C10031850 / invoice 10000

HISTORY: always picky - o varies diet according to what he seems to prefer
last few days has been vomiting after every meal. this am struggling to walk.
not keeping water down
noted to be drinking a lot this am but brings it straight up.
prior to this a good but not considered excessive drinker
usually around 65 kg 
unlikely to haveehad access to foreign bodies or toxins
 qar mm pink tacky crt 2 sec hr 160 bpm temp 38,.5C abdo palp no mass lesions detected no overt pain
 rr 20 bpm 
 digital rectal exam no faeces palpable
 assessment vomiting unknown cause
 recommend bloods  and ivf. may need imaging 
gave maropitant inj 
bloods: marked elevation sdma creat urea and phos (on dilution creat 1544 urea 85.3 phos 6.49)
 mild elevation amylase/alt (likely secondary to vomiting)
assessment acute (toxic/infectious/obstructive) or chronic renal failure vs addisons - leaning towards chronic rather than acute dse dt weight loss 
need urine sample but bladder small and didnt urinate on walk. 
regardless of cause elevation of creat and urea if renal or prerenal has guarded prognosis
next steps: urinalysis, cortisol levels, imaging - ultrasound or ct, 
regardless he is likely to need multiple days hospitalisation and ivf and would require referral for fluid therapy from tomorrow afternoon as we are not staffed
o happy for me to send hx to sash to get an estimate on workup and care 

collect urine by cystocentesis - isosthenuric urine (after fluid therapy) no evidence uti. blood may reflect collection technique or haematuria - bladder or renal origin
o has financial constraints - ultrasound and cortisol levels not performed today 

pm qar mm pink improving crt<2sec hr temp abdo palp large bladder. urinated several small to medium amounts on walk, good stream. drinkign water not eating (chicken available)

14.3 am qar mm pink (improved on yesterday) crt<2sec hr 120 bpm rr 32 bpm temp 38.0C urinated large volume on walk
WEIGHT: 56.7