C10031809 / invoice 10000

HISTORY
Brought up all his dinner from the night before, not sure when it happened just found it. Partially digested food. 
Was given cooked mince with veggies for dinner, standard food for him. 
Not interested in breakfast, not even chicken. First time he has rejected food, did manage to get him to take a schmako about 30 minutes ago with some enthusiasm. 
Seemed very flat, really lethargic. 

O report increase water intake in the past 24 hours. 

No diarrhoea. 

MEDICATIONS
- 4 week course of Enro finished 2 weeks ago. 
- pred increased to 1.5 x 5mg ONCE daily 2 weeks ago. He did not want to take that this morning given he was not eating. 
- Cardisure as per normal. 
- Ketamine SQ once weekly now off Previcox 

PHYSICAL ASSESSMENT 
DEMENOUR: QAR, opting to rest for most of the consult, sitll interacting when approached but definitely quieter for Charlie 
HR:100
RR: 60
MM: P, M, <1 
T: 39.8C 
CARDIOVASCULAR- Grade 3 heart murmur as per previous 
RESPIRATORY- good for Charlie, harshness still throughout lung fields, slight increase as you move ventrally but not wet crackles. Slight inspiratory wheeze when getting more agitated, if at rest not present. 
EARS- clean, no odour, discharge or erythema
EYES- clear, bright, symmetrical
ABDOMEN- tense throughout, has been a slight tenser dog to palpate abdomen in the past but obvious bracing today. 
LYMPH NODES- NAD
MUSCULOSKELETAL- stiff movement, decreased ROM in hindlimbs, slight reduction in mobility in spine but no pain response 

DIAGNOSTICS:
CHEM 18 + HAEMATOLOGY - ATTACHED
Significant leukocytosis with neutrophilia and monocytosis. 
Significant elevation lipase and amyalse. 

CLIENT COMMUNICATION 
May be as simple as pancreatitis HOWEVER, this is Charlie. 
Requires hospitalisation regardless, given lengthy Hx would recommend emergency through UQ. 
Requires abdominal imaging we cannot provide today, just wanted a basis of bloodwork to ensure not referring something with an obvious end result. 
O consented - collected meds from home and will take him down. 
UQ called to be advised.