C10031186 / invoice 20000

Reason: Ibuprofen ToxicityConsult Time: History: Subjective: Objective: Temp            MM              CRT             HR             FPCV:  NADRESP:   NAD           RRGIT:   NADU/G:  NADNeuro:  NADM/S:  NADInteg:  NADOphth:  NADAssessment: Plan: Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No    Vital Signs    

Reason: Ibuprofen ToxicityHospital: 1830-0700 Friday History:Peanut has been hospitalised for ibuprofen toxicity. Today is day 8 of hospitalisation. See previous entry for more details. Had a hepatopathy and azotaemia during duration of stay but as of today, hepatopathy has resolved though remains azotaemic.Last urea was 15 (was 16.2 previously), Crea 214 (was 147 previously). Plan for ongoing supportive care and repeat biochemistry q24. Has marked perianal scalding and requires sedation for bum cleans. Examination: Demeanour: BARVitals: HR=PR=140  , mm pink, CRT  <2 sec, RR 36, Temp 37.6*C CVS: NAD on auscultation. No murmurs or arrhythmias noted. Pulses normal. Resp: NAD on auscultation. Normal bronchovesicular sounds. Normal respiratory effort and character at rest.Abdo: comfortable on palpation. UG: scalding has improved. Tolerating flamazine cream. MSK: normal gait. EENO: NADL/N: peripheral lymph nodes WNLIntegument: NADNeuro: No cranial or peripheral neurological deficits noted.Hydration: No clinical evidence of dehydrationNausea: None seenNutrition: eating puppy kibble well Urination: UOP: 6-7.14ml/kg/hr Defecation: passing jelly like soft stools with no blood Assessment: 1. Suspect renal insufficiency secondary to ibuprofen ingestion (~5600mg/kg)A: Remains bright and eating overnight though UOP remains high. Suspect will have renal insufficiency for life. Treatment:1. Esomeprazole 1mg/kg SIV q12 - discontinued2. SAMe 1 tab PO q24 3. Peptosyl 1ml PO q8 4. Methadone 0.2mg/kg IV PRN q4-6 5. Fentanyl 6ug/hr patch active from 0100 6. Pro-kolin 2ml PO q12 7. Ondansetron 2mg PO q12 Plan: Repeat biochemistry in the morning.Potential discharge pending results. Client Communication:--- 14/03/2026 04:55:15 VLI:Sent text. Hi Jessie, Peanut has been bright and eating overnight. His stools are also starting to firm up. His urine output is still very high despite not being on fluids which is still slightly worrying. We will ring you after his bloods this morning. Warm regards, AEC Woolloongabba.    Vital Signs    

Reason: Ibuprofen ToxicityHospital Time Period: 0630-1900History: see previous for full hx Hospitalised since last Friday for ibuprofen toxicity (~ 500mg/kg dose) Has had gastroenteritis + hepatopathy + AKI Have been improving in hospital - still passing small amts of soft D+ - liver values normalised- creatinine yx at 146 (improved) - electrolytes normalising - eating in hospital - fluids weaned down - UOP still high Subjective: QAR Objective:BCS:    3/9                Wgt:  4.2  kg Pain Score (CSU):   1/4CV: NMA - no obvious arrythmia  RESP:     clear bronchovesicular sounds bilaterally       GIT: comfortable on palaption U/G: clean - passed small blobs of dark D+. TenesmusNeuro: normal mentation M/S: ambulatory Integ: clean - perinanal scalding - still sensitive and reactive but improved from last 48 hrsOphth: clear LNs: normal in size and consistency Eating puppy biscuits and wet gastro food when offeredINTERNAL LABORATORYPCV/TS:38/62	Biochemistry ALB 25 LOW Normal liver values BUN 15 HIGH - improved from yx 16 CREAT 214 HIGH - increased from yx 146Electrolytes Normal Na and Cl K+ 3.3 LOW - improved from yx Repeat electrolytesNa 138 LOW Normal K+ and Cl Assessment: AKI - ibuprofen intoxication Treatment:1) Esomeprazole 1mg/kg SIV TID 2) ondansetron 0.2mg/kg SIV TID 3) maropitant 1mg/kg IV SID4) Prokolin 2ml PO BID 5) SAMe PO SID 6) fentanyl patch 12 mcg/hr (1/2 patch) - placed at 1300 - active at 0100Plan: Diagnostic plan :repeat biochem bloods/lytes Therapeutic plan :trial off fluids - monitor UOP and appetite Discharge plan :Referral plan :ADDENUM--- 13/03/2026 15:35:16 CD5:IV catheter replaced Off fluids at this stage UOP 4.7ml/k/hr Perianal region creamed with Naocort - still reactive IV catheter replaced - injectable meds at this stage --- 13/03/2026 17:10:37 CD5:Ate puppy biscuits well and some wet food No further D+ at this stage Client Communication:Financial Update:--- 13/03/2026 14:14:48 CD5:O has visited today - long discussion about repeat bloods today - concerns with deteriorationWould like to continue to stay today - will get bloods repeated tmr Will trial PO food and water and monitor UOP overnight Updated O in the evening - O will be visiting at 2030Next update in the AM Handed over to hospital o/n - new hx (VL)    Vital Signs    Weight: 4.2;       HeartRate: 140;       RespirationRate: pant;       PainScore: 1/4;       Temperature: 38.9;       CRT: 2;       MMColour: p/m;       BodyScore: 3/9;