C10031493 / invoice 10000

Reason: Dark choc ingestionHistory Summary:Presented this evening following ingestion of an unknown quantity of 99% dark chocolate, estimated to be between 60 to 80 grams. The ingestion occurred sometime between 4:30 PM and 9:00 PM. Based on a body weight of 23 kg and an estimated ingestion of 80g, the chocolate toxicity calculator suggests a risk of mild gastrointestinal signs. Has a history of generalised atopy leading to recurrent otitis externa and previous mouth injuries, but is otherwise healthy. No vomiting or diarrhoea. UTD with vaccinations/flea/tick/worm. EDDU normal. TRIAGE:HR: 120 bpmRR: 24 bpmTemp: 38.5MM: Pink & moistCRT: < 2 secondsMentation: Bright, alert and responsivePain Scale (MGCS): 0/4Hydration status (%): EuhydratedEXAMINATION:Body Condition Score: 5/9 Cardiovascular: Cardiac auscultation normal, normal rhythm, no murmur detected. Pulse pressures normal and synchronous.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed.Musculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performed.Gastrointestinal:- Oral: pink and tacky, no mouth pain, dental score: 2/4 - Abdominal: comfortable on abdominal palpation - Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSF. ectoparasite negative Lymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Dark chocolate toxicity2. History of generalised atopy and recurrent otitis externaDIFFERENTIAL DIAGNOSIS:Theobromine toxicity secondary to dark chocolate ingestion.DIAGNOSTICS/MANAGEMENT PLANEmesis was induced with one apomorphine tablet, resulting in multiple episodes of brown vomit containing a large amount of chocolate. The emesis was subsequently reversed with metoclopramide 0.5 mg/kg administered subcutaneously. Plan is to discharge with activated charcoal and for the owner to monitor for signs of toxicity.REVISED ASSESSMENT:Mild chocolate toxicity.PATIENT UPDATE:Stable/Improved: Stable, bright and alert. No neurological or cardiac signs of toxicity are currently present.E/D/D/U/V: Multiple induced vomits in hospital. No further vomiting post-antiemetic.TREATMENT SUMMARY:- Apomorphine tablet (1) orally to induce emesis.- Metoclopramide 0.5 mg/kg subcutaneously to reverse emesis.- Activated charcoal 5 mL/kg orally, two doses prescribed for at-home administration.OWNER COMMUNICATION:Discussed the case with the owner, Rebecca. Explained that based on the estimated amount of chocolate ingested, only mild gastrointestinal signs like vomiting and diarrhoea are expected over the next few days. Advised that a significant amount of chocolate was brought up with induced emesis. Instructed to administer one dose of activated charcoal tonight mixed with a small meal, and a second dose tomorrow morning. Advised to monitor for any neurological signs (e.g., tremors, seizures) or signs of tachycardia (racing heart) and to return for immediate assessment if any concerns arise. The owner understood the plan and advice provided.PLAN:Discharge home with activated charcoal. Owner to monitor closely for any signs of worsening toxicity. Re-presentation advised if any neurological signs or significant tachycardia develop.For any questions regarding the case, please contact the Underwood and Jindalee Clinical Support Line at 07 3147 8746 (Mon-Fri, 9am-6pm), or our hospitals during after hours.    Vital Signs    Weight: 23;