C10029868 / invoice 10000

HISTORY: Presenting Complaint: Abdo pain, PUPD

Regular vet: Comet Bay 

History: 
Owner has noticed Diesel has been very sensitive when owners are picking up/holding. This has been getting worse for the last month. Tried to bite owner yesterday when she pushed him to the side. 
Has had MCT's removed 8 years ago. 
Umbilical hernia surgery when puppy - re opened so rpt surgery using wire?
Drinking increased in last few wks, similar timeline to pain. Abdo also incr in size
Changed biscuits from holistic to BeFrank several mnths ago


Appetite: Normal 
Water intake: Excessive drinking 
Urination: More frequent - wears a nappy at night - owner says can't hold urine all night 
Faeces: Normal
Energy levels: Normal
Coughing or sneezing: Nil
Vomiting: Nil
Diet: Be Frank biscuits
Parasite Control: UTD
Vaccination status: UTD
Current Medications: Cardisure

Observation:
EXAMINATION
Demeanour: BAR
BCS: 5.5/9
Integument: Mild umbilical hernia with palpable corrective material, no reaction to palp, rest NAD
Eyes: NAD
Ears: NAD externally
Nose: NAD
Mouth: NAD
CRT: 1-2s          
MM: pink
Dental disease: Grade - 3/4
HR: 120  BPM,    Rhythm: reg reg, SSFP, G 4/6 HM
RR: Panting, no incr lung sounds between
Temp: 38.8  C
Peripheral LN's: wnl
Abdomen: Mid-cranial abdo pain
Musculoskeletal: Ambulating on all 4 limbs, mild TLJ pain and sacral pain, reduced hip RoM bilat L>R with L G2/4 MPL
Neurological: NAD
Urogenital: Desexed
Rectal: formed F+, rest NAD

Assessment:
Abdominal pain
PUPD

Client Communication:
Disc bloods v FAST scan, warned user limitations and possible need for sedation/analgesia. Adv alternatively pain trial and RV UP for bloods. O consented to bloods and analgesia

Plan: 
15ug/kg bup IM
WEIGHT: 8.80

HISTORY: History:
Got into 10 x 1.25mg cardisure tablets about 2.5 hours prior to arrival. No vomiting or any other signs as of yet
Had his usual dose this morning 
On pimobendan 1.25mg PO BID
No other concerns

Observation:
Mentation: BAR
MM: Pink moist
CRT: <2
LN: WNL
H/L: Grade 3-4 Heart murmur. No arrhythmias auscultated
HR: 124
RR: 32. Normal lung sounds 
Abdo palp: NAD, comfortable
MsK: weight bearing on all 4, no limp
Skin: NAD
Temp: 38.6

Assessment:
1) Ingestion of cardisure tablets
Approx 12.5mg total 

Plan: 
0.7ml apomorphine subcut @ 7:30pm - some specks of tablets in vomitus, continued to vomit bile
0.5mg/kg metoclopramide subcut 

Monitored in hospital for next hour - no concerns
HR remaining around 120
Normotensive: SYS/DIA = 135/89. MAP =103

Offered monitoring overnight in hospital but O happy to monitor at home
To monitor at home and any concerns RV for hospitalisation
To skip tomorrow morning dose of cardisure but continue again from tomorrow night