol/L) *H
BUN/Crea:  10.9 (0.2-400.00 mg/mg)

---- ASSESSMENT
- normal blood pH, on acidic side - Resp acidosis, metabolic alkalosis
- electrolytes all normal, no lactate increase

- to proceed with imaging

----- ORTHOGONAL ABDOMINAL RADIOGRAPHS
- gas filled caecum
- colon full of poop with mineralised bits (likely bits of toy and foerign material) - soft (if a little dry) on rectal exam
- no apparent obstruction at present, reflected by bloods

PLAN
- fluids, pain relief, antiemetic and going to FEED (any diet restrictions) to get things moving
- Ideally going to take big POO
- if bright and happy - to go home and monitor. If further vomiting - will need U/S

RELAYED TO O - yes - MA spoke to Sarah 12:50pm 13/3/26
- O went out and bought another of toy torn up today - squeaker is HUGE. Not seeing bubble on radiographs (only gas fileld region = caecum) however possible to have been torn to bits
- O happy with plan - P to stay for afternoon for pain relief, fluids. Very happy no overt concern for obstruction and aware that, if continuing to vom, U/S indicated (discussed emergency)

------ 15:30pm
- P had Large solid poo on walk outdoors - several pieces of green plastic found in (overall very dry crumbly) faeces
- repeated radiographs - sedated with 0.01mg/kg medetomadine IV + propofol PRN
- No gas building up, significant amount of faeces in colon evacuated
- concern that MAYBE there may be matieroial in stomach - if OKAY, can get u/s with Dr Kerri next week - OTHERWISE EMERGENCY if any further ovmiting for abdo U/S and possible ex lap

- partially reversed with 0.1ml atipamizole

Reason:   Vomiting up toys
History: 
- vomited yesterday - found tiny bit of a toy. Had been eating, pooing, playing like normal
- was playing this morning with little brother Bailey - Toy had a squeaker BUT when P tore toy was taken away. Squeaker not found anywhere

- vom - 2x this morning - once with parts of (different, green) toy, second vom JUST liquid
- poos have been normal (as of yesterday - had a bit of green toy in it) but none so far this morning

- tears things up BUT not a typical one to eat them

EDUD - Appetite not eating this morning, water intake normal

Current medications: 
- none

Examine: 
Mentation: BAR
Body condition score:  3/5
MM: pink, mild tachy                CRT:  1sec
HR:  60              RR:  WNL
LN: NAD
Temperature: 38.0

Ocular: clean, clear of discharge, good tear film
Oral/Dental stage: 1/4
Ears: clean, clear of discharge
Cardiovascular: no murmur or arrhythmia, no tachycardia
Respiratory: normal adventitious lung sounds - no crackles or wheezes
Gastrointestinal: 
**** mild tension cranial abdomen, no over pain/fluid, no FB palpable
- gut sounds present but quiet
Integumentary & lumps (measurement, location): clean coat, nom inflammation or lesions
- appropriate skin tent
Musculoskeletal: ambualting on lal 4 limbs, no ataxia, full MSK exam not perfomredf
Urogenital: ne
Neurological: no nystagmus, strabismus or ataxia, full neuro exam not performed

Problem List:
- foreign body ingestion - bringing up bits of foreign body
- vomiting
- 5% dehydration

- concern for intestinal obstruction

Assessment: 
- discussed imaging and blood gas with O - if necessary many be requiring surgery. Discussed depending on location if FB assessed radiographically - possible to pass by itself, but concern being if positioned orally to ileocolic junction
- has been estimated for pain relief and fluid therapy as needed

PLAN
- admit for imaging (GA) and bloods, supportive care

Reason:  
History: 
Check ears
Family was up in Kalbarri, not sure if something blew in. Have noted scratching L ear and shaking head. Doesn't seem bothered by the right side.
Not as offen but every now and then will scratch
First noted last week.
No known ear infections previously. 

EDUF normal, no V+/D+

Current medications: none 

What Preventative health cover is being used and do you need to purchase any today? nexgard spectra UTD

Examine: 
Mentation: BAR
Body condition score: 5/9
MM:     PM           CRT: <2s
HR:           100     RR: wnl
LN: wnl
Temperature: ne

Ocular: nad
Oral/Dental stage: grade 1
Ears: no inflammation or discharge either ear, TM intact, no FB present, very mild amount of waxy debris in the left ear
Cardiovascular: no murmur or arrhythmia
Respiratory: normal lung sounds
Gastrointestinal: soft and comfortable
Integumentary & lumps (measurement, location): nad
Musculoskeletal: nad
Urogenital: nad
Neurological: nad
 
Assessment: 
Ear exam clear - no obvious sign of infection.
Offered to do ear cytology, owner declined for now

Treatment: 
Owner to clean with gentle ear cleaner twice this week and monitor.

Plan: 
If still bothered by ear then revisit and consider ear cytology

On-going medications required: Y/N (use prescription tab for further supply):

Followup: